2021 MyTruAdvantage Select (HMO)
Highlights of this plan include our $0 per month premiums, $0 medical deductibles and low copays, $0 PCP (Primary Care Provider) visits, and $0 or low copays for generic drugs. We also have extras like vision, hearing and fitness, as well as rich dental benefits. Finally, with advantages like an out-of-pocket maximum of just $4500, skilled nursing benefit that doesn't require an inpatient hospital stay first, no referrals for in-network specialists, and worldwide coverage for emergency and urgently needed care up to $25000, the advantage is yours with MyTruAdvantage Select (HMO). Please see below for more detail.
- $0 monthly premium
- $0 medical deductible
- $0 prescription deductible
- $0 PCP copay
- Enhanced dental benefit
- Vision with hardware allowance
- Hearing aid discounted pricing
- Over-the-counter allowance
- Preferred pharmacy prescription pricing
- Gym membership and at-home fitness kits
*Service area includes the following counties: Bartholomew, Brown, Clay, Hamilton, Hancock, Howard, Jackson, Jennings, Johnson, Madison, Marion, Parke, Posey, Sullivan, Vanderburgh, Vermillion, Vigo, and Warrick
$0 a month
In-network Benefits
Annual Deductible
The amount you’ll pay for most covered in-network medical services before you start paying only copayments or coinsurance and MyTruAdvantage pays the balance.
Out-of-Pocket Maximum
This is the most you pay during a calendar year for in-network and out-of-network services before MyTruAdvantage begins to pay 100% of the allowed amount. This limit includes copayments and coinsurance payments. It does not include your monthly premium or Part D drug costs.
Inpatient Hospital Care
Outpatient Hospital Care
for each visit
Includes Ambulatory Surgical Center, Outpatient hospital and Observation Visits.
Doctor Visits
Preventive Care
Each service
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
Lab Services (Outpatient Diagnostic)
Each service
Tests and Procedures (Outpatient Diagnostic)
Each service
Outpatient X-rays
Each service
Diagnostic Radiological Services
Each service
Complex Radiology/imaging (such as MRI and CT scan)
Radiation Therapy
Each service
Routine Hearing Exam
up to one per year
Routine hearing services must be provided by a TruHearing provider.
Hearing Aid
Depending on the type
Preventive (Routine) Dental
Each service
Cleanings & exams (2 per year), and bitewing x-rays (one per year)
$1000 maximum benefit coverage per year
Routine Vision Exam
Each exam
Routine vision services must be provided by an "Eyemed Select" provider.
Glasses/Contacts
Annual benefit amount
Mental Health Care Inpatient Visit
Each day, Days 1-5/days 6-90
Outpatient Group and Individual Therapy
Each visit
Skilled Nursing Facility
Each day, Days 1-5/days 6-100
This plan covers up to 100 days each benefit period
Physical Therapy
Each visit
Ambulance
Each trip, Ground/air
Transportation
Over-the-Counter (OTC) Card
Every 3 months
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.
Fitness Benefit
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
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.
Annual Deductible
For all tiers
Tier 1 (Preferred Generic), Tier 2 (Non-Preferred Generic), Tier 3 (Preferred Brand), Tier 4 (Non-Preferred Drug), Tier 5 (Specialty Tier)
Initial Coverage
After you pay your yearly deductible, you pay the following until your total yearly drug costs reach $4130. 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.
Tier 1 (Preferred generic)
Tier 2 (Non-preferred Generic)
Tier 3 (Preferred Brand)
Tier 4 (Non-preferred Drug)
Tier 5 (Specialty)
Preferred and standard retail (30-day)
Coverage Gap
When you reach your total yearly drug cost (which includes what our plan has paid and what you have paid) of $4130, you'll enter what is called a coverage gap. At this time, you wil pay 25% of the plan's cost for covered generic drugs and 25% of the plan's cost for covered brand drugs, plus dispensing fee, until your total costs reach $6550.
Most Medicare plans have this coverage gap (also called the "donut hole"), but not everyone will enter the coverage gap.
Catastrophic Coverage
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $6550, you pay the greater of: 5% of the cost, or $3.70 copay for generic (including brand drugs treated as generic) and a $9.20 copay for all other drugs
Plan Features & Services
Plan Documents
Download an Information and Enrollment Kit:
Our Plans
*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.
