SelectHealth Advantage Essential (HMO)

Medicare Plan Details (2022 Plan)


Monthly Premium

 

by SelectHealth
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 5.0
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

 

$0
$0
$0
$0
$6,700 In-network
No
Yes
Yes
Yes

Doctor Services

$0 copay
$50 copay per visit

Tests, labs, & imaging

$10 copay or 20% coinsurance
$10 copay
$300 copay
$20 copay
$90 copay per visit (always covered)
$50 copay per visit (always covered)

Hospital Services

$300 per day for days 1 through 7
$0 per day for days 8 through 90
$0-320 copay or 20% coinsurance per visit

Skilled nursing facility

$0 per day for days 1 through 20
$160 per day for days 21 through 75
$0 per day for days 76 through 100

Preventive services

$0 copay

Ambulance

$250 copay

Therapy services

$40 copay
$40 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 copay

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

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$0.00 copay$0.00 copay


Generic drugs :
$3.95 copay or 5% (whichever costs more)

Brand-name drugs :
$9.85 copay or 5% (whichever costs more)

Generic$15.00 copay$15.00 copay
Preferred Brand$45.00 copay
Non-Preferred Drug
Specialty Tier30%
1 * The above cost-sharing only applies to some drugs on this tier. For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

20% coinsurance
20% coinsurance

Hearing

$50 copay
$0 copay
$699-2,399 copay

Preventive Dental

$0 copay
$0 copay
Not covered
$0 copay

Comprehensive dental

60% coinsurance
50% coinsurance
60% coinsurance
50% coinsurance
50% coinsurance
50% coinsurance
60% coinsurance

Vision

$50 copay
$0 copay
$0 copay
Not covered
Not covered
$0 copay

Other benefits

Limited coverage
Not covered
Limited coverage
Limited coverage
Limited coverage
Limited coverage
Limited coverage
 5
 5
 4
 5
 5
 5
 4.5
 5
 5
 5
 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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