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Guidewell Mutual Holding Corporation

Plan ID: H1035-2-0

FHCP Medicare Rx Plus (HMO-POS)

2025 FHCP Medicare Rx Plus (HMO-POS) H1035 — 002 — 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 FHCP Medicare Rx Plus (HMO-POS) H1035 - 002 - 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

$49.00 /mo

Monthly premium

Drug deductible

$3400.00

Out-of-pocket maximum

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

Overview Benefits & Costs Drug Coverage Additional Benefits

Plan Overview

2025 FHCP Medicare Rx Plus (HMO-POS) H1035 — 002 — 0 is a HMO-POS offered in Counties: BRE, FLA, SEM, SJO and VOL by Guidewell Mutual Holding Corporation. It has a monthly premium of $49.00.

Premium Breakdown

Standard Part B Premium

$185.00

Part B premium reduction

- $0

Monthly Plan Premium

$49.00

Total Premium:

$234.00

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

Out-of-pocket maximum

$3400.00

Plan Organization:

Guidewell Mutual Holding Corporation

Plan Type:

HMO-POS

Location:

Counties: BRE, FLA, SEM, SJO and VOL

Drugs Covered:

Yes

Drug Formulary:

Formulary Link

Pharmacies:

Pharmacies Link

Doctor Choice:

Doctors Link:

Doctors Link

Deductibles

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

Drug deductible

Sign up for FHCP Medicare Rx Plus (HMO-POS)

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Drug Coverage

FHCP Medicare Rx Plus (HMO-POS) 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

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
$49.00	$49.00

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	-	$17.00 Copay	-	-
2. Standard Generic	-	-	-	-
3. Preferred Brand	-	-	-	-
4. Non-Preferred Drug	-	-	-	-
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.

Additional Benefits

FHCP Medicare Rx Plus (HMO-POS) also provides the following benefits.

Note:

Limits, Authorizations, and Referrals may apply for the benefits below. Contact the plan for details.

Comprehensive dental

Oral and Maxillofacial Surgery

In-Network: No Coins - 0.00 Copay

Prosthodontics, removable

In-Network: No Coins - 0.00 Copay

Preventive dental

Dental X-Rays

In-Network: No Coins - - Copay

Oral Exams

In-Network: No Coins - - Copay

Prophylaxis (cleaning)

In-Network: No Coins - - Copay

Diagnostic procedures/lab services/imaging

Diagnostic radiology services

Diagnostic tests and procedures

$0-175 copay

Outpatient x-rays

$10-50 copay

Lab services

$0 copay

Doctor visits

Specialist

$20 copay per visit

Primary

$0 copay

Emergency care/Urgent care

Emergency

$100 copay per visit (always covered)

Urgent care

$0-20 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment

$20 copay

Routine foot care

Not covered

Ground ambulance

All service types

$175 copay

Hearing

Medicare-Covered Hearing Exam

$45 copay

Hearing aids

$0 copay

Hearing aids OTC

Not covered

Fitting/evaluation

$0 copay

Inpatient hospital coverage

All service types

$300 per day for days 1 through 6 $0 per day for days 7 through 90 $0 per day for days 91 and beyond

Outpatient hospital coverage

All service types

$0-200 copay per visit

Optional benefits

All service types

Yes

Medical equipment/supplies

Diabetes supplies

0-20% coinsurance per item

Prosthetics

Durable medical equipment

Medicare Part B drugs

Chemotherapy

0-20% coinsurance

Other Part B drugs

0-20% coinsurance

Mental health services

Inpatient hospital - psychiatric

$300 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 and beyond

Outpatient individual therapy visit with a psychiatrist

$20 copay

Outpatient group therapy visit

$20 copay

Outpatient individual therapy visit

$20 copay

Outpatient group therapy visit with a psychiatrist

$20 copay

Preventive care

All service types

$0 copay

Rehabilitation services

Occupational therapy visit

$20 copay

Physical therapy and speech and language therapy visit

$0-20 copay

Skilled Nursing Facility

All service types

$0 per day for days 1 through 20 $172 per day for days 21 through 100

Transportation

All service types

Not covered

Vision

Other

Not covered

Upgrades

Not covered

Eyeglass lenses

Not covered

Routine eye exam

$15 copay

Contact lenses

Not covered

Eyeglass frames

Not covered

Eyeglasses (frames and lenses)

$0 copay

Wellness programs (eg, fitness, nursing hotline)

All service types

Covered

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.

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.

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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.

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Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

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