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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 Georgia Counties. This plan received an overall rating of 2.5 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 $1.40. 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 $4200.00 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) plan features an annual drug deductible of $400 before coverage begins. You can minimize your out-of-pocket expenses with no copay for Tier 6 select care drugs at any pharmacy, as well as no copay for Tier 1 preferred generics at preferred pharmacies and through preferred mail order. Tier 2 generic medications also offer no copay via preferred mail order, or a low $5 copay for a one-month supply at preferred retail pharmacies. For brand-name and specialty medications, your costs are determined by coinsurance percentages. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 34% coinsurance across all pharmacy and mail-order options. Specialty tier drugs under Tier 5 are available with a 28% coinsurance for a one-month supply.
Additional Benefits
The Clear Spring Health BrightPath Advantage (HMO) plan offers affordable coverage for core medical needs, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits range from no copay up to a $35 copay, while inpatient hospital stays require a $295 daily copay for the first seven days. Emergency room visits carry a $120 copay, and outpatient hospital stays require a $250 copay, both with no coinsurance. For extra benefits, members enjoy preventive dental care with no copay or coinsurance up to a $3,000 annual limit, as well as routine eyeglasses up to a $200 maximum. Routine vision and hearing exams require a $40 copay, while prescription hearing aids are covered up to $500 per ear with no copay. Additionally, the plan provides a $50 quarterly over-the-counter allowance and covers durable medical equipment and dialysis with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital stays are partially covered by Clear Spring Health BrightPath Advantage (HMO) with no coinsurance, though prior authorization is required. Acute stays require a $295 copay (days 1-7) and psychiatric stays require a $250 copay (days 1-7), with no copay for days 8-90, while upgrades, non-Medicare-covered stays, and additional days are not covered.
Outpatient Services See details
Clear Spring Health BrightPath Advantage (HMO) covers outpatient hospital and observation services with a $250 copay per stay and no coinsurance, and ambulatory surgical center services with a $200 copay and no coinsurance. Outpatient substance abuse services require a $40 copay per session with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Clear Spring Health BrightPath Advantage (HMO) covers partial hospitalization services with a $50.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Clear Spring Health BrightPath Advantage (HMO) covers ground ambulance services with a $265 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved locations with no copay and no coinsurance, while 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, with both copays waived if you are admitted to the hospital within 24 hours. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation 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 require a $40 copay with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Clear Spring Health BrightPath Advantage (HMO) with no copay and no coinsurance for services like annual physicals and kidney disease education. However, additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, 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, smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling services.
Hearing Services See details
Hearing services are covered by Clear Spring Health BrightPath Advantage (HMO), including annual routine exams and fitting evaluations for a $40 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $500 maximum per ear yearly, 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) partially covers vision services, offering one annual routine eye exam with a $40 copay and no coinsurance, and one annual pair of eyeglasses with no copay, no coinsurance, and a $200 maximum limit. Other eye exam services, contact lenses, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered by Clear Spring Health BrightPath Advantage (HMO) with a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and most comprehensive services up to a $3,000 annual limit. However, this benefit is only partially covered as 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 and no coinsurance, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while Part B chemotherapy, radiation, and other drugs have no 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 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Clear Spring Health BrightPath Advantage (HMO), as diagnostic procedures, tests, and lab services are not covered. Covered diagnostic and diagnostic radiological services require no copay and no coinsurance, outpatient X-rays have no copay, and therapeutic radiological services require a 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are partially covered by Clear Spring Health BrightPath Advantage (HMO) with no coinsurance, though copays may apply to certain covered services. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Clear Spring Health BrightPath Advantage (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a prior three-day hospital stay. This benefit features no copay for days 1 through 20 and a $167 copay for days 21 through 100, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Clear Spring Health BrightPath Advantage (HMO) provides coverage for over-the-counter (OTC) items with no copay and no coinsurance, offering up to $50 every three months for eligible supplies. Other supplemental services, such as acupuncture and meal benefits, are not covered under this plan.
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