SelectHealth Advantage Essential (HMO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by SelectHealth
Additional Coverage
Hearing Vision
Overall Government Star Rating
 4.5
out of 5 stars

State: Idaho

Select your county to view the price for this plan

 


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
No

Medical Benefits

Doctor Services

$5 per visit
$50 per visit

Tests, labs, & imaging

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

Hospital Services

$295 per day for days 1 through 6
$0 per day for days 7 through 90
$5-300 or 20% 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

Therapy services

$40
$40

Mental health services

$40
$40
$40
$40

Opioid treatment services

Covered

Other services

20% per item
20% per item
$0 copay

Prescription Drug Benefits

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

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$3.00 copay$3.00 copay


Generic drugs :
$3.60 copay or 5% (whichever costs more)

Brand-name drugs :
$8.95 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%
20%

Extra Benefits

Hearing

$50
Not covered
$699-2,399

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

$50
Not covered
Not covered
Not covered
Not covered
Not covered

Other benefits

Limited coverage
Not covered
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
 5
 4
 4
 5
 4
 5
 4
 3
 5
 4
 4

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