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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 Metro Chicago. 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.
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. Additionally, this plan comes with a Part B Premium reduction of $1.80. 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.
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 $2900.00 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) prescription drug plan features a $200 annual deductible. This plan offers no copay for Tier 1 preferred generics at preferred pharmacies and preferred mail order, as well as no copay for Tier 6 select care drugs at any pharmacy. For standard pharmacies and mail order services, Tier 1 drugs have a $10 copay and Tier 2 generics have a $15 copay, though Tier 2 generics have no copay through preferred mail order. For brand-name and specialty medications, costs are structured around coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 31% coinsurance. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply, with all of these coinsurance rates remaining the same across preferred, standard, and mail-order options.
Additional Benefits
The Clear Spring Health BrightPath Advantage (HMO) plan offers robust healthcare coverage with predictable costs, featuring no copays for primary care visits, home health services, and annual preventive exams. For inpatient hospital stays, members pay a $225 copay per day for days 1 through 8 and no copay for days 9 through 90, while emergency room visits incur a $120 copay. Outpatient hospital services and specialist visits generally feature affordable copays ranging from $0 to $200, with no coinsurance required for most standard medical treatments. This plan also includes essential supplemental benefits, such as preventive dental care, prescription hearing aids up to $500 per ear, and eyewear up to a $200 annual limit, all with no copays. Additionally, members can access up to 12 one-way transportation trips per year and receive a $50 quarterly over-the-counter item allowance with no copays. For durable medical equipment and dialysis services, members will pay no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Clear Spring Health BrightPath Advantage (HMO) with no coinsurance, requiring a $225 copay for days 1 through 8 and no copay for days 9 through 90 for both acute and psychiatric stays. Prior authorization is required, and some services such as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Clear Spring Health BrightPath Advantage (HMO) covers outpatient services with no coinsurance, featuring copays of $30 to $200 for outpatient hospital and observation services, and a $30 copay for ambulatory surgical center services. Outpatient substance abuse services require a $30 to $40 copay, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Clear Spring Health BrightPath Advantage (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Clear Spring Health BrightPath Advantage (HMO) covers ambulance services with a $225 copay and no coinsurance for both ground and air transport, which require prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Clear Spring Health BrightPath Advantage (HMO) covers emergency services with a $120 copay and no coinsurance, and urgently needed services with a $65 copay and no coinsurance. These copayments are waived if you are admitted to the hospital within 24 hours, though worldwide emergency services are not covered.
Primary Care See details
Clear Spring Health BrightPath Advantage (HMO) covers primary care, occupational therapy, and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $35 copay and no coinsurance. Physical, speech, mental health, psychiatric, and opioid treatment services have a $30 copay and no coinsurance, whereas podiatry and chiropractic services are not covered.
Preventive Services See details
Clear Spring Health BrightPath Advantage (HMO) covers preventive services with no copay and no coinsurance for annual physical exams and routine screenings, though kidney disease education requires a 20% coinsurance and prior authorization. Additional preventive benefits are only partially covered with no copay and no coinsurance, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Clear Spring Health BrightPath Advantage (HMO) partially covers hearing services, including routine exams and fitting evaluations for a $30 copay and no coinsurance. While prescription hearing aids offer no copay and no coinsurance up to $500 per ear annually, some services are covered but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services under Clear Spring Health BrightPath Advantage (HMO) are partially covered, offering one routine eye exam per year with a $30 copay and no coinsurance. Eyewear is also partially covered with no copay and no coinsurance up to a $200 annual limit for one pair of eyeglasses, though contact lenses, upgrades, separate lenses or frames, and other eye exams are not covered.
Dental Services See details
Dental services are partially covered by Clear Spring Health BrightPath Advantage (HMO), with Medicare-covered dental services requiring a $30 copay and no coinsurance. Other covered preventive and comprehensive dental services have no copay and no coinsurance, though implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Clear Spring Health BrightPath Advantage (HMO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Clear Spring Health BrightPath Advantage (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Clear Spring Health BrightPath Advantage (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered, offering diabetic therapeutic shoes and inserts with no copay and a 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Clear Spring Health BrightPath Advantage (HMO) diagnostic and radiological services are partially covered, as diagnostic procedures, tests, and lab services are not covered. Covered diagnostic services require no copay and no coinsurance, while radiological services require prior authorization and feature a $0 copay for X-rays, a minimum $20 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Clear Spring Health BrightPath Advantage (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Clear Spring Health BrightPath Advantage (HMO) partially covers Cardiac Rehabilitation Services with no coinsurance and a $20 copayment for covered services. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Clear Spring Health BrightPath Advantage (HMO) with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $178 daily copay for days 21 through 100. Prior authorization and a prior three-day inpatient hospital stay are required for admission, and additional days beyond the standard 100 days are not covered.
Other Services See details
Clear Spring Health BrightPath Advantage (HMO) partially covers Other Services, providing Over-the-Counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $50 every three months. Acupuncture, meal benefits, and other additional services under this benefit category are not covered.
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