Clear Spring Health BrightPath Advantage (HMO)

Clear Spring Health BrightPath Advantage (HMO) is a HMO plan offered by Group 1001 available for enrollment in 2025 to people living in Rockford, Metro St. Louis. The overall rating for this plan is not yet available for 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.

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:

Drug Coverage

The Clear Spring Health BrightPath Advantage (HMO) plan features a $200 annual drug deductible and offers excellent savings on generic medications. You will enjoy no copay for Tier 1 preferred generics when using a preferred pharmacy or preferred mail order, and no copay for Tier 6 select care drugs at any network pharmacy. Tier 2 generic drugs are also highly affordable, featuring no copay through preferred mail order and a low $5 copay for a one-month supply at preferred pharmacies. For brand-name and specialty medications, your costs are determined by a percentage of the drug cost rather than flat copays. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 29% coinsurance at both preferred and standard pharmacies. Tier 5 specialty drugs are available with a 30% coinsurance for a one-month supply across all network pharmacies and mail-order services.

Additional Benefits

The Clear Spring Health BrightPath Advantage (HMO) plan offers affordable healthcare coverage featuring no copay for primary care visits, telehealth, and home health services. For inpatient hospital stays, members pay a daily copay of either $225 for days 1 through 8 or $800 for days 1 through 60 with no coinsurance, while outpatient hospital services require copays ranging from $30 to $200. Emergency care is available with a $120 copay, which is waived if admitted within 24 hours, and ambulance services require a $225 copay with no coinsurance. This plan also includes strong supplemental benefits, such as dental and vision coverage with no copay or coinsurance for preventive dental care up to $1,500 annually and one annual pair of eyeglasses up to a $200 limit. Routine hearing exams carry a $30 copay, but prescription hearing aids feature no copay up to a $500 annual maximum per ear. Additionally, members benefit from an over-the-counter allowance of up to $50 every three months with no copay, while durable medical equipment requires no copay and a 20% coinsurance.