A non-government entity
Clear Spring Health BrightPath Advantage (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clear Spring Health BrightPath Advantage (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 BrightPath Advantage (PPO) in 2026, please refer to our full plan details page.
Clear Spring Health BrightPath Advantage (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 2026.
It's important to know that Clear Spring Health BrightPath Advantage (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 BrightPath Advantage (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 BrightPath Advantage (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 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 BrightPath Advantage (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 BrightPath Advantage (PPO) plan features a $400 drug deductible and offers excellent savings on generic medications. You will pay no copay for Tier 1 preferred generics at preferred pharmacies or through preferred mail order, and Tier 6 select care drugs have no copay across all pharmacies and mail-order options. For Tier 2 generic drugs, you can also enjoy no copay when using preferred mail order, while standard pharmacies charge a $10 copay for a one-month supply. For higher-tier medications, this plan transitions from flat copayments to coinsurance percentages. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs have a 30% coinsurance across all pharmacy and mail-order networks. Tier 5 specialty drugs require a 28% coinsurance for a one-month supply, regardless of whether you use a preferred or standard pharmacy.
Additional Benefits
The Clear Spring Health BrightPath Advantage (PPO) plan offers comprehensive medical coverage with cost-effective options, featuring no copay for primary care visits, telehealth, and routine preventive services. For specialized care, specialist visits range from no copay to a $25 copay, while inpatient hospital stays require a daily copay for the first seven days and no copay thereafter. Outpatient hospital services carry a $250 copay, and emergency room visits require a $115 copay, which is waived if you are admitted. This plan also includes valuable supplemental benefits, such as dental coverage with no copay up to a $2,000 annual limit and prescription hearing aids with no copay up to $500 per ear. Routine eye exams and hearing exams both require a $50 copay, while one pair of eyeglasses is covered with no copay up to a $200 limit. Additionally, members benefit from a $50 quarterly over-the-counter item allowance and no copay for home health services.
Inpatient Hospital See details
Clear Spring Health BrightPath Advantage (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $295 copay for days 1 through 7 (and no copay for days 8 through 90) and psychiatric stays require a $250 copay for days 1 through 7 (and no copay for days 8 through 90), while additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Clear Spring Health BrightPath Advantage (PPO) covers outpatient services with no coinsurance, including a $250 copay for outpatient hospital and observation services and a $175 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 services are covered by Clear Spring Health BrightPath Advantage (PPO) with a $50.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services under the Clear Spring Health BrightPath Advantage (PPO) require prior authorization, costing a $275 copay for ground transportation and 20% coinsurance for air transportation. Additional transportation services to plan-approved or any health-related locations are not covered by this plan.
Emergency Services See details
Clear Spring Health BrightPath Advantage (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Clear Spring Health BrightPath Advantage (PPO) covers primary care, occupational therapy, and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $25 copay with no coinsurance. Other services like physical therapy, mental health, and psychiatric care have a $40 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Clear Spring Health BrightPath Advantage (PPO) provides partially covered Preventive Services with no copay and no coinsurance for covered services, including annual physical exams, kidney disease education, memory fitness, and remote access technologies. However, sub-services such as 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/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Clear Spring Health BrightPath Advantage (PPO), as OTC, inner ear, outer ear, and over the ear hearing aids are not covered. Covered routine hearing exams and fitting evaluations require a $50 copay and no coinsurance, whereas covered prescription hearing aids have no copay and no coinsurance up to a $500 maximum per ear annually.
Vision Services See details
Vision services are partially covered by Clear Spring Health BrightPath Advantage (PPO), offering one routine eye exam per year with a $50 copay and no coinsurance, while other eye exam services are not covered. Eyewear is also partially covered, providing one pair of eyeglasses per year with no copay or coinsurance up to a $200 limit, but contact lenses, upgrades, and separate lenses or frames are excluded.
Dental Services See details
Clear Spring Health BrightPath Advantage (PPO) covers Medicare-covered dental services for a $30 copay and no coinsurance, while other preventive and comprehensive dental benefits are partially covered with no copay and no coinsurance up to a $2,000 annual maximum. Implant services and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Clear Spring Health BrightPath Advantage (PPO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have no copay and between no coinsurance and 20% coinsurance, while Part B insulin is covered with a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Clear Spring Health BrightPath Advantage (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Clear Spring Health BrightPath Advantage (PPO), including durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Clear Spring Health BrightPath Advantage (PPO) covers diagnostic radiological services and outpatient X-rays with no copay, while therapeutic radiological services require a 20% coinsurance. Some diagnostic services are covered, but diagnostic procedures, tests, and lab services are not covered.
Home Health Services See details
Home health services are covered by the Clear Spring Health BrightPath Advantage (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Clear Spring Health BrightPath Advantage (PPO) covers some cardiac rehabilitation services with no coinsurance and copays ranging from $15 to $20, although standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Clear Spring Health BrightPath Advantage (PPO) with no coinsurance, requiring prior authorization and a three-day inpatient hospital stay prior to admission. There is no copay for days 1 through 20, followed by a $160 daily copay for days 21 through 100, with additional days beyond the Medicare-covered limit not covered.
Other Services See details
Other services are partially covered by Clear Spring Health BrightPath Advantage (PPO), which features over-the-counter (OTC) items with no copay and no coinsurance up to a $50 limit every three months. Acupuncture, meal benefits, and other additional services under this category 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