$0 medicare advantage plan

  • $0 monthly premium
  • $0 medical deductible
  • $0 primary care copay
  • $0 copays for commonly prescribed drugs
  • $0 SilverSneakers® fitness membership
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This $0 premium plan includes
over $5,000 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 included

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Eyewear Allowance

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Meals Program

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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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This new plan is everything you want in a Medicare plan and more, including a low monthly premium, a long list of valuable extras and low Maximum Out-of-Pocket costs to help protect your savings.

2021 Plan HighlightsExperience Health Medicare Advantage (HMO)
Monthly Plan Premium$0
Maximum Out-of-Pocket Amount$4,980 (in-network) per calendar year
Doctor and Hospital Visits
Primary Care Doctor Copay$0 per visit
Specialist Copay$35 per visit
Physical Therapy$35 copay
Mental Health Service$25 Outpatient individual/group therapy visit
Urgent Care Copay$50 copay
Emergency Room Visit$90 copay
Outpatient Hospital$300 copay
Inpatient Hospital$300 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 – 52; $0 per day for days 53 – 100
Ambulance Services$375 copay
Diagnostics and Supplies
Lab Services$8 copay
X-rays (Outpatient)$10 copay
Diagnostic Radiology scan$75 – CT scan; $100 – MRI; $150 – PET
Durable Medical Equipment20% of cost
Diabetes Supplies$0 copay
Select Insulin$35 copay through Part D Senior Savings Model (PDSS)
Medicare Part B Drugs (including chemotherapy)20% of cost
Additional Benefits
SilverSneakers® Fitness Program$0
Dental Reimbursement Allowance$500 annual preventive coverage and $500 annual comprehensive coverage (reimbursed at 50%)
Routine Eye Exam$20 copay
Eyewear Allowance (contacts, eyeglasses, eyeglass frames, eyeglass lenses)$250 per calendar year
OTC Allowance$300 per calendar year ($75 per quarter)
Meals Program20 home-delivered meals after inpatient hospitalization
Acupuncture$35 copay for up to 20 visits per calendar year
Hearing Exam/Hearing Aids$0 copay for routine exam; $699 - $999 copay per hearing aid
Prescription Drug Benefits30-Day90-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:* Specialty30% coinsurance30% coinsurance
Tier 6: Select Care Drugs$0 copay$0 copay

*Subject to $100 drug deductible

See Experience Health Medicare Advantage (HMO) 2020 Plan Benefits.

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