Provider Partners Maryland Community Plan (HMO I-SNP)

Medicare Plan Details (2022 Plan)


Monthly Premium

 

by Provider Partners Health Plans
Additional Coverage
HearingVisionDental
Overall Government Star Rating
No Rating
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

 

$37
$0
$37
$233 per year for in-network services.
$7,550 In-network
No
Yes
Yes
Yes

Doctor Services

20% coinsurance per visit
20% coinsurance per visit

Tests, labs, & imaging

20% coinsurance
20% coinsurance
20% coinsurance
20% coinsurance
20% coinsurance per visit (always covered)
20% coinsurance per visit (always covered)

Hospital Services

In 2022 the amounts for each benefit period are:
$1,556 deductible for days 1 through 60
$389 copay per day for days 61 through 90
20% coinsurance per visit

Skilled nursing facility

In 2022 the amounts for each benefit period are:
$0 copay for days 1 through 20
$194.50 copay per day for days 21 through 100

Preventive services

$0 copay

Ambulance

20% coinsurance

Therapy services

20% coinsurance
20% coinsurance

Mental health services

20% coinsurance
20% coinsurance
20% coinsurance
20% coinsurance

Opioid treatment services

Covered

Other services

20% coinsurance per item
20% coinsurance per item
20% coinsurance per item

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

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25%

Brand-name drugs :
25%


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

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

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

20% coinsurance
20% coinsurance

Hearing

20% coinsurance
$0 copay
$0 copay
$0 copay
$0 copay

Preventive Dental

$0 copay
$0 copay
$0 copay
$0 copay

Comprehensive dental

$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay

Vision

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

Other benefits

Not covered
Limited coverage
Not covered
Not covered
Not covered
Not covered
Limited coverage
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
 3.5
 4
No Rating
No Rating
 3

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