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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 2024
AARP Medicare Advantage Patriot No Rx
AARP Medicare Advantage from UHC IN-0017
AARP Medicare Advantage from UHC IN-0020
Aetna Medicare SmartFit
Aetna Medicare Premier Plus
Aetna Medicare Eagle
American Health Advantage Of Indiana
Anthem Chronic Care
Anthem Dual Advantage
Anthem Full Dual Advantage Aligned
CommuniCare Advantage Sapphire
Humana Gold Plus – Diabetes And Heart
Humana Together In Health
My TruAdvantage Select Plus
Red, White And Tru
Zing Elite Select IN
Zing ESRD Select IN
Zing Open Choice Diabetes & Heart IN
Zing Open Choice IN
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:
77 – Marion County
76 – Hamilton County
74 – Hancock County
72 – Johnson County
71 – Hendricks County
65 – Boone County
63 – Shelby County
62 – Howard County
61 – Madison County
61 – Randolph County
61 – Lake County
60 – Benton County
59 – Brown County
58 – Henry County
58 – Franklin County
58 – Allen County
58 – Warren County
57 – Fountain County
57 – Fayette County
57 – Porter County
56 – Tipton County
56 – White County
56 – Clinton County
56 – Wayne County
55 – Carroll County
55 – Morgan County
55 – Union County
Counties with least available MA plans:
44 – Steuben County
45 – Lagrange County
45 – Vigo County
45 – Wabash County
46 – Washington County
46 – Adams County
47 – DeKalb County
47 – Spencer County
47 – Noble County
47 – Jasper County
47 – Pulaski County
47 – Rush County
47 – Kosciusko County
47 – Grant County
47 – Wells County
47 – Starke County
47 – DeKalb County
48 – Dubois County
48 – Scott County
48 – Perry County
48 – Whitley County
48 – Gibson County
48 – Scott County
49 – Crawford County
49 – Dearborn County
49 – Elkhart County
49 – Orange County
49 – Decatur County
49 – Bartholomew County
49 – Huntington County
49 – Marshall County
49 – Miami County
49 – Vermillion County
Indiana Medicare Advantage Plans Without Prescription Drug Coverage
AARP Medicare Advantage Patriot No Rx – PPO with $0 monthly premium and $8,850 maximum out-of-pocket expenses. 4.0 summary Star Rating with $0 and $0-$45 office visit copays and $0-$40 Urgent Care copay. In-network diagnostic tests, lab services, and outpatient x-rays are subject to $50, $0, and $35 copays respectively. Inpatient hospital visits are subject to a $425 copay for days 1-4, and the outpatient hospital copay is $0-$425. The ground ambulance copay is $275, and rehabilitation therapy visit copays are $0-$40. Mental health outpatient group and individual therapy visit copays are $15 and $0-$25.
Aetna Medicare Eagle – PPO with $0 monthly premium and $4,390 maximum out-of-pocket expenses. 4.0 summary Star Rating with $0 and $30 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 $260 copay for days 1-6, 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 Veteran – PPO with $0 monthly premium and $6,700 maximum out-of-pocket expenses. 3.0 summary Star Rating with $0 and $45 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 $350 copay for days 1-5, 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 $15 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. 3.0 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 Plans With Prescription Drug Coverage
AARP Medicare Advantage Advantage – HMO-POS with $0 monthly premium, $0 deductible, and $3,700 maximum out-of-pocket expenses. 4.5 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 $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 $20. 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), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $31 (Tier 2), $143 (Tier 3), $300 (Tier 4), and n/a (Tier 5).
AARP Medicare Advantage Profile – HMO-POS with $0 monthly premium, $0 deductible, and $3,900 maximum out-of-pocket expenses. 4.5 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 $325 copay for days 1-5, and the outpatient hospital copay is $0-$295. The ground ambulance copay is $235, and rehabilitation therapy visit copays are $20. 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 $325 copay for days 1-5, and the outpatient hospital copay is $0-$295. The ground ambulance copay is $220, and rehabilitation therapy visit copays are $20. 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 $18 monthly premium, $150 deductible, and $3,700 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 $325 copay for days 1-5, and the outpatient hospital copay is $0-$295. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $20. 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 2 – PPO with $0 monthly premium, $0 deductible, and $4,500 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 $25 copays respectively. Inpatient hospital visits are subject to a $295 copay for days 1-6, and the outpatient hospital copay is $0-$295. The ground ambulance copay is $250, and rehabilitation therapy visit copays are $25. 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).
Aetna Medicare Prime – HMO with $0 monthly premium, $0 deductible, and $3,900 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-$50, $0, and $5 copays respectively. Inpatient hospital visits are subject to a $275 copay for days 1-7, and the outpatient hospital copay is $0-$250. 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 $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), $21 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).
Aetna Medicare Value– HMO with $0 monthly premium, $0 deductible, and $4,950 maximum out-of-pocket expenses. 3.5 summary Star Rating with $0 and $40 office visit copays and $60 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), $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), $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 $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), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $20 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).
Aetna Medicare Premier Plus – HMO with $187 monthly premium, $350 deductible, and $4,250 maximum out-of-pocket expenses. 3.5 summary Star Rating with $0 office visit copays and $0 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 $190 copay for days 1-7, and the outpatient hospital copay is $0-$265. 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 $0 (Tier 1), $10 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 27% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $20 (Tier 2), $141 (Tier 3), $300 (Tier 4), and n/a (Tier 5).
Anthem MediBlue Extra– HMO with $21.10 monthly premium, $505 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 $10 (Tier 1), $20 (Tier 2), $37 (Tier 3), $90 (Tier 4), and 25% (Tier 5). 90-day preferred pharmacy copays are $30 (Tier 1), $60 (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-$95, $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, $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-$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, $0 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 $81 monthly premium, $0 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 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).