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  1. FL
  2. Capital Health Plan
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Capital Health Plan Silver Advantage (HMO)

Medicare Plan Details (2023 Plan)

Monthly Premium

 

by Capital Health Plan
Additional Coverage
HearingVision
Overall Government Star Rating
 4.5
out of 5 stars

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Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D

 

Plan Details

$0
$0
$0
$0
$3,650 In-network
No
Yes
Yes
No
http://www.capitalhealth.com/Medicare
http://www.capitalhealth.com/Medicare

Medical Benefits

Doctor Services

$10 copay per visit
$50 copay per visit

Tests, labs, & imaging

$0 copay
$0 copay
$100 copay
$0 copay
$120 copay per visit (always covered)
$20 copay per visit (always covered)

Hospital Services

$300 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
$350 copay per visit

Skilled nursing facility

$20 per day for days 1 through 20
$150 per day for days 21 through 100

Preventive services

$0 copay

Ambulance

$250 copay

Therapy services

$30 copay
$30 copay

Mental health services

$40 copay
$40 copay
$40 copay
$40 copay

Opioid treatment services

Covered

Other services

20% coinsurance per item
20% coinsurance per item
0-20% coinsurance per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$10.00 copay


Generic drugs :
$4.15 copay or 5% (whichever costs more)

Brand-name drugs :
$10.35 copay or 5% (whichever costs more)

Generic$14.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier33%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

20% coinsurance
20% coinsurance

Extra Benefits

Hearing

$50 copay
Not covered
Not covered
Not covered
Not covered

Preventive Dental

Not covered
Not covered
Not covered
Not covered

Comprehensive dental

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Vision

$10-50 copay
$0 copay
$0 copay
Not covered
Not covered
Not covered

Other benefits

Limited coverage
Not covered
Not covered
Not covered
Not covered
Not covered
Limited coverage

Health Plan Star Ratings

(government star ratings are out of 5 stars)
 4.5
 5
 4
 5
 4
 4

Prescription Drug Plan Star Ratings

(government star ratings are out of 5 stars)
 4
 3
 4
 4
 4

When Can I Sign Up for Medicare?

Enter your birthday month and year to learn when you can sign up for different Medicare plan options.

 

 

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