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 MA 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 2023

Aetna Medicare Prime

Aetna Medicare Premier Plus

Aetna Medicare Eagle

Anthem MediBlue Plus

Ascension Complete St. Vincent Access

Ascension Complete  St. Vincent Access Plus

Ascension Complete St. Vincent Access Reward

Ascension Complete  St. Vincent DSNP

CareSource Dual Advantage

Cigna Saver Rx

CommuniCare Advantage CSNP

Health Alliance Medicare HMO Classic Rx

Humana USAA Honor With Rx

Humana Value Plus

Humana Gold Plus –  Diabetes And Heart

IU Health Plans Medicare Flex Network

IU Health Plans Medicare Kidney Care

My TruAdvantage Choice Plus

Reid Health Alliance Medicare HMO Basic Rx 2

Wellcare Low Premium Open

Wellcare Dual Access Open

Wellcare No Premium

UnitedHealthcare Dual Complete Choice Select

UnitedHealthcare Assisted Living Plan

Zing Premium Giveback

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:

67 – Marion County

65 – Hamilton County

64 – Hancock County

63 – Warren County

62 – Fountain County

61 – Howard County

61 – Madison County

61 – Hendricks County

62 – Fountain County

60 – Randolph County

59 – Henry County

57 – Pike County

57 – Tipton County

56 – Clinton County

56 – Shelby County

56 – Johnson County

55 – Vanderburgh County

55 – Brown County

54 – Putnam County

54 – Allen County

54 – Boone County

54 – Cass County

54 – Vermilion County

Counties with least available MA plans:

37 – Crawford County

38 – Ripley County

38 – Perry County

38 – Spencer County

38 – Dubois County

39 – Scott County

39 – Ohio County

39 – Jefferson County

40 – Washington County

39 – Scott County

39 – Switzerland County

40 – Jasper County

41 – Dearborn County

41 – Lagrange County

41 – Clark County

41 – Floyd County

41 – Harrison County

41 – Pulaski County

41 – Orange County

42 – Rush County

42 – Steuben County

42 – Fulton County

42 – Starke County

43 – Martin County

43 – Grant County

43 – Decatur County

43 – Adams County

43 – DeKalb County

43 – Martin County

44 – Sullivan 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 $0 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-$350. 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 $4,390 maximum out-of-pocket expenses. 3.5 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 $275 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 $30. 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 $10 and $45 office visit copays and $60 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 $60 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 $5,900 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 $0-$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 $30.

 

HumanaChoice – Regional PPO with $0 monthly premium and $5,700 maximum out-of-pocket expenses. 4.0 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 $325 copay for days 1-6, and the outpatient hospital copay is $35-$245. 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.

 

Wellcare Patriot Giveback Open – PPO with $0 monthly premium and $5,500 maximum out-of-pocket expenses. 4.0 summary Star Rating with $5 and $40 office visit copays and $40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$40, $0, and $0 copays respectively. Inpatient hospital visits are subject to a $400 copay for days 1-5, and the outpatient hospital copay is $350. The ground ambulance copay is $300, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $25.

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 Advantage – 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 $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 $0 (Tier 1), $12 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $36 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

AARP Medicare Advantage Profile – HMO-POS with $0 monthly premium, $0 deductible, and $4,500 maximum out-of-pocket expenses. 4.5 summary Star Rating with $0 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 $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 $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).

 

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 $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 $280, 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 $0 (Tier 1), $8 (Tier 2), $45 (Tier 3), $95 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $24 (Tier 2), $135 (Tier 3), $285 (Tier 4), and n/a (Tier 5).

 

AARP Medicare Advantage Choice Plan 1 – PPO with $22 monthly premium, $150 deductible, and $4,900 maximum out-of-pocket expenses. 4.0 summary Star Rating with $0 and $35 office visit copays and $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 $0 (Tier 1), $10 (Tier 2), $45 (Tier 3), $95 (Tier 4), and 30% (Tier 5). 90-day preferred pharmacy copays are $0 (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 $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 $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 30% (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).

 

Aetna Medicare Prime – HMO with $0 monthly premium, $0 deductible, and $3,900 maximum out-of-pocket expenses. $0 and $30 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-$225. 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. 4.5 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 $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 $26 monthly premium, $0 deductible, and $5,300 maximum out-of-pocket expenses. 4.5 summary Star Rating with $0 and $30 office visit copays and $50 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$50, $0, 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 $19 monthly premium, $200 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-$25, $0-$15, 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 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 Boost– HMO with $0 monthly premium, $200 deductible, and $7,550 maximum out-of-pocket expenses. $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 Extra– HMO with $25.80 monthly premium, $480 deductible, and $6,700 maximum out-of-pocket expenses. $0 and $30 office visit copays and $35 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$90, $0-$10, and $50-$90 copays respectively. Inpatient hospital visits are subject to a $290 copay for days 1-7, and the outpatient hospital copay is $0-$245. 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), $9 (Tier 2), $37 (Tier 3), $90 (Tier 4), and 25% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $27 (Tier 2), $111 (Tier 3), $270 (Tier 4), and n/a (Tier 5).

 

Anthem MediBlue Plus– HMO with $0 monthly premium, $0 deductible, and $3,900 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-$160, $0, 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 $35.

30-day preferred pharmacy copays are $2 (Tier 1), $9 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 33% (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 $19 monthly premium, $100 deductible, and $3,900 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-$160, $0-$10, 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-$300. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $35. Mental health outpatient group and individual therapy visit copays are $35.

30-day preferred pharmacy copays are $4 (Tier 1), $13 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 31% (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  – PPO with $0 monthly premium, $175 deductible, and $4,900 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-$175, $0-$10, and $50-$100 copays respectively. Inpatient hospital visits are subject to a $390 copay for days 1-5, 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.

30-day preferred pharmacy copays are $5 (Tier 1), $15 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 30% (Tier 5). 90-day preferred pharmacy copays are $15 (Tier 1), $45 (Tier 2), $126 (Tier 3), $285 (Tier 4), and n/a (Tier 5).

 

Anthem MediBlue Access Basic  – Regional PPO with $80 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 $6 (Tier 1), $15 (Tier 2), $37 (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, $480 deductible, and $2,900 maximum out-of-pocket expenses. $0 and $50 office visit copays and $45 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to a $0-$100 copay. Inpatient hospital visits are subject to a $500 copay for days 1-5, and the outpatient hospital copay is $350. 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 $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), $1`1 (Tier 3), $270 (Tier 4), and n/a (Tier 5).

 

Ascension Complete St. Vincent Secure– HMO with $0 monthly premium, $0 deductible, and $2,900 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 $295 copay for days 1-6, and the outpatient hospital copay is 20%. 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), $1 (Tier 2), $37 (Tier 3), $90 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $3 (Tier 2), $111 (Tier 3), $270 (Tier 4), and n/a (Tier 5).

 

Ascension Complete St. Vincent Access– PPO with $0 monthly premium, $0 deductible, and $2,900 maximum out-of-pocket expenses. $0 and 20% office visit copays and $40 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 $575 copay for days 1-4, and the outpatient hospital copay is 20%. The ground ambulance copay is 20%, 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), $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).

 

Ascension Complete St. Vincent Access Plus – PPO with $0 monthly premium, $0 deductible, and $2,900 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 $350 copay for days 1-6, 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), $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).

 

Health Alliance Medicare POS Basic Rx – HMO-POS with $53.00 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 $40, $0-$40, and $50 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 $33.00 monthly premium, $0 deductible, and $6,700 maximum out-of-pocket expenses. $5 and $45 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 $75.00 monthly premium, $0 deductible, and $4,700 maximum out-of-pocket expenses. $10 and $40 office visit copays and $40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $15, $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 $50, $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 $20. 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 $20 monthly premium, $0 deductible, and $3,900 maximum out-of-pocket expenses. $0 and $30 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 $325 copay for days 1-6, and the outpatient hospital copay is $0-$300. The ground ambulance copay is $290, and rehabilitation therapy visit copays are $10-$40. Mental health outpatient group and individual therapy visit copays are $30.

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), $15 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

Humana Gold Choice – PFFS with $83 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 $0-$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 $6,700 maximum out-of-pocket expenses. $0 and $50 office visit copays and $50 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $0-$50, $0-$35, and $0-$110 copays respectively. Inpatient hospital visits are subject to a $490 copay for days 1-4, and the outpatient hospital copay is $0-$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 $0 (Tier 1), $17 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 28% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $51 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

Humana Value Plus – PPO with $26.30 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 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 01 (Tier 1), $45 (Tier 2), $141 (Tier 3), $291 (Tier 4), and n/a (Tier 5).

 

IU Health Plans Medicare Select Plus – HMO with $0 monthly premium, $200 deductible, and $2,950 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 $30 copays respectively. Inpatient hospital visits are subject to a $340 copay for days 1-6, and the outpatient hospital copay is $310. 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 $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 $6,850 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 $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 $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).

 

MDwise Medicare Inspire – HMO with $0 monthly premium, $100 deductible, and $5,200 maximum out-of-pocket expenses. $5 and $40 office visit copays and $40 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $50, $0, and $25 copays respectively. Inpatient hospital visits are subject to a $295 copay for days 1-7, and the outpatient hospital copay is $275. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $30.

30-day preferred pharmacy copays are $3.50 (Tier 1), $12.50 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 31% (Tier 5). 90-day preferred pharmacy copays are $10.50 (Tier 1), $37.50 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

MDwise Medicare Inspire Plus – HMO with $25 monthly premium, $0 deductible, and $4,300 maximum out-of-pocket expenses. $0 and $40 office visit copays and $40 Urgent Care copays. 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 $295 copay for days 1-7, and the outpatient hospital copay is $275. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $40. Mental health outpatient group and individual therapy visit copays are $25.

30-day preferred pharmacy copays are $3.50 (Tier 1), $12.50 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $10.50 (Tier 1), $37.50 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).

 

My TrueAdvantage Select – HMO with $0 monthly premium, $0 deductible, and $4,200 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 $260, 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), $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 $35 office visit copays and $50 Urgent Care copays. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $15, $15, and $30 copays respectively. Inpatient hospital visits are subject to a $350 copay for days 1-5, and the outpatient hospital copay is $40-$225. The ground ambulance copay is $260, and rehabilitation therapy visit copays are $40. 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  – 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 Basic Rx – HMO-POS with $0 monthly premium, $100 deductible, and $6,800 maximum out-of-pocket expenses. $5 and $45 office visit copays and $50 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 $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 $5,900 maximum out-of-pocket expenses. $10 and $45 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).