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inurance organization provider

Banner Health

Plan ID: H5843-5-0

Banner Medicare Advantage Prime (HMO)

2025 Banner Medicare Advantage Prime (HMO) H5843005 0 is a Medicare Advantage plan with drug coverage. It has received a 3.5-out-of-5 star rating from CMS for 2025.

Learn more about Banner Medicare Advantage Prime (HMO) H5843 - 005 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.

3.5 / 5 stars for 2025

$0.00 /mo

Monthly premium

$0

Drug deductible

$2995.00

Out-of-pocket maximum (Out-of-Network)

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Overview Icon

Plan Overview

2025 Banner Medicare Advantage Prime (HMO) H5843005 0 is a HMO offered in Yuma County by Banner Health. It has a monthly premium of $0.00.

Premium Breakdown

Standard Part B Premium

$185.00

Part B premium reduction

- $0

Monthly Plan Premium

$0.00

Total Premium:

$185.00

Note:

The standard Medicare Part B premium for 2025 is $185.00. Your premium may differ based on factors like late enrollment, income (IRMAA), or disability status. Most people enrolled in Medicare Part B are required to pay this premium.

Special needs plan type

No

Out-of-pocket maximum (In-Network)

N/A

Out-of-pocket maximum (Out-of-Network)

$2995.00

Out-of-pocket maximum (Combined)

N/A

Plan Organization:

Banner Health

Plan Type:

HMO

Location:

Yuma County

Drugs Covered:

Yes

Drug Formulary:

Pharmacies:

Doctors Link:

Deductibles

The amount you must pay each year before your plan starts to pay for covered services or drugs.

Drug deductible

$0

Sign up for Banner Medicare Advantage Prime (HMO)

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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 Icon

Drug Coverage

Banner Medicare Advantage Prime (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Benefit Type

Enhanced Alternative

Prescription drug deductible

$0

Part D Premium Reduction

This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.

Part D

LIS Full

$0.00

$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2000.00. Once you reach that amount, you will enter the next coverage phase.

30 Days
60 Days
90 Days

Tier

Preferred Pharmacy

Standard Pharmacy

Preferred Mail

Standard Mail

1. Preferred Generic

-

$5.00 copay

-

-

2. Standard Generic

-

$47.00 copay

-

-

3. Preferred Brand

-

$100.00 copay

-

-

4. Non-Preferred Drug

-

33% coinsurance

-

-

5. Specialty Tier

-

-

-

-

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.

Nursing Icon

Additional Benefits

Banner Medicare Advantage Prime (HMO) also provides the following benefits.

Additional Coverage Icon

Hearing Services

Hearing Services benefits are covered.

Hearing Exams

Hearing Exams benefits are covered – including services not usually covered by Medicare plans.

More Details:

Is there a deductible?

No

Is there a deductible?

No

Is there a maximum plan benefit coverage?

No

Routine Hearing Exams

Routine Hearing Exams benefits are covered.

More Details:

Is this benefit unlimited?

No, indicate number

Number of visits

1

Periodicity

Every year

Fitting/Evaluation for Hearing Aid

Fitting/Evaluation for Hearing Aid benefits are covered.

More Details:

Is this benefit unlimited?

No, indicate number

Number of visits

1

Periodicity

Every year

Prescription Hearing Aids

Prescription Hearing Aids benefits are covered – including services not usually covered by Medicare plans.

More Details:

Service maximum plan benefit coverage

Yes

Select Coverage

Both ears combined

Maximum plan benefit coverage type

Plan-specified amount per period

Maximum amount

1000.00

Periodicity

Every year

Prescription Hearing Aids (all types)

Prescription Hearing Aids (all types) benefits are covered.

More Details:

Is this benefit unlimited?

No, indicate number

Number of visits

1

Periodicity

Every year

Prescription Hearing Aids - Inner Ear

Not covered.

Prescription Hearing Aids - Outer Ear

Not covered.

Prescription Hearing Aids - Over the Ear

Not covered.

OTC Hearing Aids

Not covered.

Additional Coverage Icon

Vision Services

Vision Services benefits are covered.

Eye Exams

Eye Exams benefits are covered – including services not usually covered by Medicare plans.

More Details:

Is there a deductible?

No

Is there a deductible?

No

Is there a maximum plan benefit coverage?

No

Routine Eye Exams

Routine Eye Exams benefits are covered.

More Details:

Is this benefit unlimited?

No, indicate number

Number of visits

1

Periodicity

Every year

Eyewear

Eyewear benefits are covered – including services not usually covered by Medicare plans.

Cost Sharing:

- Coinsurance: 20%. - Copay: See below for more copay info.

More Details:

Which Eyewear Benefits have a Coinsurance

Contact lenses

Which Eyewear Benefits have a Copayment

Eyeglass lenses

Is there a deductible?

No

Is there a deductible?

No

Is there a maximum plan benefit coverage?

Yes

Maximum plan benefit coverage type

Plan-specified amount per period

Do you offer a Combined Max Plan Benefit Coverage Amount for all Eyewear?

Yes

Combined maximum amount

250.00

Periodicity

Every year

Contact Lenses

Contact Lenses benefits are covered.

More Details:

Is this benefit unlimited?

No, indicate number

Number of pairs

1

Periodicity

Every year

Eyeglasses (lenses and frames)

Eyeglasses (lenses and frames) benefits are covered.

Cost Sharing:

- Copay: $25.00.

More Details:

Is this benefit unlimited?

No, indicate number

Number of pairs

1

Periodicity

Every year

Eyeglass lenses

Not covered.

Eyeglass frames

Not covered.

Upgrades

Upgrades benefits are covered.

Additional Coverage Icon

Dental Services

Dental Services benefits are covered.

Medicare Dental Services

Medicare Dental Services benefits are covered.

Cost Sharing:

- Coinsurance: 20%.

More Details:

Coinsurance percentage

20

Other Dental Services

Other Dental Services benefits are covered.

More Details:

Is there a maximum plan benefit coverage?

Yes

Maximum amount

1000.00

Periodicity

Every year

Oral Exams

Oral Exams benefits are covered.

More Details:

Is this benefit unlimited?

No

Number of visits

2

Periodicity

Every year

Dental X-Rays

Dental X-Rays benefits are covered.

More Details:

Is this benefit unlimited?

No

Number of X-Rays

1

Periodicity

Other, Describe

Description

Every 12 months

Prophylaxis (Cleaning)

Prophylaxis (Cleaning) benefits are covered.

More Details:

Is this benefit unlimited?

No

Number of visits

2

Periodicity

Every year

Fluoride Treatment

Fluoride Treatment benefits are covered.

More Details:

Is this benefit unlimited?

No

Number of visits

2

Periodicity

Every year

Orthodontic Services

Orthodontic Services benefits are covered.

More Details:

Is there a maximum plan benefit coverage?

Yes

Maximum plan benefit coverage type

Covered under Diagnostic and Preventive Dental (16b)

Restorative Services

Restorative Services benefits are covered. Prior Authorization is required.

More Details:

Is this benefit unlimited?

No

Number of visits

1

Periodicity

Other, Describe

Description

See note.

Adjunctive General Services

Adjunctive General Services benefits are covered. Prior Authorization is required.

More Details:

Is this benefit unlimited?

No

Number of visits

1

Periodicity

Other, Describe

Description

See note.

Endodontics

Endodontics benefits are covered. Prior Authorization is required.

More Details:

Is this benefit unlimited?

No

Number of visits

1

Periodicity

Other, Describe

Description

Pulpotomy or pupal debridement, root canals, apicoectomy, retrograde filling-1 per tooth per lifetime.

Periodontics

Periodontics benefits are covered. Prior Authorization is required.

More Details:

Is this benefit unlimited?

No

Number of visits

1

Periodicity

Other, Describe

Description

See note.

Prosthodontics, removable

Prosthodontics, removable benefits are covered.

Cost Sharing:

- Coinsurance: 0% - 50%.

More Details:

Is this benefit unlimited?

No

Number of visits

1

Periodicity

Other, Describe

Description

See note.

Maxillofacial Prosthetics

Maxillofacial Prosthetics benefits are covered. Prior Authorization is required.

More Details:

Is this benefit unlimited?

Yes

Implant Services

Not covered.

Prosthodontics, fixed

Prosthodontics, fixed benefits are covered. Prior Authorization is required.

Cost Sharing:

- Coinsurance: 50%.

More Details:

Is this benefit unlimited?

No

Number of visits

1

Periodicity

Other, Describe

Description

Fixed dentures (bridges) and retainers-1 per tooth per 60 monthsRe-cement, rebond or repair partial dentures- 1 per 24 months after 6 months of placement

Coinsurance percentage

50

Oral and Maxillofacial Surgery

Oral and Maxillofacial Surgery benefits are covered. Prior Authorization is required.

More Details:

Is this benefit unlimited?

No

Number of visits

1

Periodicity

Other, Describe

Description

See note.

Orthodontics

Not covered.

Additional Coverage Icon

Home Infusion bundled Services

Home Infusion bundled Services benefits are covered. Prior Authorization is required.

Cost Sharing:

- Coinsurance: See below for more coinsurance info.

More Details:

Which Medicare Part B Rx Drugs have a Coinsurance

Medicare Part B Chemotherapy/Radiation Drugs, Other Medicare Part B Drugs

Does this plan have a service specific maximum enrollee out-of-pocket cost (MOOP)?

No

Does the plan offer step therapy?

Yes

Does the benefit step from?

Part B to Part D

Insulin

Insulin benefits are covered.

Medicare Part B Insulin Drugs

Medicare Part B Insulin Drugs benefits are covered.

Cost Sharing:

- Coinsurance: See below for more coinsurance info. - Copay: $35.00.

More Details:

Minimum coinsurance

0

Maximum coinsurance

20

Does the Part B drugs - Insulin cost sharing count towards any plan-level deductible?

No

Medicare Part B Chemotherapy/Radiation Drugs

Medicare Part B Chemotherapy/Radiation Drugs benefits are covered.

More Details:

Minimum coinsurance

0

Maximum coinsurance

20

Other Medicare Part B Drugs

Other Medicare Part B Drugs benefits are covered.

More Details:

Minimum coinsurance

0

Maximum coinsurance

20

Additional Coverage Icon

Preventive Services

Preventive Services benefits are covered.

Medicare-covered Zero Dollar Preventive Services

Medicare-covered Zero Dollar Preventive Services benefits are covered.

Annual Physical Exam

Annual Physical Exam benefits are covered – including services not usually covered by Medicare plans.

More Details:

Is there a maximum plan benefit coverage amount?

No

Additional Preventive Services

Additional Preventive Services benefits are covered – including services not usually covered by Medicare plans.

More Details:

Is there a service-specific Maximum Plan Benefit Coverage amount for Other Defined Supplemental Benefits?

No

Health Education

Not covered.

In-Home Safety Assessment

Not covered.

Personal Emergency Response System (PERS)

Not covered.

Medical Nutrition Therapy (MNT)

Not covered.

Post discharge In-Home Medication Reconciliation

Not covered.

Re-admission Prevention

Not covered.

Wigs for Hair Loss Related to Chemotherapy

Not covered.

Weight Management Programs

Not covered.

Alternative Therapies

Not covered.

Therapeutic Massage

Not covered.

Adult Day Health Services

Not covered.

Nutritional/Dietary Benefit

Not covered.

Home-Based Palliative Care

Not covered.

In-Home Support Services

Not covered.

Support for Caregivers of Enrollees

Not covered.

Additional Sessions of Smoking and Tobacco Cessation Counseling

Not covered.

Fitness Benefit

Fitness Benefit benefits are covered.

More Details:

Type of Fitness Benefit offered

Memory Fitness

Enhanced Disease Management

Not covered.

Telemonitoring Services

Not covered.

Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)

Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) benefits are covered.

Home and Bathroom Safety Devices and Modifications

Not covered.

Counseling Services

Not covered.

Kidney Disease Education Services

Kidney Disease Education Services benefits are covered. A doctor referral is required.

Other Preventive Services

Other Preventive Services benefits are covered.

More Details:

Is a referral required for any Services?

No

Glaucoma Screening

Glaucoma Screening benefits are covered.

Diabetes Self-Management Training

Diabetes Self-Management Training benefits are covered.

Barium Enemas

Barium Enemas benefits are covered.

Digital Rectal Exams

Digital Rectal Exams benefits are covered.

EKG following Welcome Visit

EKG following Welcome Visit benefits are covered.

Other Services

Other Services benefits are covered.

Acupuncture

Not covered.

Over-the-Counter (OTC) Items

Over-the-Counter (OTC) Items benefits are covered.

More Details:

Does the plan provide Over-The-Counter (OTC) Items as a supplemental benefit under Part C?

Yes

Is there a maximum plan benefit coverage amount?

Yes

Maximum plan benefit coverage amount

140.00

Periodicity

Every three months

Does your Maximum Plan Benefit Coverage amount carry forward to the next period if it is unused?

Yes

Plan offers Nicotine Replacement Therapy (NRT) as a Part C OTC benefit?

Yes

The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.

The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.

Plan offers Naloxone coverage as a Part C OTC benefit?

Yes

Does this cover all of the drugs on the CMS OTC list which may be found in Chapter 4 of the Medicare Managed Care Manual

Yes

Meal Benefit

Meal Benefit benefits are covered. Prior Authorization is required.

More Details:

Does the plan provide a limited duration Meal Benefit as a supplemental benefit under Part C? Note: Only primarily health-related meals offered in accordance with Chapter 4 of the MMCM should be entered in this section.

Yes

Type of primarily health related meals benefit offered

For a chronic illness

Is there a maximum plan benefit coverage amount?

No

Dual Eligible SNPs with Highly Integrated Services

Not covered.

Other Services

Other Services benefits are covered.

More Details:

Is Authorization required for one or more Additional Services?

No

Is a referral required for one or more Additional Services?

No

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services

Not covered.

Private Duty Nursing Services

Not covered.

Case Management (Long Term Care)

Not covered.

Institution for Mental Disease Services for Individuals 65 or Older

Not covered.

Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities

Not covered.

Case Management

Not covered.

Tobacco Cessation Counseling for Pregnant Women

Not covered.

Freestanding Birth Center Services

Not covered.

Respiratory Care Services

Not covered.

Family Planning Services

Not covered.

Nursing Home Services

Not covered.

Home and Community Based Services

Not covered.

Personal Care Services

Not covered.

Self-Directed Personal Assistance Services

Not covered.

Dialysis Services

Dialysis Services benefits are covered.

Cost Sharing:

- Coinsurance: See below for more coinsurance info.

More Details:

Minimum coinsurance

20

Maximum coinsurance

20

Additional Coverage Icon

Medical Equipment

Medical Equipment benefits are covered.

Durable Medical Equipment (DME)

Durable Medical Equipment (DME) benefits are covered.

More Details:

Is there a coinsurance?

Yes

Minimum coinsurance

20

Maximum coinsurance

20

Is there a copayment ?

No

Are there preferred vendors/manufacturers for Durable Medical Equipment (DME)?

No

Authorization required for this benefit?

Yes

Durable Medical Equipment for use outside the home

Not covered.

Prosthetics/Medical Supplies - Non-Medicare benefit

Prosthetics/Medical Supplies - Non-Medicare benefit benefits are covered.

More Details:

Is there a coinsurance?

Yes

Which Prosthetics/Medical Supplies have a Coinsurance

Medicare-covered Prosthetic Devices, Medicare-covered Medical Supplies

Is there a copayment ?

No

Authorization required for this benefit?

Yes

Prosthetic Devices

Prosthetic Devices benefits are covered.

More Details:

Minimum coinsurance

20

Maximum coinsurance

20

Medical Supplies

Medical Supplies benefits are covered.

Cost Sharing:

- Coinsurance: 20%.

Diabetic Equipment

Diabetic Equipment benefits are covered. Prior Authorization is required.

Cost Sharing:

- Coinsurance: See below for more coinsurance info.

More Details:

Which Diabetic Supplies and Services have a Coinsurance

Medicare-covered Diabetic Supplies

Do you limit Diabetic supplies and services to those from specified manufacturers

Yes

Diabetic Supplies

Not covered.

Diabetic Therapeutic Shoes/Inserts

Diabetic Therapeutic Shoes/Inserts benefits are covered.

More Details:

Minimum coinsurance

20

Maximum coinsurance

20

Additional Coverage Icon

Ambulance and Transportation Services

Ambulance and Transportation Services benefits are covered.

All Ambulance Services

All Ambulance Services benefits are covered. Prior Authorization is required.

More Details:

Is there a coinsurance?

No

Is there a copayment ?

Yes

Which Services have a Copayment

Medicare-covered Ground Ambulance Services, Medicare-covered Air Ambulance Services

Is this Copayment waived if admitted to hospital?

No

Ground Ambulance Services

Ground Ambulance Services benefits are covered.

Cost Sharing:

- Copay: $265.00.

Air Ambulance Services

Air Ambulance Services benefits are covered.

Cost Sharing:

- Copay: $265.00.

Transportation Services

Transportation Services benefits are covered.

Transportation Services - Plan Approved Health-related Location

Not covered.

Transportation Services - Any Health-related Location

Not covered.

Additional Coverage Icon

Outpatient Services

Outpatient Services benefits are covered.

All Outpatient Hospital Services

All Outpatient Hospital Services benefits are covered.

Cost Sharing:

- Copay: See below for more copay info.

More Details:

Which Services have a Copayment

Medicare-covered Outpatient Hospital Services, Medicare-covered Observation Services

Outpatient Hospital Services

Outpatient Hospital Services benefits are covered. Prior Authorization is required.

Cost Sharing:

- Copay: $200.00.

Observation Services

Observation Services benefits are covered.

Cost Sharing:

- Copay: $200.00.

More Details:

Periodicity

Per stay

Ambulatory Surgical Center (ASC) Services

Ambulatory Surgical Center (ASC) Services benefits are covered. Prior Authorization is required.

Cost Sharing:

- Copay: $200.00.

Outpatient Substance Abuse Services

Outpatient Substance Abuse Services benefits are covered.

Cost Sharing:

- Copay: See below for more copay info.

More Details:

Which Outpatient Substance Abuse services have a Copayment

Medicare-covered Individual Sessions, Medicare-covered Group Sessions

Individual Sessions for Outpatient Substance Abuse

Individual Sessions for Outpatient Substance Abuse benefits are covered.

More Details:

Minimum copayment

20.00

Maximum copayment

20.00

Group Sessions for Outpatient Substance Abuse

Group Sessions for Outpatient Substance Abuse benefits are covered.

More Details:

Minimum copayment

20.00

Maximum copayment

20.00

Outpatient Blood Services

Not covered.

Additional Coverage Icon

Diagnostic and Radiological Services

Diagnostic and Radiological Services benefits are covered.

All Diagnostic services

All Diagnostic services benefits are covered. Prior Authorization is required.

More Details:

Is there a copayment?

Yes

Which Outpatient Diagnostic Procedures/Tests/Lab Services have a Copayment

Medicare-covered Diagnostic Procedures/Tests, Medicare-covered Lab Services

If a member receives multiple services at the same location on the same day, does only the maximum copay apply?

Yes

Diagnostic Procedures/Tests

Diagnostic Procedures/Tests benefits are covered.

More Details:

Minimum copayment

0.00

Maximum copayment

10.00

Lab Services

Lab Services benefits are covered.

Cost Sharing:

- Copay: $0.00.

All Radiological Services

All Radiological Services benefits are covered. Prior Authorization is required.

More Details:

Is there a copayment?

Yes

Which Outpatient Diagnostic/Therapeutic Radiological Services have a Copayment

Medicare-covered Therapeutic Radiological Services, Medicare-covered X-Ray Services

If a member receives multiple services at the same location on the same day, does only the maximum copay apply?

Yes

Diagnostic Radiological Services

Diagnostic Radiological Services benefits are covered.

Cost Sharing:

- Copay: At most $200.00. See below for more copay info.

More Details:

Minimum copayment

125.00

Therapeutic Radiological Services

Therapeutic Radiological Services benefits are covered.

Cost Sharing:

- Copay: At most $60.00. See below for more copay info.

More Details:

Minimum copayment

60.00

Outpatient X-Ray Services

Not covered.

Additional Coverage Icon

Primary Care

Primary Care benefits are covered.

Primary Care Physician Services

Primary Care Physician Services benefits are covered.

Chiropractic Services

Chiropractic Services benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.

Cost Sharing:

- Copay: $20.00.

More Details:

Which Chiropractic Services have a Copayment

Routine Care, Other

Is there a maximum plan benefit coverage amount?

No

Routine Chiropractic Care

Routine Chiropractic Care benefits are covered.

Cost Sharing:

- Copay: $35.00.

More Details:

Is this benefit unlimited?

No, indicate number

Visits

6

Periodicity

Every year

Occupational Therapy Services

Occupational Therapy Services benefits are covered.

More Details:

Is there a coinsurance?

No

Is there a copayment ?

No

Authorization required for this benefit?

Yes

Referral required for this benefit?

No

Physician Specialist Services

Physician Specialist Services benefits are covered. Prior Authorization is required.

Cost Sharing:

- Copay: $15.00.

Mental Health Specialty Services

Mental Health Specialty Services benefits are covered.

Cost Sharing:

- Copay: See below for more copay info.

More Details:

Which Mental Health Specialty Services have a Copayment

Medicare-covered Individual Sessions, Medicare-covered Group Sessions

Individual Sessions for Mental Health Specialty Services

Individual Sessions for Mental Health Specialty Services benefits are covered.

More Details:

Minimum copayment

25.00

Maximum copayment

25.00

Group Sessions for Mental Health Specialty Services

Group Sessions for Mental Health Specialty Services benefits are covered.

More Details:

Minimum copayment

25.00

Maximum copayment

25.00

Podiatry Services

Not covered.

Other Health Care Professional

Other Health Care Professional benefits are covered. Prior Authorization is required.

Cost Sharing:

- Copay: See below for more copay info.

More Details:

Minimum copayment

20.00

Maximum copayment

20.00

Psychiatric Services

Psychiatric Services benefits are covered.

Cost Sharing:

- Copay: See below for more copay info.

More Details:

Which Psychiatric Services have a Copayment

Medicare-covered Individual Sessions, Medicare-covered Group Sessions

Individual Sessions for Psychiatric Services

Individual Sessions for Psychiatric Services benefits are covered.

More Details:

Minimum copayment

25.00

Maximum copayment

25.00

Group Sessions for Psychiatric Services

Group Sessions for Psychiatric Services benefits are covered.

More Details:

Minimum copayment

25.00

Maximum copayment

25.00

Physical Therapy and Speech-Language Pathology Services

Physical Therapy and Speech-Language Pathology Services benefits are covered.

More Details:

Is there a coinsurance?

No

Is there a copayment ?

No

Authorization required for this benefit?

Yes

Referral required for this benefit?

No

Additional Telehealth Benefits

Additional Telehealth Benefits benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.

Cost Sharing:

- Copay: $0.00 - $25.00.

More Details:

Medicare-covered benefits that may have Additional Telehealth Benefits available

4b: Urgently Needed Services, 7a: Primary Care Physician Services, 7c: Occupational Therapy Services, 7d: Physician Specialist Services, 7e1: Individual Sessions for Mental Health Specialty Services, 7e2: Group Sessions for Mental Health Specialty Services, 7g: Other Health Care Professional, 7h1: Individual Sessions for Psychiatric Services, 7h2: Group Sessions for Psychiatric Services, 7i: Physical Therapy and Speech-Language Pathology Services

Opioid Treatment Program Services

Opioid Treatment Program Services benefits are covered.

Cost Sharing:

- Copay: See below for more copay info.

More Details:

Minimum copayment

20.00

Maximum copayment

20.00

Home Health Services

Home Health Services benefits are covered.

More Details:

Is there a coinsurance?

No

Is there a copayment ?

No

Authorization required for this benefit?

No

Referral required for this benefit?

No

Additional Hours of Care

Not covered.

Personal Care Services

Not covered.

Partial Hospitalization

Partial Hospitalization benefits are covered. Prior Authorization is required.

Cost Sharing:

- Copay: $55.00.

Emergency Services

Emergency Services benefits are covered.

Emergency Services

Emergency Services benefits are covered.

Cost Sharing:

- Copay: $120.00.

More Details:

Is there a coinsurance?

No

Is there a copayment?

Yes

Is the copayment for Medicare-covered benefits waived if admitted to hospital?

Yes

Select either days or hours within which admission must occur for waiver

Hours

Enter number of days or hours

24

Does the cost sharing count towards any plan-level deductible?

No

Urgently Needed Services

Urgently Needed Services benefits are covered.

More Details:

Is there a coinsurance?

No

Is there a copayment?

No

Worldwide Emergency Services

Worldwide Emergency Services benefits are covered – including services not usually covered by Medicare plans.

Cost Sharing:

- Copay: See below for more copay info.

More Details:

Which Worldwide Services have a Copayment

Worldwide Urgent Coverage

Is there a maximum plan benefit coverage?

Yes

Is the maximum plan benefit coverage amount unlimited?

No

Maximum amount

25000.00

Worldwide Emergency Coverage

Worldwide Emergency Coverage benefits are covered.

Cost Sharing:

- Copay: $120.00.

Worldwide Urgent Coverage

Not covered.

Worldwide Emergency Transportation

Not covered.

Additional Coverage Icon

Cardiac Rehabilitation Services

Cardiac Rehabilitation Services benefits are covered.

Cost Sharing:

- Copay: See below for more copay info.

More Details:

Which Cardiac and Pulmonary Rehabilitation Services have a Copayment

Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Additional Cardiac Rehabilitation Services

Cardiac Rehabilitation Services

Not covered.

Intensive Cardiac Rehabilitation Services

Not covered.

Pulmonary Rehabilitation Services

Not covered.

SET for PAD Services

Not covered.

Additional Coverage Icon

Skilled Nursing Facility (SNF)

Skilled Nursing Facility (SNF) benefits are covered. Prior Authorization is required.

Cost Sharing:

- Copay: See below for more copay info.
Days 1-20: Days 21-100:
Copayment0.00178.00

More Details:

Does the plan provide Skilled Nursing Facility Services as a supplemental benefit under Part C?

No

Do you allow less than 3 day inpatient hospital stay prior to SNF admission?

Yes

Days

Zero

Do you charge the Medicare-defined cost share for tier 1?

No

Periodicity

Original Medicare

Additional Days beyond Medicare-covered for Skilled Nursing Facility (SNF)

Not covered.

Non-Medicare-covered Stay for Skilled Nursing Facility (SNF)

Not covered.

Additional Coverage Icon

Inpatient Hospital

Inpatient Hospital benefits are covered.

Inpatient Hospital-Acute

Inpatient Hospital-Acute benefits are covered. Prior Authorization is required.

Cost Sharing:

- Copay: See below for more copay info.
Days -: Days 6-90:
Copayment275.000.00
Begin Day1-
End Day5-
Copayment0.00-
Begin Day1-
End Day60-

More Details:

Do you charge the Medicare-defined cost share for tier 1?

No

Copayment for Medicare-covered stay

0.00

Periodicity

Original Medicare

Additional Days for Inpatient Hospital-Acute

Not covered.

Non-Medicare-covered Stay for Inpatient Hospital-Acute

Not covered.

Upgrades for Inpatient Hospital-Acute

Not covered.

Inpatient Hospital Psychiatric

Inpatient Hospital Psychiatric benefits are covered. Prior Authorization is required.

Cost Sharing:

- Copay: See below for more copay info.
Days -: Days 6-90:
Copayment275.000.00
Begin Day1-
End Day5-
Copayment0.00-
Begin Day1-
End Day60-

More Details:

Do you charge the Medicare-defined cost share for tier 1?

No

Copayment for Medicare-covered stay

0.00

Periodicity

Original Medicare

Additional Days for Inpatient Hospital Psychiatric

Not covered.

Non-Medicare-covered Stay for Inpatient Hospital Psychiatric

Not covered.

Overview Icon

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.

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Get Personalized Help from a licensed insurance agent

1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week

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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.

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