2022 MyTruAdvantage Choice (PPO)
The MyTruAdvantage Choice (PPO) plan offers a low monthly premium and copay, along with the option to see providers outside of the MyTruAdvantage network. It also includes out-of-state travel coverage. With the MyTruAdvantage Choice (PPO), you get an affordable and flexible plan, plus all the extras you can count on.
$12 a month
The amount you pay for covered health care services before MyTruAdvantage starts to pay. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services.
The highest yearly amount you will have to pay out-of-pocket for covered healthcare services. Your coinsurance or copays count towards the maximum out-of-pocket; premiums and prescription costs do not.
Inpatient Hospital Care
There is no limit to the number of days covered by the plan each hospital stay.
Outpatient Hospital Care
Includes Ambulatory surgical center, Outpatient hospital and Observation.
Emergency Care and Urgently needed services section wherever you are in the United States or all over the world.
Includes immunizations, physical exams (initial exam and annual wellness visit), colorectal screening, pap smears and pelvic exams screening, prostate cancer screening, bone mass measurement, mammography screening, and outpatient hospital services - preventive.
Emergency & Urgent Care
This includes what you pay for radiology/imaging services such as a CT scan or MRI
Medicare-Covered Hearing Exam
Routine Hearing Exam
Routine hearing services must be provided by a TruHearing provider.
Preventive (Routine) Dental
There is a buy-up option with additional coverage for an additional premium. Please see Optional Benefits section for more information.
Medicare-Covered Vision Exam
Routine Vision Exam
Mental Health Care - Inpatient Visit
Outpatient Group Therapy
Outpatient Individual Therapy
Skilled Nursing Facility
Over-the-Counter (OTC) Card
The OTC benefit offers you an easy way to get generic over-the-counter health and wellness products by phone at 1-888-628-2770 (TTY: 711) or online at www.cvs.com/otchs/MyTruAdvantage. You order from a list of approved OTC items, and OTC Health Solutions will mail them directly to your home address.
Includes a no-cost gym membership at a participating fitness center or YMCA, one Stay Fit Kit (options include a Fitbit, Garmin, yoga, or strength kit), and 2 home fitness kits, where you can choose from 34 options like Aqua, Tai Chi, Chair-based exercise and more.
Prescription Drug Benefits - Part B
Medicare Part B Drugs may require prior authorization. The copay for chemotherapy drugs and other Part B drugs is 20%. Step Therapy may be required for certain Part B drugs (see Chapter 4 section 2.1 "Medicare Part B Drugs" of the EOC at www.MyTruAdvantage.com/Members for more details).
Prescription Drug Benefits - Part D
The below tables are broken out by preferred pharmacy, standard pharmacy and mail order. Please see the Pharmacy list to see what pharmacies are in which category.
Tier 1 (Preferred Generic), Tier 2 (Generic), Tier 3 (Preferred Brand), Tier 4 (Non-Preferred Drug), Tier 5 (Specialty Tier)
You pay the following until your total yearly drug costs reach $4430. Total yearly drug costs are the total drug costs paid by both you and our Part D plan. Once you reach that amount, you will enter the Coverage Gap. You may get your drugs at network retail pharmacies and mail order pharmacies. During this stage, your out-of-pocket costs for Select Insulins will be $35 for a one-month (30-day) supply.
Tier 1 (Preferred Generic)
Tier 2 (Generic)
Tier 3 (Preferred Brand)
Tier 4 (Non-preferred Drug)
Tier 5 (Specialty)
When you reach your total yearly drug cost (which includes what our plan has paid and what you have paid) of $4430, you will enter what is called a coverage gap. At this time, you will pay 25% of the plan's cost for covered generic drugs and 25% of the plan's cost for covered brand drugs, plus a dispensing fee, until your total costs reach $7050. Most Medicare plans have this coverage gap (also called the "donut hole"), but not everyone will enter the coverage gap. During this stage, your out-of-pocket costs for Select Insulins will be $35 for a one-month (30-day) supply.
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7050, you pay the greater of: 5% of the cost, or $3.95 copay for generic (including brand drugs treated as generic) and a $9.85 copay for all other drugs.
Enhanced Dental Package for MyTruAdvantage Choice (PPO)
$0 for each service: Emergency palliative treatment, fluoride treatment, brush biopsy, and other basic services such as films, tests, and anesthesia. 50% of the cost: All other radiographs, simple extractions, fillings, denture coverage (full, partial, reline and repair), and crown repair. Dentures covered at 1 per 5 years, and relines and tissue conditioning covered at 1 per year.
MyTruAdvantage Choice (PPO) Optional supplemental benefits (OSB) are only available to members of MyTruAdvantage Choice (PPO) plan. Members of MyTruAdvantage plans that offer OSBs may enroll in OSBs at the time of MAPD enrollment or within two months of the MAPD plan’s effective date. Benefits may change on January 1 each year. Enrollees must use network providers for specific OSBs when stated in the Evidence of Coverage (EOC); otherwise, covered services may be received from non-network providers at a higher cost. Enrollees must continue to pay the Medicare Part B premium, their MyTruAdvantage plan premium and the OSB premium.
Plan Features & Services
Download an Information and Enrollment Kit:
* Certain procedures, services and drugs may need advance approval from your plan. This is called a “prior authorization” or “preauthorization". Please refer to the plan’s Evidence of Coverage for all services that require Prior Authorization.