$0 medicare advantage plan
Experience Health Medicare AdvantageSM (HMO) 2023 benefits include:
- $0 monthly premium
- $0 medical deductible
- $0 drug deductible
- $0 primary care copay
- $0 copays for commonly prescribed drugs
- $0 SilverSneakers® fitness membership
This $0 premium plan comes with
over $10,000 in value-added extras:
Care Support
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Dental Reimbursement
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OTC Allowance
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Routine Eye Exam
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Silversneakers® fitness membership
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Eyewear Allowance
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Meals Program
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Mental Health
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Hearing Exam/Hearing Aids
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Acupuncture
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Worldwide Travel Coverage
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Part D Senior Savings Model (PDSS)
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Transportation Services
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In-home Support Services
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Personal Emergency Response System (PERS)
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Bathroom Safety Devices
Learn MoreThis 2023 plan is everything you want in a Medicare plan and more, including a $0 monthly premium, a long list of valuable extras and low Maximum Out-of-Pocket costs to help protect your savings.
| 2023 Plan Highlights | Experience Health Medicare Advantage (HMO) |
|---|---|
| Monthly Plan Premium | $0 |
| Maximum Out-of-Pocket Amount | $3,900 per calendar year (in-network covered hospital and medical services)
Please note that you’ll still need to pay your Part D prescription drug cost-share. |
| Doctor and Hospital Visits | |
|---|---|
| Primary Care Doctor | $0 copay per visit |
| Specialist | $20 copay per visit with NO REFERRALS |
| Physical Therapy | $20 copay per visit |
| Mental Health Service | $0 copay Outpatient individual/group therapy visit |
| Urgent Care | $35 copay per visit. This coverage is worldwide. |
| Emergency Room Visit | $90 copay per visit. This coverage is worldwide. |
| Outpatient Hospital | $200 copay per visit |
| Inpatient Hospital | $295 per day for days 1 – 6; $0 for days 7 and beyond |
| Skilled Nursing Facility | $0 per day for days 1 – 20; $165 per day for days 21 – 45; $0 per day for days 46 – 100 |
| Ambulance Services | $295 copay. This coverage is worldwide. |
| Diagnostics and Supplies | |
|---|---|
| Lab Services | $8 copay |
| X-rays (Outpatient) | $10 copay |
| Diagnostic Radiology Scans | $75 copay – CT Scan; $100 copay – MRI; $150 copay – PET |
| Durable Medical Equipment | 20% of cost |
| Diabetic Supplies | $0 copay |
| Insulin | $35 copay for on-formulary insulins through Part D Senior Savings Model (PDSS), which is applicable in the Initial Coverage and Coverage Gap phases of the Part D benefit. Only non-LIS enrollees are eligible for the $35 copay under the PDSS Model |
| Medicare Part B Drugs (including chemotherapy) | 20% of cost |
| Additional Benefits | |
|---|---|
| SilverSneakers® Fitness Program | $0 copay |
| Dental Reimbursement Allowance | $500 annual preventive coverage and $1,500 annual comprehensive coverage |
| Routine Eye Exam | $0 copay |
| Eyewear Allowance (contacts, eyeglasses, eyeglass frames, eyeglass lenses) | $300 per calendar year |
| OTC | $440 allowance per calendar year ($110 per quarter) |
| Meals Program | $0 copay for up to 20 home-delivered meals after each inpatient hospitalization |
| Acupuncture | $50 reimbursement allowance per visit for up to 20 visits per year (in addition to Medicare coverage for chronic lower back pain) |
| Hearing Exam/ Hearing Aids |
$0 copay for routine exam; $599 - $899 copay per hearing aid |
| Transportation | $0 copay for up to 12 one-way trips to or from approved health care locations per year |
| Personal Emergency Response System (PERS) | $0 copay for a medical alert system (wristband and pendant options) through NationsResponse®, powered by ADT®. Your medical alert system will give you the help you need at the push of a button. |
| In-Home Support Services | $0 copay for up to 6 hours of in-home support services per month. Members can get assistance with common tasks such as meal preparation, light housekeeping, errands, technology and accompaniment to appointments. |
| Bathroom Safety Devices | $0 copay for up to two products per year. Contact plan for an approved list of products. |
| Prescription Drug Benefits | 30-Day | 90-Day Mail Order |
|---|---|---|
| Tier 1: Preferred Generic | $0 copay | $0 copay |
| Tier 2: Generic | $5 copay | $12.50 copay |
| Tier 3: Preferred Brand | $45 copay | $112.50 copay |
| Tier 4: Non-preferred Drug | $99 copay | $247.50 copay |
| Tier 5: Specialty | 33% coinsurance | 33% coinsurance |
| Tier 6: Select Care Drugs | $0 copay | $0 copay |
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