Clear Spring Health Essential (HMO)

Virginia Medicare Advantage Plan (2024 Plan)


Monthly Premium

Your Cost
$0
by Clear Spring Health

Additional Coverage

HearingVisionDental

Overall Government Star Rating

No Rating (new plan)

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Plan Name
Clear Spring Health Essential (HMO)
Insurance Carrier
Clear Spring Health
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

Clear Spring Health Essential (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Virginia and offered by the health insurance company Clear Spring Health. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$3,250
Primary doctor visit
$0 copay
Specialist visit
$0-30 copay per visit
ER visit
$120 copay per visit (always covered)
Ambulance
$265 copay

Clear Spring Health Essential (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $3,250 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 Clear Spring Health Essential (HMO) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Clear Spring Health Essential (HMO) 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. Clear Spring Health Essential (HMO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Clear Spring Health Essential (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Not covered
Telehealth
Limited coverage

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$3,250 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$0-30 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$0 copay
Lab services
$0 copay
Diagnostic radiology services (like MRI)
$20-140 copay
Outpatient x-rays
$0 copay
Emergency care
$120 copay per visit (always covered)
Urgent care
$30 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$250 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient hospital coverage
$25-260 copay per visit

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$178 per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$265 copay

Therapy services

Occupational therapy visit
$25 copay
Physical therapy & speech & language therapy visit
$0 copay

Mental health services

Outpatient group therapy with a psychiatrist
$25 copay
Outpatient individual therapy with a psychiatrist
$25 copay
Outpatient group therapy visit
$25 copay
Outpatient individual therapy visit
$25 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
$0 copay

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

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$9.00 copay


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic$12.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier33%

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
$25 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$0 copay

Preventive Dental

Oral exam
$0 copay
Cleaning
$0 copay
Fluoride treatment
$0 copay
Dental x-rays
$0 copay

Comprehensive dental

Non-routine services
Not covered
Diagnostic services
$0 copay
Restorative services
$0 copay
Endodontics
$0 copay
Periodontics
$0 copay
Extractions
$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
$0 copay

Vision

Routine eye exam
$0 copay
Contact lenses
Not covered
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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