Medicare Advantage plans in Indiana provide Seniors with an alternative to original Medicare that typically includes prescription drug benefits. Private insurers offer these types of plans (MA and Part C) throughout all counties in the state. Although the cost of coverage can vary, typically, rates are less than Medigap Supplement plans. Also, additional benefits are often available, including dental, vision, hearing, and fitness club and gym membership discounts. Health and wellness coverage is also often included, and customized plans are offered to provide treatment for special conditions. Generally, there is also less paperwork with these types of plans.

Hoosier State MA plans can not decline applicants for poor health, pre-existing conditions, or age, during an Open Enrollment period (October 15th- December 7th) or when first eligible for Medicare benefits. Filing claims is quite easy and often paperless. Denial of services and claims can be appealed. Applicants that have not reached age 65 but are on Medicare because of a disability, can obtain an Advantage plan without being denied.

 

New MA Indiana Plans For 2022

AARP Medicare Advantage (HMO-POS)

Aetna Medicare Assure Premier (HMO D-SNP)

Aetna Medicare Premier (PPO)

Aetna Medicare Eagle (PPO)

Aetna Medicare Value (PPO)

Anthem MediBlue Access (PPO)

Anthem MediBlue Access Preferred (PPO)

Anthem MediBlue Plus (HMO)

Anthem MediBlue Service (PPO)

Ascension Complete St. Vincent DSNP (HMO D-SNP)

Ascension Complete St. Vincent Access (PPO)

CareSource Dual Advantage (HMO D-SNP)

HumanaChoice (PPO)

IU Health Plans Medicare Flex Network (HMO-POS)

MDWise Medicare Inspire (HMO)

MDWise Medicare Inspired Duals (HMO D-SNP)

MDWise Medicare Inspired Flex (HMO-POS)

MDWise Medicare Inspire Plus  (HMO)

WellCare No Premium Open (PPO)

WellCare Patriot Giveback Open (PPO)

WellCare Giveback (HMO)

Zing Signature Care (HMO-POS)

Zing Open Access IN (HMO-POS)

Zing Complete Plus IN (HMO POS D-SNP)

Zing Choice IN (HMO)

Zing Dual Platinum Plus (HMO-POS D-SNP)

 

Advantage plans (Part C) must abide by the rules and regulations of Medicare. The policy rates, out-of-pocket expenses, deductibles, copays, coinsurance, and drug formulary lists can differ. Many plans may not require a referral to see a specialist, while other plans will have more stringent guidelines. The four main types of  plans are Special Needs Plans (SNP), Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Private Fee-For-Service (PFFS).

Also available are PSO (Preferred Sponsored Organizations), which are managed care plans with a provider network, and MSAs (Medical Savings Accounts) that combine a savings account with a high-deductible policy. Religious Fraternal Benefit Society plans is a managed care contract formed by recognized fraternal or religious organizations.

MAP plans also provide the protection for beneficiaries. Covered protections include:

Grievance and appeal procedure

Physicians must  be permitted to inform all treatment options

If requirements are met, contract must be guaranteed to be issued

24/7 care

Access to specialists

Paid emergency coverage if symptoms indicate immediate treatment

You also must reside in the service area (county) of the plan you apply for. If a portion of the year is spent in another state, it’s important to determine if the plan’s service area provides network coverage in that state. It is possible that if you move outside of the state, the current Indiana MA plan may not be available. Changing to a different plan is typically possible during an Open Enrollment period. Although medical underwriting may not be required, the new plan’s benefits, costs, and service area may be different than the current plan. A Supplement plan is not needed when an MA plan is purchased. Note: Prices of MA plans often vary,depending upon your county of residence.

Counties with most available MA plans:

57 – Marion County

55 – Hamilton County

53 – Hancock County

52 – Howard County

52 – Madison County

52 – Hendricks County

50 – Fountain County

50 – Warren County

48 – Clinton County

48 – Pike County

47 – Putnam County

47 – Shelby County

47 – Tipton County

46 – Allen County

46 – Vanderburgh County

46 – Brown County

46 – Johnson County

46 – Boone County

45 – Cass County

45 – Henry County

Counties with least available MA plans:

29 – Washington County

30 – Crawford County

30 – Ripley County

30 – Sullivan County

30 – Spencer County

30 – Greene County

31 – Blackford County

31 – Scott County

31 – Jefferson County

31 – Dubois County

31 – Martin County

31 – Ohio County

31 – Dearborn County

31 – Perry County

31 – Scott County

32 – Clark County

32 – Floyd County

32 – Harrison County

32 – Lagrange County

32 – Rush County

32 – DeKalb County

33 – Pulaski County

33 – Orange County

35 – Decatur County

35 – Jasper County

Indiana Medicare Advantage Plans Without Prescription Drug Coverage

AARP Medicare Advantage Patriot – PPO with $0 monthly premium and $5,500 maximum out-of-pocket expenses. 4.0 summary Star Rating with $10 and $40 office visit copays and $40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $30, $0, and $30 copays respectively. Inpatient hospital visits are subject to a $350 copay for days 1-5, and the outpatient hospital copay is $0-$370. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $15 and $25.

 

Aetna Medicare Eagle – PPO with $0 monthly premium and $5,500 maximum out-of-pocket expenses. 4.5 summary Star Rating with $0 and $35 office visit copays and $45 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$75, $0, and $20 copays respectively. Inpatient hospital visits are subject to a $290 copay for days 1-7, and the outpatient hospital copay is $0-$350. The ground ambulance copay is $290, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

 

Anthem MediBlue Service – PPO with $0 monthly premium and $6,700 maximum out-of-pocket expenses. $20 and $50 office visit copays and $25 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$100, $0-$50, and $50-$110 copays respectively. Inpatient hospital visits are subject to a $295 copay for days 1-7, and the outpatient hospital copay is $0-$275. The ground ambulance copay is $290, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

 

Health Alliance Medicare HMO Basic – HMO with $0 monthly premium and $6,700 maximum out-of-pocket expenses. 4.0 summary Star Rating with $25 and $50 office visit copays and $65 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to 20%, 0%-20%, and 20% copays respectively. Inpatient hospital visits are subject to a $300 copay for days 1-6, and the outpatient hospital copay is 20%. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

 

Health Alliance Medicare POS Basic – HMO-POS with $23 monthly premium and $6,700 maximum out-of-pocket expenses. 4.0 summary Star Rating with $35 and $50 office visit copays and $65 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $40, $0-$40, and $40 copays respectively. Inpatient hospital visits are subject to a $450 copay for days 1-4, and the outpatient hospital copay is 25%. The ground ambulance copay is $350, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

 

Humana Honor – PPO with $0 monthly premium and $6,700 maximum out-of-pocket expenses. 4.0 summary Star Rating with $15 and $45 office visit copays and $15-$45 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$105, $0-$35, and $15-$110 copays respectively. Inpatient hospital visits are subject to a $350 copay for days 1-5, and the outpatient hospital copay is $45-$325. The ground ambulance copay is $270, and rehabilitation therapy visit copays are $20-$40. Mental health outpatient group and individual therapy visit copays are $40.

 

HumanaChoice – Regional PPO with $0 monthly premium and $6,200 maximum out-of-pocket expenses. 3.5 summary Star Rating with $10 and $35 office visit copays and $10-$35 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$105, $0-$40, and $10-$95 copays respectively. Inpatient hospital visits are subject to a $295 copay for days 1-6, and the outpatient hospital copay is $45-$295. The ground ambulance copay is $270, and rehabilitation therapy visit copays are $20-$40. Mental health outpatient group and individual therapy visit copays are $40.

 

IU Health Plans Medicare Select – HMO with $0 monthly premium and $5,000 maximum out-of-pocket expenses. 4.5 summary Star Rating with $0 and $40 office visit copays and $65 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to 20%, $10, and $25 copays respectively. Inpatient hospital visits are subject to a $335 copay for days 1-6, and the outpatient hospital copay is $300. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

 

Reid Health Alliance Medicare – HMO with $0 monthly premium and $6,700 maximum out-of-pocket expenses. 4.0 summary Star Rating with $20 and $50 office visit copays and $45 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $10, $0-$10, and 20% copays respectively. Inpatient hospital visits are subject to a $300 copay for days 1-6, and the outpatient hospital copay is $345. The ground ambulance copay is $300, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

Note: Medicare Supplement plans in Indiana also do not cover prescription drugs and require a separate Part D plan.

 

Indiana Medicare Advantage Rates

 

Indiana Medicare Advantage Plans With Prescription Drug Coverage

AARP Medicare Advantage Profile – HMO-POS with $0 monthly premium, $210 deductible, and $4,500 maximum out-of-pocket expenses. 4.5 summary Star Rating with $5 and $40 office visit copays and $30-$40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $30, $0, and $25 copays respectively. Inpatient hospital visits are subject to a $370 copay for days 1-5, and the outpatient hospital copay is $0-$370. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $15 and $25.

30-day preferred pharmacy copays are $3 (Tier 1), $12 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 29% (Tier 5). 90-day preferred pharmacy copays are $9 (Tier 1), $36 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

AARP Medicare Advantage Focus – PPO with $0 monthly premium, $0 deductible, and $3,900 maximum out-of-pocket expenses. 4.0 summary Star Rating with $0 and $30 office visit copays and $30-$40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $30, $0, and $25 copays respectively. Inpatient hospital visits are subject to a $370 copay for days 1-5, and the outpatient hospital copay is $0-$370. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $30. Mental health outpatient group and individual therapy visit copays are $15 and $25.

30-day preferred pharmacy copays are $2 (Tier 1), $8 (Tier 2), $45 (Tier 3), $95 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $9 (Tier 1), $36 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

AARP Medicare Advantage Choice Plan 1 – PPO with $22 monthly premium, $185 deductible, and $5,200 maximum out-of-pocket expenses. 4.0 summary Star Rating with $0 and $25 office visit copays and $30-$40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $30, $0, and $25 copays respectively. Inpatient hospital visits are subject to a $370 copay for days 1-5, and the outpatient hospital copay is $0-$350. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $35. Mental health outpatient group and individual therapy visit copays are $15 and $25.

30-day preferred pharmacy copays are $3 (Tier 1), $10 (Tier 2), $45 (Tier 3), $95 (Tier 4), and 29% (Tier 5). 90-day preferred pharmacy copays are $9 (Tier 1), $30 (Tier 2), $135 (Tier 3), $285 (Tier 4), and n/a (Tier 5).

 

AARP Medicare Advantage Choice Plan 2 – PPO with $0 monthly premium, $185 deductible, and $5,500 maximum out-of-pocket expenses. 4.0 summary Star Rating with $0 and $25 office visit copays and $30-$40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $30, $0, and $30 copays respectively. Inpatient hospital visits are subject to a $390 copay for days 1-5, and the outpatient hospital copay is $0-$370. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $15 and $30.

30-day preferred pharmacy copays are $3 (Tier 1), $10 (Tier 2), $45 (Tier 3), $95 (Tier 4), and 29% (Tier 5). 90-day preferred pharmacy copays are $9 (Tier 1), $30 (Tier 2), $135 (Tier 3), $285 (Tier 4), and n/a (Tier 5).

 

AARP Medicare Advantage Choice Premier – PPO with $29.60 monthly premium, $445 deductible, and $7,550 maximum out-of-pocket expenses. 4.0 summary Star Rating with $0 and $25 office visit copays and $30-$40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $30, $0, and $30 copays respectively. Inpatient hospital visits are subject to a $390 copay for days 1-5, and the outpatient hospital copay is $0-$370. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $15 and $30.

30-day preferred pharmacy copays are 25% (Tier 1), 25% (Tier 2), 25% (Tier 3), 25% (Tier 4), and 25% (Tier 5). 90-day preferred pharmacy copays are $25% (Tier 1), 25% (Tier 2), 25% (Tier 3), 25% (Tier 4), and 25% (Tier 5).

 

AARP Medicare Advantage Plan 1 – HMO-POS with $0 monthly premium, $0 deductible, and $3,900 maximum out-of-pocket expenses.  4.5 summary Star Rating with $0 and $40 office visit copays and $30-$40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $30, $0, and $25 copays respectively. Inpatient hospital visits are subject to a $360 copay for days 1-5, and the outpatient hospital copay is $0-$360. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $15 and $25.

30-day preferred pharmacy copays are $3 (Tier 1), $12 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $9 (Tier 1), $36 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

Aetna Medicare Prime – HMO with $0 monthly premium, $0 deductible, and $4,300 maximum out-of-pocket expenses. $0 and $35 office visit copays and $40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$50, $0, and $5 copays respectively. Inpatient hospital visits are subject to a $265 copay for days 1-7, and the outpatient hospital copay is $0-$250. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $0 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

Aetna Medicare Value– HMO with $0 monthly premium, $0 deductible, and $5,950 maximum out-of-pocket expenses. 4.0 summary Star Rating with $0 and $45 office visit copays and $65 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$75, $0-$15, and $20 copays respectively. Inpatient hospital visits are subject to a $290 copay for days 1-7, and the outpatient hospital copay is $0-$325. The ground ambulance copay is $295, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $10 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

Aetna Medicare Premier– PPO with $29 monthly premium, $0 deductible, and $5,700 maximum out-of-pocket expenses. 4.0 summary Star Rating with $0 and $35 office visit copays and $50 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$75, $0-$5, and $20 copays respectively. Inpatient hospital visits are subject to a $240 copay for days 1-7, and the outpatient hospital copay is $0-$325. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $0 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

Allwell Medicare– HMO with $0 monthly premium, $0 deductible, and $4,100 maximum out-of-pocket expenses. $0 and $40 office visit copays and $40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-10%, $0, and $0-$25 copays respectively. Inpatient hospital visits are subject to a $295 copay for days 1-6, and the outpatient hospital copay is $265. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $25. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $0 (Tier 1), $5 (Tier 2), $37 (Tier 3), $90 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $15 (Tier 2), $111 (Tier 3), $270 (Tier 4), and n/a (Tier 5).

 

Allwell Medicare– PPO with $0 monthly premium, $0 deductible, and $5,500 maximum out-of-pocket expenses. $5 and $25 office visit copays and $40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$5, $0-$5, and $0-$35 copays respectively. Inpatient hospital visits are subject to a $300 copay for days 1-6, and the outpatient hospital copay is $325. The ground ambulance copay is $295, and rehabilitation therapy visit copays are $35. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $0 (Tier 1), $5 (Tier 2), $37 (Tier 3), $90 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $15 (Tier 2), $111 (Tier 3), $270 (Tier 4), and n/a (Tier 5).

 

Allwell Medicare Boost– HMO with $0 monthly premium, $200 deductible, and $7,550 maximum out-of-pocket expenses. 4.0 summary Star Rating with $10 and $40 office visit copays and $65 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$40, $0-$10, and $40 copays respectively. Inpatient hospital visits are subject to a $350 copay for days 1-5, and the outpatient hospital copay is $350. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $0 (Tier 1), $5 (Tier 2), $37 (Tier 3), $90 (Tier 4), and 29% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $15 (Tier 2), $111 (Tier 3), $270 (Tier 4), and n/a (Tier 5).

 

Allwell Medicare Complement– HMO with $29.60 monthly premium, $445 deductible, and $5,500 maximum out-of-pocket expenses. $0 and $40 office visit copays and $40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0 copays respectively. Inpatient hospital visits are subject to a $325 copay for days 1-6, and the outpatient hospital copay is $325. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $30.

30-day preferred pharmacy copays are $2 (Tier 1), $8 (Tier 2), $47 (Tier 3), 45% (Tier 4), and 25% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $24 (Tier 2), $141 (Tier 3), 45% (Tier 4), and n/a (Tier 5).

Anthem MediBlue Plus– HMO with $0 monthly premium, $75 deductible, and $4,900 maximum out-of-pocket expenses. $5 and $40 office visit copays and $35 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$160, $0-$10, and $50-$120 copays respectively. Inpatient hospital visits are subject to a $295 copay for days 1-7, and the outpatient hospital copay is $0-$275. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $35. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $9 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 31% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $27 (Tier 2), $126 (Tier 3), $285 (Tier 4), and n/a (Tier 5).

 

Anthem MediBlue Access Preferred– PPO with $16 monthly premium, $125 deductible, and $4,900 maximum out-of-pocket expenses. $5 and $45 office visit copays and $35 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$160, $0-$20, and $50-$110 copays respectively. Inpatient hospital visits are subject to a $370 copay for days 1-5, and the outpatient hospital copay is $0-$350. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $4 (Tier 1), $13 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 30% (Tier 5). 90-day preferred pharmacy copays are $12 (Tier 1), $39 (Tier 2), $126 (Tier 3), $285 (Tier 4), and n/a (Tier 5).

 

Anthem MediBlue Access Plus– PPO with $54 monthly premium, $60 deductible, and $6,400 maximum out-of-pocket expenses. $10 and $40 office visit copays and $35 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$215, $0-$20, and $50-$110 copays respectively. Inpatient hospital visits are subject to a $310 copay for days 1-7, and the outpatient hospital copay is $0 or 20%. The ground ambulance copay is $265, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $4 (Tier 1), $12 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 32% (Tier 5). 90-day preferred pharmacy copays are $12 (Tier 1), $36 (Tier 2), $126 (Tier 3), $285 (Tier 4), and n/a (Tier 5).

 

Anthem MediBlue Access  – HMO with $29 monthly premium, $150 deductible, and $6,700 maximum out-of-pocket expenses. $10 and $50 office visit copays and $35 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$160, $0-$20, and $50-$110 copays respectively. Inpatient hospital visits are subject to a $310 copay for days 1-7, and the outpatient hospital copay is $0 or 20%. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $4 (Tier 1), $13 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 30% (Tier 5). 90-day preferred pharmacy copays are $12 (Tier 1), $39 (Tier 2), $126 (Tier 3), $285 (Tier 4), and n/a (Tier 5).

 

Anthem MediBlue Access Basic  – Regional PPO with $84 monthly premium, $100 deductible, and $6,400 maximum out-of-pocket expenses. $10 and $40 office visit copays and $35 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$145, $0-$10, and $50-$110 copays respectively. Inpatient hospital visits are subject to a $290 copay for days 1-7, and the outpatient hospital copay is $0 or 20%. The ground ambulance copay is $295, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $20 (Tier 2), $47 (Tier 3), 46% (Tier 4), and 31% (Tier 5). 90-day preferred pharmacy copays are $18 (Tier 1), $45 (Tier 2), $111 (Tier 3), 46% (Tier 4), and n/a (Tier 5).

 

Ascension Complete St. Vincent Reward  – HMO with $0 monthly premium, $390 deductible, and $7,550 maximum out-of-pocket expenses. $0 and $50 office visit copays and $50 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to a $0 copay. Inpatient hospital visits are subject to a $375 copay for days 1-5, and the outpatient hospital copay is $325. The ground ambulance copay is $325, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $6 (Tier 1), $15 (Tier 2), $37 (Tier 3), 46% (Tier 4), and 31% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $60 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

Ascension Complete St. Vincent Secure– HMO with $0 monthly premium, $0 deductible, and $4,500 maximum out-of-pocket expenses. $0 and $30 office visit copays and $30 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to a $0 copay. Inpatient hospital visits are subject to a $395 copay for days 1-6, and the outpatient hospital copay is $270. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $30. Mental health outpatient group and individual therapy visit copays are $30.

30-day preferred pharmacy copays are $0 (Tier 1), $10 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $10 (Tier 2), $131 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

Ascension Complete St. Vincent Access– HMO with $19 monthly premium, $100 deductible, and $5,200 maximum out-of-pocket expenses. $0 and $35 office visit copays and $35 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to a $0 copay. Inpatient hospital visits are subject to a $335 copay for days 1-5, and the outpatient hospital copay is $325. The ground ambulance copay is $270, and rehabilitation therapy visit copays are $35. Mental health outpatient group and individual therapy visit copays are $35.

30-day preferred pharmacy copays are $0 (Tier 1), $10 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 31% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $30 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

CareSource Advantage Zero Premium – HMO with $0 monthly premium, $100 deductible, and $6,700 maximum out-of-pocket expenses. $10 and $50 office visit copays and $45 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $35, $35, and $50 copays respectively. Inpatient hospital visits are subject to a $365 copay for days 1-5, and the outpatient hospital copay is $295. The ground ambulance copay is $225, and rehabilitation therapy visit copays are 20%. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $5 (Tier 1), $15 (Tier 2), $45 (Tier 3), $100 (Tier 4), and 31% (Tier 5). 90-day preferred pharmacy copays are $15 (Tier 1), $45 (Tier 2), $135 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

CareSource Advantage – HMO with $24.50 monthly premium, $30 deductible, and $4,600 maximum out-of-pocket expenses. $0 and $35 office visit copays and $35 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0, $0, and $25 copays respectively. Inpatient hospital visits are subject to a $285 copay for days 1-7, and the outpatient hospital copay is $295. The ground ambulance copay is $225, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $35.

30-day preferred pharmacy copays are $4 (Tier 1), $10 (Tier 2), $45 (Tier 3), $100 (Tier 4), and 32% (Tier 5). 90-day preferred pharmacy copays are $12 (Tier 1), $30 (Tier 2), $135 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

Health Alliance Medicare POS Basic Rx – HMO-POS with $51.00 monthly premium, $30 deductible, and $4,600 maximum out-of-pocket expenses. $15 and $50 office visit copays and $65 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $40, $0-$40, and $40 copays respectively. Inpatient hospital visits are subject to a $450 copay for days 1-4, and the outpatient hospital copay is 25%. The ground ambulance copay is $350, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 33% (Tier 5).

 

Health Alliance Medicare HMO Basic Rx – HMO with $32.00 monthly premium, $0 deductible, and $6,700 maximum out-of-pocket expenses. $15 and $50 office visit copays and $65 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to 20%, $0-20%, and 20% copays respectively. Inpatient hospital visits are subject to a $300 copay for days 1-6, and the outpatient hospital copay is 20%. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 33% (Tier 5).

 

Health Alliance Medicare HMO 40 Rx – HMO with $73.00 monthly premium, $0 deductible, and $4,700 maximum out-of-pocket expenses. $10 and $45 office visit copays and $40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $10, $0-$10, and $10 copays respectively. Inpatient hospital visits are subject to a $275 copay for days 1-7, and the outpatient hospital copay is $275. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 33% (Tier 5).

 

Health Alliance Medicare POS 30 Rx – HMO-POS with $105.00 monthly premium, $0 deductible, and $5,500 maximum out-of-pocket expenses. $15 and $45 office visit copays and $40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $40, $0-$40, and $40 copays respectively. Inpatient hospital visits are subject to a $350 copay for days 1-5, and the outpatient hospital copay is $325. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 33% (Tier 5).

 

Health Alliance Medicare HMO 20 Rx – HMO with $125.00 monthly premium, $0 deductible, and $4,000 maximum out-of-pocket expenses. $20 and $40 office visit copays and $25 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $10, $0-$10, and $0 copays respectively. Inpatient hospital visits are subject to a $250 copay for days 1-7, and the outpatient hospital copay is $275. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $20.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 33% (Tier 5).

 

Health Alliance Medicare POS 10 Rx – HMO-POS with $165.00 monthly premium, $0 deductible, and $4,500 maximum out-of-pocket expenses. $20 and $40 office visit copays and $30 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0 copays respectively. Inpatient hospital visits are subject to a $250 copay for days 1-8, and the outpatient hospital copay is $275. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $20. Mental health outpatient group and individual therapy visit copays are $30.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 33% (Tier 5).

 

Humana Medicare Advantage Plans In Ohio

 

Humana Gold Plus – HMO with $0 monthly premium, $0 deductible, and $3,900 maximum out-of-pocket expenses. $0 and $35 office visit copays and $0-$35 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$105, $0-$35, and $0-$110 copays respectively. Inpatient hospital visits are subject to a $350 copay for days 1-5, and the outpatient hospital copay is $40-$325. The ground ambulance copay is $290, and rehabilitation therapy visit copays are $15-$40. Mental health outpatient group and individual therapy visit copays are $35.

30-day preferred pharmacy copays are $2 (Tier 1), $8 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $24 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

Humana Gold Choice – PFFS with $82 monthly premium, $225 deductible, and $0 maximum out-of-pocket expenses. $20 and $50 office visit copays and $20-$50 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$110, $0-$35, and $20-$110 copays respectively. Inpatient hospital visits are subject to a $390 copay for days 1-5, and the outpatient hospital copay is $50-$365. The ground ambulance copay is $270, and rehabilitation therapy visit copays are $20-$40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $7 (Tier 1), $17 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 29% (Tier 5). 90-day preferred pharmacy copays are $21 (Tier 1), $51 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

HumanaChoice – PPO with $0 monthly premium, $250 deductible, and $7,550 maximum out-of-pocket expenses. $30 and $50 office visit copays and $30-$50 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$50, $0-$35, and $30-$110 copays respectively. Inpatient hospital visits are subject to a $490 copay for days 1-4, and the outpatient hospital copay is $50-$465. The ground ambulance copay is $290, and rehabilitation therapy visit copays are $10-$40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $7 (Tier 1), $17 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 28% (Tier 5). 90-day preferred pharmacy copays are $21 (Tier 1), $51 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

Humana Value Plus – PPO with $29.60 monthly premium, $260 deductible, and $7,550 maximum out-of-pocket expenses. 20% office visit copays and 20% Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0, $0, and 20% copays respectively. Inpatient hospital visits are subject to a $1,700 copay, and the outpatient hospital copay is $65. The ground ambulance copay is $290, and rehabilitation therapy visit copays are 20%. Mental health outpatient group and individual therapy visit copays are 20%.

30-day preferred pharmacy copays are $0 (Tier 1), $15 (Tier 2), $47 (Tier 3), $97 (Tier 4), and 28% (Tier 5). 90-day preferred pharmacy copays are $21 (Tier 1), $51 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

IU Health Plans Medicare Select Plus – HMO with $0 monthly premium, $200 deductible, and $3,250 maximum out-of-pocket expenses. $0-$10 and $40 office visit copays and $45 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to 20%, $10, and $25 copays respectively. Inpatient hospital visits are subject to a $335 copay for days 1-6, and the outpatient hospital copay is $310. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $3 (Tier 1), $12 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 29% (Tier 5). 90-day preferred pharmacy copays are $9 (Tier 1), $36 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

IU Health Plans Medicare Choice – HMO-POS with $98 monthly premium, $200 deductible, and $6,700 maximum out-of-pocket expenses. $5 and $40 office visit copays and $65 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to 20%, $10, and $25 copays respectively. Inpatient hospital visits are subject to a $335 copay for days 1-6, and the outpatient hospital copay is $325. The ground ambulance copay is $220, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $6 (Tier 1), $15 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 29% (Tier 5). 90-day preferred pharmacy copays are $18 (Tier 1), $45 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

My TrueAdvantage Select – HMO with $0 monthly premium, $0 deductible, and $4,500 maximum out-of-pocket expenses. $0 and $35 office visit copays and $50 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $10, $10, and $30 copays respectively. Inpatient hospital visits are subject to a $325 copay for days 1-6, and the outpatient hospital copay is $40-$175. The ground ambulance copay is $270, and rehabilitation therapy visit copays are $30 and $35. Mental health outpatient group and individual therapy visit copays are $35.

30-day preferred pharmacy copays are $0 (Tier 1), $7 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $21 (Tier 2), $126 (Tier 3), $285 (Tier 4), and n/a (Tier 5).

 

My TrueAdvantage Choice – PPO with $12 monthly premium, $100 deductible, and $5,000 maximum out-of-pocket expenses. $5 and $40 office visit copays and $50 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $15, $15, and $25 copays respectively. Inpatient hospital visits are subject to a $350 copay for days 1-5, and the outpatient hospital copay is $35-$225. The ground ambulance copay is $260, and rehabilitation therapy visit copays are $35. Mental health outpatient group and individual therapy visit copays are $30 and $35.

30-day preferred pharmacy copays are $2 (Tier 1), $8 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 31% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $24 (Tier 2), $126 (Tier 3), $285 (Tier 4), and n/a (Tier 5).

 

ProMedica Medicare Plan Essential Medical And Drug – HMO with $0 monthly premium, $0 deductible, and $3,400 maximum out-of-pocket expenses. $0 and $35 office visit copays and $35 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $15, $0-15, and $15 copays respectively. Inpatient hospital visits are subject to a $225 copay for days 1-5, and the outpatient hospital copay is $200. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $30. Mental health outpatient group and individual therapy visit copays are $35.

30-day preferred pharmacy copays are $0 (Tier 1), $10 (Tier 2), $45 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $30 (Tier 2), $135 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

Reid Health Alliance Medicare POS Rx Basic – HMO-POS with $0 monthly premium, $100 deductible, and $6,800 maximum out-of-pocket expenses. $10 and $45 office visit copays and $50 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $15, $0-$10, and $0 copays respectively. Inpatient hospital visits are subject to a $400 copay for days 1-5, and the outpatient hospital copay is 20%. The ground ambulance copay is $300, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 31% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 31% (Tier 5).

 

Reid Health Alliance Medicare POS Rx  – HMO-POS with $35 monthly premium, $0 deductible, and $6,700 maximum out-of-pocket expenses. $10 and $50 office visit copays and $40 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $20, $0-$20, and $30 copays respectively. Inpatient hospital visits are subject to a $325 copay for days 1-6, and the outpatient hospital copay is $425. The ground ambulance copay is $300, and rehabilitation therapy visit copays are $35. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 33% (Tier 5).

 

Reid Health Alliance Medicare HMO Rx  – HMO with $51 monthly premium, $0 deductible, and $6,700 maximum out-of-pocket expenses. $20 and $50 office visit copays and $45 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $10, $0-$10, and 20% copays respectively. Inpatient hospital visits are subject to a $300 copay for days 1-6, and the outpatient hospital copay is $345. The ground ambulance copay is $300, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 33% (Tier 5).

 

Simplete Richland 1 – HMO with $0 monthly premium, $0 deductible, and $4,000 maximum out-of-pocket expenses. $0 and $25 office visit copays and $40 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $10, $0-$10, and $10 copays respectively. Inpatient hospital visits are subject to a $200 copay for days 1-8, and the outpatient hospital copay is $100 per visit. The ground ambulance copay is $220, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 33% (Tier 5).

 

Simplete 1 – HMO with $0 monthly premium, $0 deductible, and $4,000 maximum out-of-pocket expenses. $0 and $25 office visit copays and $40 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $10, $0-$10, and $10 copays respectively. Inpatient hospital visits are subject to a $200 copay for days 1-8, and the outpatient hospital copay is $100 per visit. The ground ambulance copay is $220, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 33% (Tier 5).

 

Simplete 2 – HMO with $28 monthly premium, $0 deductible, and $4,500 maximum out-of-pocket expenses. $5-$20 and $25-$40 office visit copays and $40 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $10 copays. Inpatient hospital visits are subject to a $200 copay for days 1-8, and the outpatient hospital copay is $100 per visit. The ground ambulance copay is $220, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 33% (Tier 5).

 

Simplete 3 – HMO-POS with $48 monthly premium, $0 deductible, and $4,500 maximum out-of-pocket expenses. $5-$25 and $25-$40 office visit copays and $40 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $10-$25, $0-$25, and $10 copays. Inpatient hospital visits are subject to a $200 copay for days 1-8, and the outpatient hospital copay is $100 per visit. The ground ambulance copay is $220, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 33% (Tier 5).

 

Simplete Riverside 2 – HMO with $50 monthly premium, $0 deductible, and $4,950 maximum out-of-pocket expenses. $5-$25 and $10-$40 office visit copays and $40 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $10 copays. Inpatient hospital visits are subject to a $225 copay for days 1-8, and the outpatient hospital copay is $100 per visit. The ground ambulance copay is $220, and rehabilitation therapy visit copays are $10-$40. Mental health outpatient group and individual therapy visit copays are $40.

30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 33% (Tier 5).

 

Zing Choice IN – HMO with $0 monthly premium, $0 deductible, and $3,500 maximum out-of-pocket expenses. $0 and $35 office visit copays and $10 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $25, $0, and $5 copays respectively. Inpatient hospital visits are subject to a $300 copay for days 1-5, and the outpatient hospital copay is $40-$250. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $20. Mental health outpatient group and individual therapy visit copays are $35.

30-day preferred pharmacy copays are $2 (Tier 1), $10 (Tier 2), $35 (Tier 3), $95 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $30 (Tier 2), $105 (Tier 3), $285 (Tier 4), and n/a (Tier 5).

 

Zing Essential Wellness IN – HMO C-SNP with $0 monthly premium, and $0 deductible. $0 and $20 office visit copays and $10 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $25, $0, and $0 copays respectively. Inpatient hospital visits are subject to a $200 copay for days 1-5, and the outpatient hospital copay is $25-$250. The ground ambulance copay is $175, and rehabilitation therapy visit copays are $20. Mental health outpatient group and individual therapy visit copays are $20.

30-day preferred pharmacy copays are $2 (Tier 1), $10 (Tier 2), $35 (Tier 3), $95 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $30 (Tier 2), $105 (Tier 3), $285 (Tier 4), and n/a (Tier 5).