If you’re looking for a plan with a $0 premium, $0 copays, $0 deductible and more no-cost advantages, check out the HMO plan below. If you want low premiums and copays, plus the ability to go out of network and get out-of-state travel coverage, check out our PPO.
Medicare Advantage with Prescription Drug
Coverage Insurance Plan
Coverage Insurance Plan
$0 a month
Deductible - Medical Services:
Does not include prescription drugs.
Does not include prescription drugs.
$0
Annual Out-of-Pocket Maximum:
$4200
Inpatient Hospital Visit:
In-network:
$325
$0
per day, days 1 - 6 each additional day
per day, days 1 - 6 each additional day
Outpatient Hospital Coverage - In-network:
$175
For each visit
For each visit
Primary Care Physician (PCP) :
$0
for each visit
for each visit
Specialist Visit:
$35
Deductible - Prescription Drug (Part D)
$0
Tier 1/Tier 2 (Generic) Prescription Drugs At Preferred Pharmacy:
$0/$7
30-day supply
30-day supply
Medicare Advantage with Prescription Drug
Coverage Insurance Plan
Coverage Insurance Plan
$12 a month
Deductible - Medical Services - In-network/Out-of-network:
Does not include prescription drugs.
Does not include prescription drugs.
$0
Annual Out-of-Pocket Maximum - In-network/In- and-Out-of-network Combined:
$5000/$10000
Inpatient Hospital Visit:
In-network:
$350
$0
per day, days 1 - 5 each additional day
per day, days 1 - 5 each additional day
Out-of-network:
40%
of each day
of each day
Outpatient Hospital Coverage - In-network/Out of-network:
$225/$375
for each visit
for each visit
Primary Care Physician (PCP) - In-network/Out of-network:
$5/$40
for each visit
for each visit
Specialist Visit - In-network/Out-of-network:
$35/$55
Deductible - Prescription Drug (Part D) - Tiers 1-2/ Tiers 3-5
$0/$100
Tier 1/Tier 2 (Generic) Prescription Drugs At Preferred Pharmacy:
$2/$8
30-day supply
30-day supply
Both plans also include no or low-cost supplemental benefits like:
For more information, see the Supplemental Benefits page or the 2022 Summary of Benefits
