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. And if you want low premiums and copays, plus the ability to go out of network, 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:
$4500
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 2021 Summary of Benefits
