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Clear Spring Health Select Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clear Spring Health Select Plus (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 Select Plus (HMO) in 2025, please refer to our full plan details page.
Clear Spring Health Select Plus (HMO) is a HMO plan offered by Group 1001 available for enrollment in 2025 to people living in Select Georgia Counties. The overall rating for this plan is not yet available for 2025.
It's important to know that Clear Spring Health Select Plus (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 Select Plus (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 Select Plus (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 $3.50. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3450.00 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 Select Plus (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance based on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have a $42 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your Part D costs are $0. Check the plan's formulary for specific drug coverage details.
Additional Benefits
The Clear Spring Health Select Plus (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. It also covers primary care, preventive, hearing, vision, and dental services, with specific copays for each. Additionally, the plan provides coverage for ambulance, emergency, and home health services, as well as home infusion and dialysis, and medical equipment with coinsurance. This plan includes additional benefits such as partial hospitalization, transportation services, and over-the-counter items. However, some services like cardiac rehabilitation, and several other services have limited coverage or are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a copay of $295 for days 1-7, and no copay for days 8-90; for days 1-7 you also pay a copay of $800. For Inpatient Hospital Psychiatric, you pay a copay of $250 for days 1-7, and no copay for days 8-90; for days 1-7 you also pay a copay of $800. Additional Days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and ambulatory surgical center services. Outpatient Hospital Services and Observation Services have a $250 copay per stay, while Ambulatory Surgical Center Services have a $200 copay. Outpatient Substance Abuse Services are covered with a $40 copay for both individual and group sessions, but Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Clear Spring Health Select Plus (HMO) plan, but requires prior authorization. The copay for this benefit is $50.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Clear Spring Health Select Plus (HMO) plan. Ground ambulance services have a $265 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 12 one-way trips per year using rideshares, buses, or medical transport. 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 Clear Spring Health Select Plus (HMO) plan. Emergency Services have a $90 copay and no coinsurance, while Urgently Needed Services have a $35 copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Clear Spring Health Select Plus (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, and physician specialist services with a copay between $0 and $35. Mental health specialty services, psychiatric services, and opioid treatment program services have a $40 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $40 copay. Additional telehealth benefits are also covered.
Preventive Services See details
The Clear Spring Health Select Plus (HMO) plan covers preventive services, including Medicare-covered preventive services with no copay, and other preventive services. Annual physical exams, health education, in-home safety assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), post-discharge in-home medication reconciliation, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services with Clear Spring Health Select Plus (HMO) include hearing exams with a $40 copay, and prescription hearing aids (all types) with a maximum plan benefit coverage of $500 every year, but does not cover prescription hearing aids for the inner ear, outer ear, and over the ear, or OTC hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are also covered.
Vision Services See details
Vision services are covered, including routine eye exams with a $40 copay. Eyewear is covered with a combined maximum benefit of $200 per year for eyeglasses (lenses and frames); however, contact lenses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include Medicare dental services with a $30 copay. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, orthodontics, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics. Orthodontic services have a maximum benefit of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Clear Spring Health Select Plus (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay, with 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 by the Clear Spring Health Select Plus (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment. However, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a coinsurance of at most 20%, and Diagnostic Radiological Services with a copay of at most $100.00. Lab Services are not covered. Outpatient X-Ray Services have no copay, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Clear Spring Health Select Plus (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Clear Spring Health Select Plus (HMO) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization, and the plan has a $0 copay for days 1-20, and a $167 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services with the Clear Spring Health Select Plus (HMO) plan covers over-the-counter (OTC) items with a maximum benefit of $60.00 per month, including nicotine replacement therapy and Naloxone coverage, but it does not cover acupuncture, meal benefits, or several other listed services.
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