Medicare Plans

Medicare Advantage Plans

Whether you are new to Medicare or not, it is always good to explore your options when choosing a Medicare Advantage plan

Our Medicare Advantage plans are different from other plans. They are local plans, dedicated to serving local people and are led by doctors you know.

Your care and your insurance are working together, creating a simpler health care experience for you.

2017 Premier Health Advantage (HMO) Plan

The Premier Health Advantage (HMO) plan provides a long list of money-saving benefits that stack up against the benefits offered by other plans. Some of the plan benefits and copay details for Premier Health Advantage (HMO) are listed in the table below.

View a complete list of benefits for more information.

Medicare Advantage Plan Benefit Premier Health Advantage (HMO)
Monthly Plan Premium $0 in addition to your Medicare Part B premium
Annual Out-of-Pocket Maximum (The total amount you will have to pay each year for copays and coinsurance.) $3,900 for all Medicare-covered benefits
Primary Care and Specialty Physician Visits $10 for each primary care physician visit
$40 for each specialist visit
Urgent Care $40 for each visit
Emergency Care $75 for each visit
Inpatient Hospital and Inpatient Mental Health Care $250 per day (days 1-6) / Mental health
$295 per day (days 1-6) / Acute
Skilled Nursing Facility (SNF) $0 per day (days 1-20)
$160 per day (days 21-100)
Outpatient Rehabilitation $40 for each visit
Outpatient Surgery $275, depending on the service
Ambulatory Surgery Center (ASC) $250 for each visit
Durable Medical Equipment 20% of the cost of each item
Diabetic Supplies $0 for each item
Lab Services, x-rays and Advanced Imaging $0 for lab services
$15 for general x-rays
$50-$200 per service (radiology CT scans, MRIs, MRAs and PET scans)
Preventive Services $0 for annual wellness exam, routine physical exam, immunizations (e.g. flu and pneumonia) and preventive screenings, including mammograms, Pap, pelvic, prostate, colorectal exams and bone mass measurement
Routine Vision $0 for one routine eye exam per year
$0-$40 copay for medically necessary exams depending on the service
$100 allowance toward the cost of glasses or contacts per year
Routine Dental $0 for routine oral exam and cleaning every six months
$0 for one fluoride treatment per year
$0 for one dental x-ray per year
Nurse Advice Line Free access to healthcare advice and information from registered nurses, 24 hours a day, 7 days a week.

2017 Premier Health Advantage (HMO) Pharmacy Benefits

The Premier Health Advantage (HMO) plan combines medical and Part D prescription drug coverage into one plan. Our plan has six levels of drug benefits: preferred generic, non-preferred generic, preferred-brand, non-preferred brand, specialty, and adherence. There is a $100 deductible for tiers 3, 4, and 5.

Premier Health Advantage (HMO) In-Network Pharmacy/Mail-Order Pharmacy Benefits
Prescription Drug Level (Tier) One Month Supply
(30-days)
Three Month Supply
(90-days)
Preferred Generic Drugs $3 copay $9 copay
Non-preferred Generic Drugs $15 copay $45 copay
Preferred Brand-Name Drugs $47 copay $141 copay
Non-preferred Brand-Name Drugs $100 copay $300 copay
Specialty Drugs (one month supply only) 31% of the cost per prescription N/A
Adherence Drugs $0 $0
Initial Coverage Limit (ICL) $3,700
Coverage Gap After your total yearly drug costs reach $3,700, you will pay 51% of the costs for generic drugs. You will receive a discount on brand-name drugs and generally pay no more than 40% (plus dispensing fee) of the plan’s cost. You pay whichever is less your normal copay amount ($3 for 30-day supply) or 51% for preferred generic drugs and $0 for adherence drugs.
Catastrophic Coverage After your yearly out-of-pocket drug costs reach $4,950, you pay the greater of:

5% of the cost, or
$3.30 copay for generic drugs (including brand drugs treated as generic)
$8.25 copay for all other drugs

2017 Premier Health Advantage VIP (HMO SNP) Plan

Do you have Medicare and Medicaid? We have a special healthcare plan just for you.

Our plan helps make Medicare and Medicaid benefits easier to manage. Some of the plan benefits and copay details for Premier Health Advantage VIP are listed in the table below.

View a complete list of benefits for more information.

Medicare Advantage Plan Benefit Premier Health Advantage VIP (HMO SNP)
Monthly Plan Premium $0 in addition to your Medicare Part B premium
Annual Out-of-Pocket Maximum (The total amount you will have to pay each year for copays and coinsurance.) $6,700 for all Medicare-covered benefits
Inpatient Hospital Care and Inpatient Mental Health Care $0 of the cost of a visit/inpatient
$0 of the cost of a visit/mental health
Skilled Nursing Facility (SNF) $0 of the cost of a visit
Primary Care and Specialty Physician Visits 0% of the cost per primary care physician visit
0% of the cost per specialist visit
Outpatient Rehabilitation (e.g. occupational, physical, speech and language therapy) 0% of the cost per therapy visit
Outpatient Surgery Outpatient Hospital Facility – 0% of the cost per surgical procedure
Ambulatory Surgical Center (ASC) – 0% of the cost per visit
Urgent Care 0% of the cost per visit (up to $65)
Emergency Care 0% of the cost per visit (up to $75)
Durable Medical Equipment 0% of the cost per item
Diabetic Supplies 20% of the cost per item
Lab Services, x-rays and Advanced Imaging Radiology Services (e.g. CT scans, MRI, MRA, PET scans, Nuclear Medicine and Stress tests) 0% of the cost for lab services
0% of the cost for general x-rays or ultrasound
0% of the cost for Medicare-covered therapeutic radiology services (radiation)
0% of the cost for Medicare-covered diagnostic advanced radiology imaging services
Preventive Services $0 annual wellness exam (e.g. routine physical)
$0 immunizations (e.g. flu and pneumonia)
$0 smoking cessation (counseling to stop smoking)
$0 preventive screenings and exams
Routine Vision $0 for routine vision exams each year
$100 routine vision allowance toward the cost of eyewear, including lenses, frames or contact lenses, every year
Preventive Dental $0 for one routine oral exam and cleaning every six months
$0 for one fluoride treatment each year
$0 for one dental x-ray each year
$1,000 for comprehensive dental procedures
Over the Counter (OTC) Drugs $22 allowance each month toward the cost of OTC drugs

Note: Depending on your level of Medicaid eligibility, you may not have any cost-sharing responsibility for Original Medicare services or you may pay a coinsurance of 20% of the cost for some services. If you lose your full status, you may be subject to a copay.

This plan is available to anyone who has both Medicaid and Medicare.  

2017 Premier Health Advantage VIP (HMO SNP) Pharmacy Benefits

Premier Health Advantage VIP (HMO SNP) offers Part D prescription drug coverage as part of our plan. This plan is available to anyone who has both Medicaid and Medicare. The following table provides an overview of our prescription drug benefits:

Prescription Drug Benefit *The amount members pay in all stages of prescription coverage depends on income and institutional status.
Part D Deductible $400
Member Cost Share

After the Part D deductible (if applicable) is met, member pays:

  • $0, or
  • $1.20 for generics & $3.70 for brands up to the out-of-pocket threshold, or
  • $3.30 for generics & $8.25 for brands up to the out-of-pocket threshold, or
  • 15% coinsurance up to the out-of-pocket threshold, or
  • 25% coinsurance up to the initial coverage limit
 
Initial Coverage Limit (ICL) $3,700
Out-of-Pocket Threshold $4,950
Low-income Subsidy (LIS) Medicare beneficiaries with limited income and resources may qualify for extra help to pay for prescription drugs costs referred to as low-income subsidy (LIS) assistance.
Catastrophic Coverage Benefit After the member’s yearly out-of-pocket drug costs reach $4,950

Generic drugs (including brand drugs treated as generic), either: $0 copay or $3.30, depending on the member’s LICS level

For all other drugs: $0 copay or $8.25 depending on the member’s LICS level.

Wellness and Clinical Programs

We offer wellness and clinical programs to guide and support you when you’re healthy, unwell, or recovering from an illness. Our local team of providers and professionals are ready to partner with you in mapping out your health care plan.

LEARN MORE »

You can submit feedback about your Medicare health plan or prescription drug plan directly to Medicare using the Medicare Complaint Form.

Disclaimers

Federal Contracting Disclaimer:
Premier Health Plan offers the Premier Health Advantage (HMO) and Premier Health Advantage VIP (HMO SNP) health insurance products.  Premier Health Plan has a Medicare contract and an Ohio Medicaid contract.  Enrollment in Premier Health Advantage or Premier Health Advantage VIP depends on contract renewal.  

Benefits Disclaimer:
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. Provider network may change at any time. You will receive notice when necessary.

Hours of Operation

You may call our Member Services Department toll-free at (855) 572-2161 from 8:00 am to 8:00 pm, seven days a week. TTY users should call (855) 250-5604.

Our hours of operation change throughout the year. You can call us:

  • October 1 through February 14, seven days a week from 8:00 am to 8:00 pm
  • February 15 through September 30, Monday through Friday from 8:00 am to 8:00 pm, and Saturday from 8:00 am to 3:00 pm

This insurance plan is underwritten by Premier Health Insuring Corporation. Premier Health Insuring Corporation does business under the name Premier Health Plan.

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

 

H3233_17_3074 CMS Approved
Last Updated: 11/19/2016