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Asuris Esteem (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Asuris Esteem (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Asuris Esteem (PPO) in 2025, please refer to our full plan details page.
Asuris Esteem (PPO) is a PPO plan offered by Cambia Health Solutions, Inc. available for enrollment in 2025 to people living in Spokane County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Asuris Esteem (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Asuris Esteem (PPO).
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 Asuris Esteem (PPO), 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. Additionally, this plan comes with a Part B Premium reduction of $60.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $9550.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9550.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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
Prescription drugs are not covered by Asuris Esteem (PPO).
Additional Benefits
The Asuris Esteem (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays and coinsurance. You'll have a copay for primary care visits, specialist visits, and mental health services. Preventive services, such as annual physicals, and other services, like hearing exams and vision exams, are offered with no copay. The plan also includes coverage for emergency services, ambulance, home health, and dental services. While the plan offers coverage for hearing aids and prescription drugs, it also has exclusions for certain services like acupuncture, private duty nursing, and some dental, vision, and hearing services. The plan also offers a quarterly over-the-counter benefit.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will also pay a $350 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $40 copay and 20% coinsurance, Observation Services with a $400 copay, Ambulatory Surgical Center (ASC) Services with a $40 copay and 20% coinsurance, Individual and Group Sessions for Outpatient Substance Abuse with a $30 copay, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $105 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Asuris Esteem (PPO) plan. Ground and air ambulance services have a $250 copay, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Asuris Esteem (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $40 copay; both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $250 copay; all have no coinsurance.
Primary Care See details
Asuris Esteem (PPO) covers primary care physician services with a $5 copay, chiropractic services with a $20 copay (routine care is not covered), and occupational therapy services with a $40 copay. The plan also covers physician specialist services with a $40 copay, mental health specialty services with a $30 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $40 copay. Additional telehealth benefits are covered with a copay between $5 and $40, and opioid treatment program services are covered with a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and other preventive services with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Additional preventive services are covered, but the copay information is not provided.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $40 copay, Routine Hearing Exams with no copay, and Fitting/Evaluation for Hearing Aid with no copay, and Prescription Hearing Aids (all types) with a copay between $499 and $999, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams, eyewear, and contact lenses. Eye exams and eyeglass lenses have no copay, while contact lenses and eyeglass frames are covered. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Asuris Esteem (PPO) plan covers dental services, including Medicare dental services, with a $40 copay. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, all with no copay. Restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with 50% coinsurance; however, adjunctive general services, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. The plan has a maximum benefit coverage of $1500 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Asuris Esteem (PPO) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
The Asuris Esteem (PPO) plan covers Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies - Non-Medicare benefit with 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, and Diabetic Equipment requires prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a $10 copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Asuris Esteem (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover any of the sub-services. The plan does not have any cost sharing for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, the copay is $10, for days 21-44 the copay is $214, and for days 45-100, there is no copay.
Other Services See details
The Asuris Esteem (PPO) plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Over-the-counter (OTC) items are covered, with a maximum benefit of $40 every three months. A meal benefit is also covered for chronic illnesses.
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