Longevity Health Plan (PPO I-SNP)
New Jersey Institutional Special Needs I-SNP Plan (2025 Plan)
Additional Coverage
HearingVision
Overall Government Star Rating
(coming soon)
Plan Name
Longevity Health Plan (PPO I-SNP)
Plan Type
Institutional Special Needs Plan (I-SNP)
Longevity Health Plan (PPO I-SNP) is a Institutional Special Needs Plan (I-SNP), which is available in New Jersey and offered by the health insurance company Longevity Health Plan. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.
Primary doctor visit
$0 copay
Specialist visit
$0 copay
Longevity Health Plan (PPO I-SNP) has a monthly premium cost of $172 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $10,100 In and Out-of-network
$4,200 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 Longevity Health Plan (PPO I-SNP) are defined below.
Yes
Part D Prescription Drug Coverage
Longevity Health Plan (PPO I-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. Longevity Health Plan (PPO I-SNP) includes coverage for hearing, vision.
Medicare Advantage health plans can offer even more additional benefits. Longevity Health Plan (PPO I-SNP) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Health Portion of Premium
Health Plan Max Out-of-Pocket
$10,100 In and Out-of-network
$4,200 In-network
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $0 copay
Out-of-network: $0 copay
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: $0 copay
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: $0 copay
Out-of-network: $0 copay
Outpatient x-rays
In-network: $0 copay
Out-of-network: $0 copay
Hospital Services
Inpatient hospital coverage
In-network: $1,300 per stay
Out-of-network: $1,300 per stay
Outpatient hospital coverage
In-network: $0 copay
Out-of-network: $0 copay
Skilled nursing facility
Skilled nursing facility
In-network: $0 copay
Out-of-network: $0 copay
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance
In-network: $0 copay
Out-of-network: $0 copay
Therapy services
Occupational therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy with a psychiatrist
In-network: $0 copay
Out-of-network: $0 copay
Outpatient group therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Diabetes supplies
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Catastrophic coverage phase |
---|
Preferred Generic |
Generic drugs :
25% coinsurance Brand-name drugs :
25% coinsurance |
Generic drugs :
0% coinsurance Brand-name drugs :
0% coinsurance |
Generic |
Preferred Brand |
Non-Preferred Drug |
Specialty Tier |
Part B Drugs
Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 20% coinsurance
Hearing
Hearing exam
In-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - All types
In-network: $0 copay
Out-of-network: $0 copay
Preventive Dental
Comprehensive dental
Prosthodontics, removable
Maxillofacial prosthetics
Oral and maxillofacial surgery
Adjunctive general services
Vision
Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: $0 copay
Upgrades
In-network: $0 copay
Out-of-network: $0 copay
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