A non-government entity
Clear Spring Health Choice Plan (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clear Spring Health Choice Plan (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Clear Spring Health Choice Plan (PPO) in 2025, please refer to our full plan details page.
Clear Spring Health Choice Plan (PPO) is a PPO 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 Choice Plan (PPO) 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 Choice Plan (PPO).
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 Choice Plan (PPO), 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 $5.00. 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 $250.00 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 combined Maximum Out-Of-Pocket cost of $9250.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9250.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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:
Sign up for Clear Spring Health Choice Plan (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Clear Spring Health Choice Plan (PPO) has an enhanced alternative drug benefit with a $250 deductible. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For preferred generic drugs, there is no copay at preferred pharmacies and mail order, and a $17 copay at standard pharmacies. For non-preferred drugs, you will pay 29% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Clear Spring Health Choice Plan (PPO) offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services have copays ranging from $40 to $250. Emergency services have a copay, and ambulance services have a copay or coinsurance. The plan covers primary care, preventive services, and several other services like hearing, vision, and dental, each with its own cost structure. It also includes coverage for home health services, skilled nursing facilities, and over-the-counter items. Some services, such as cardiac rehabilitation and certain transportation, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For Inpatient Hospital-Acute, you pay a copay of $295 for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you pay a copay of $250 for days 1-7, and no copay for days 8-90. Additional Days, Non-Medicare-covered Stay, and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services and observation services with a $250 copay, and ambulatory surgical center services with a $200 copay. Outpatient substance abuse services are covered with a $40 copay for individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $50 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Clear Spring Health Choice Plan (PPO). Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Clear Spring Health Choice Plan (PPO), with a $90 copay and no coinsurance. Urgently Needed Services are also covered with a $35 copay and no coinsurance, while Worldwide Emergency Services are not covered.
Primary Care See details
The Clear Spring Health Choice Plan (PPO) covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services has a $15 copay, and Occupational Therapy Services has a $35 copay, while Physician Specialist Services has a copay between $0 and $35. Individual and Group Sessions for Mental Health and Psychiatric Services have a $40 copay, Physical Therapy and Speech-Language Pathology Services have a $40 copay, and Opioid Treatment Program Services has a $40 copay.
Preventive Services See details
The Clear Spring Health Choice Plan (PPO) covers Medicare-covered preventive services and additional preventive services, but does not cover annual physical exams. Re-admission prevention, fitness benefits, remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered as well.
Hearing Services See details
Hearing services include hearing exams with a $50 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a maximum benefit of $500 per year, per ear. Prescription hearing aids are limited to 2 per year. OTC hearing aids, and prescription hearing aids for the inner and outer ear are not covered.
Vision Services See details
Vision services include routine eye exams with a $50 copay, and eyewear, with a combined maximum benefit of $200 every year. Contact lenses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Clear Spring Health Choice Plan (PPO) covers 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, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable & fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery, all with a limit of 2 visits per year. Orthodontic Services are covered up to a maximum of $2000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Clear Spring Health Choice Plan (PPO). You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies has a 20% coinsurance with no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a coinsurance of at most 20%, and outpatient X-ray services with no copay. Lab Services are not covered, while diagnostic radiological services have a copay of at most $100, 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 Choice Plan (PPO), with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Clear Spring Health Choice Plan (PPO). Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. There is no copay for days 1-20, and a $160 copay for days 21-100.
Other Services See details
The Clear Spring Health Choice Plan (PPO) covers over-the-counter items with a maximum benefit of $55.00 per month, including nicotine replacement therapy and Naloxone coverage. Acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved