Ascension Complete St. Vincent DSNP (HMO D-SNP)
Indiana Medicare-Medicaid Dual Eligible D-SNP Plan (2023 Plan)
Monthly Premium
Additional Coverage
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Plan Overview
Ascension Complete St. Vincent DSNP (HMO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Indiana and offered by the health insurance company Ascension Complete. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Cost Summary
Ascension Complete St. Vincent DSNP (HMO D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $8,300 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Ascension Complete St. Vincent DSNP (HMO D-SNP) are defined below.
Additional Benefits and Coverage
Ascension Complete St. Vincent DSNP (HMO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Ascension Complete St. Vincent DSNP (HMO D-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Ascension Complete St. Vincent DSNP (HMO D-SNP) includes coverage for the following additional benefits:
Other benefits
Plan Benefits and Coverage Details
Medical Benefits
Doctor Services
Tests, labs, & imaging
Hospital Services
Skilled nursing facility
Preventive services
Ambulance
Therapy services
Mental health services
Opioid treatment services
Other services
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $19.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
| Generic | $20.00 copay | ||
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | 41% | ||
| Specialty Tier | 25% |
Part B Drugs
Extra Benefits
Hearing
Preventive Dental
Comprehensive dental
Vision
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