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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 Select Colorado Counties. 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. Additionally, this plan comes with a Part B Premium reduction of $1.10. 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 $400.00 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 $3315.00 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 an annual drug deductible of $400. Beneficiaries can access significant savings on lower-tier drugs, including no copay for Tier 6 Select Care drugs and Tier 1 Preferred Generics filled at preferred pharmacies or through preferred mail order. Tier 2 Generic drugs also feature no copay when ordered through preferred mail delivery, or a low $5 copay for a one-month supply at a preferred retail pharmacy. For brand-name and specialty medications, costs are determined by coinsurance regardless of the pharmacy type you choose. Tier 3 Preferred Brands require a 20% coinsurance, Tier 4 Non-Preferred drugs require a 34% coinsurance, and Tier 5 Specialty drugs carry a 28% coinsurance for a one-month supply. Utilizing preferred network pharmacies and mail-order options is the most effective way to minimize your out-of-pocket drug costs with this plan.
Additional Benefits
The Clear Spring Health BrightPath Advantage (HMO) plan offers robust coverage with an emphasis on low out-of-pocket costs for essential healthcare services. Members enjoy no copays and no coinsurance for primary care visits, annual physicals, preventive screenings, and home health services. Specialist visits are also highly affordable, ranging from no copay to a twenty-dollar copay with no coinsurance. For supplemental care, the plan provides valuable dental, vision, and hearing benefits to help lower daily expenses. Preventive and comprehensive dental services, as well as routine vision exams and eyeglasses up to a two hundred dollar maximum, feature no copays or coinsurance. Inpatient hospital stays require a daily copay with no coinsurance, while emergency room visits carry a one hundred twenty dollar copay that is waived upon admission.
Inpatient Hospital See details
Clear Spring Health BrightPath Advantage (HMO) partially covers inpatient acute and psychiatric hospital services with no coinsurance, though prior authorization is required. Medicare-covered stays require a copay of either $250 per day for days 1 through 5 or $800 for days 1 through 60, followed by no copay for days 6 through 90, while upgrades, additional days, 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 a $40 to $150 copay for outpatient hospital services and a $40 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $40 copay, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Clear Spring Health BrightPath Advantage (HMO) plan with a $55.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Clear Spring Health BrightPath Advantage (HMO) covers ground and air ambulance services with a $200 copay and no coinsurance, subject to 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, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Clear Spring Health BrightPath Advantage (HMO) with a $120 copay and no coinsurance, and urgently needed services are covered with a $65 copay and no coinsurance, both of which are waived if admitted to the hospital within 24 hours. Some worldwide emergency services are covered, though worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Clear Spring Health BrightPath Advantage (HMO) offers primary care, occupational therapy, and telehealth services with no copay and no coinsurance, while specialist visits range from a $0 to $20 copay with no coinsurance. Covered physical therapy, psychiatric, and mental health services require copays ranging from $20 to $40 and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Clear Spring Health BrightPath Advantage (HMO) offers preventive services with no copay and no coinsurance for annual physicals and screenings, while kidney disease education has no copay but a 20% coinsurance. Additional preventive services are partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, extra smoking cessation, enhanced disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Clear Spring Health BrightPath Advantage (HMO) covers routine hearing exams and fitting evaluations for a $30 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $500 per ear annually, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Clear Spring Health BrightPath Advantage (HMO) provides partially covered vision services with no copay, no coinsurance, and no deductible. Covered benefits include one routine eye exam and one pair of eyeglasses (lenses and frames) per year with a $200 maximum benefit, while other eye exams, contact lenses, individual lenses, individual frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Clear Spring Health BrightPath Advantage (HMO), featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and comprehensive dental services. A $2,000 annual maximum applies to comprehensive services, and 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. Medicare Part B chemotherapy, insulin, and other drugs carry a coinsurance of up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Clear Spring Health BrightPath Advantage (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Clear Spring Health BrightPath Advantage (HMO) with no copay and 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic equipment is also covered with no copay and no coinsurance, but is only partially covered as diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Clear Spring Health BrightPath Advantage (HMO) partially covers diagnostic and radiological services, excluding diagnostic procedures, lab services, and outpatient X-ray services. Covered diagnostic services feature no copay and no coinsurance, while diagnostic radiological services require a minimum $20 copay with no coinsurance, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Clear Spring Health BrightPath Advantage (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are partially covered under Clear Spring Health BrightPath Advantage (HMO) with no coinsurance, although copayments may apply to certain covered services. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Clear Spring Health BrightPath Advantage (HMO) covers skilled nursing facility care with no coinsurance, offering 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 for admission, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Clear Spring Health BrightPath Advantage (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $50 maximum benefit every three months. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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