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Clear Spring Health BrightPath Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clear Spring Health BrightPath Advantage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Clear Spring Health BrightPath Advantage (HMO) in 2026, please refer to our full plan details page.
Clear Spring Health BrightPath Advantage (HMO) is a HMO plan offered by Group 1001 available for enrollment in 2025 to people living in Rockford Area, Chicago Area. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Clear Spring Health BrightPath Advantage (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Clear Spring Health BrightPath Advantage (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Clear Spring Health BrightPath Advantage (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Clear Spring Health BrightPath Advantage (HMO) drug plan features a $200 annual deductible. Under this plan, you will pay no copay for Tier 6 select care drugs at any pharmacy, and no copay for Tier 1 preferred generics or Tier 2 generics when using preferred mail order services. For standard pharmacies and standard mail order services, Tier 1 copays range from $5 to $15 and Tier 2 copays range from $10 to $30 depending on the supply. For brand-name and specialty medications, your costs are based on coinsurance rather than flat copays. You will pay 20% coinsurance for Tier 3 preferred brand drugs, 33% coinsurance for Tier 4 non-preferred drugs, and 30% coinsurance for a one-month supply of Tier 5 specialty drugs. These coinsurance percentages apply equally across all preferred and standard pharmacy and mail order options.
Additional Benefits
The Clear Spring Health BrightPath Advantage (HMO) offers comprehensive coverage with no copay for primary care visits, telehealth services, and preventive care. For specialist visits, members pay a $25 copay, while inpatient hospital stays require a daily copay of $220 for the first seven days, followed by no copay for days eight through 90. Emergency room visits carry a $150 copay, and urgent care services are available for a $65 copay, both with no coinsurance or deductibles. This plan also features robust additional benefits, including dental care with no copay for preventive services and a $3,000 annual maximum for comprehensive care. Routine vision and hearing exams are available for a $30 copay, with allowances of up to $300 for eyeglasses and $500 per ear for prescription hearing aids at no copay. Additionally, members pay no copay and a 20% coinsurance for durable medical equipment, while home health services and home infusions are covered with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Clear Spring Health BrightPath Advantage (HMO), featuring no coinsurance and copays of up to $800 (including $220 per day for days 1 through 7) followed by no copay for days 8 through 90. Prior authorization is required, and upgrades, additional inpatient days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Clear Spring Health BrightPath Advantage (HMO), including outpatient hospital and observation services for a $225 copay and no coinsurance, and ambulatory surgical center services for a $175 copay and no coinsurance. Outpatient substance abuse individual and group sessions carry a $40 copay with no coinsurance, while outpatient blood services require no copay and a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Clear Spring Health BrightPath Advantage (HMO) with a $25.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Clear Spring Health BrightPath Advantage (HMO), with ground ambulance services requiring a $200 copay and air ambulance services requiring a 20% coinsurance. Transportation benefits are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Clear Spring Health BrightPath Advantage (HMO) covers emergency services with a $150 copay and urgently needed services with a $65 copay, both with no coinsurance and no deductible. Copays are waived if you are admitted to the hospital within 24 hours, but worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Primary Care benefits under the Clear Spring Health BrightPath Advantage (HMO) are partially covered, with chiropractic and podiatry services not covered. Covered services include primary care and telehealth with no copay and no coinsurance, therapies for a $20 copay, specialist visits for a $25 copay, other healthcare professionals for a $30 copay, and mental health, psychiatric, and opioid treatments for a $50 copay, all with no coinsurance.
Preventive Services See details
Clear Spring Health BrightPath Advantage (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive benefits are partially covered, offering memory fitness, remote access technologies, and re-admission prevention, while sub-services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Clear Spring Health BrightPath Advantage (HMO), which offers routine hearing exams and fitting evaluations for a $30 copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to a $500 annual maximum per ear, but OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Clear Spring Health BrightPath Advantage (HMO) partially covers vision services, offering one routine eye exam per year for a $30 copay and no coinsurance, while other exam services are not covered. One pair of eyeglasses (lenses and frames) is covered annually with no copay or coinsurance up to a $300 maximum, but contact lenses, separate frames or lenses, and upgrades are excluded.
Dental Services See details
Clear Spring Health BrightPath Advantage (HMO) offers partially covered dental services with no copay and no coinsurance for preventive and most comprehensive care, while Medicare-covered dental services require a $30 copay and no coinsurance. Comprehensive services are subject to a $3,000 annual maximum, though implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Clear Spring Health BrightPath Advantage (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Clear Spring Health BrightPath Advantage (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Clear Spring Health BrightPath Advantage (HMO) provides partially covered medical equipment benefits with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, though diabetic supplies are not covered. Prior authorization is required for these covered equipment services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Clear Spring Health BrightPath Advantage (HMO), requiring prior authorization for all services. Covered diagnostic services feature no copay or coinsurance, though diagnostic procedures, tests, and lab services are not covered, while radiological services include no copay for outpatient X-rays and diagnostic radiology, and a 20% minimum coinsurance for therapeutic radiology.
Home Health Services See details
Clear Spring Health BrightPath Advantage (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Clear Spring Health BrightPath Advantage (HMO) covers cardiac rehabilitation services with no copay and no coinsurance. However, only some services are covered in practice, as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Clear Spring Health BrightPath Advantage (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $178 copay for days 21 through 100. Prior authorization and a three-day prior inpatient hospital stay are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services, including acupuncture, over-the-counter (OTC) items, and meal benefits, are not covered under the Clear Spring Health BrightPath Advantage (HMO) plan.
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