Trinity Health Plan Of New England Choice (PPO)
Connecticut Medicare Advantage Plan (2024 Plan)
by Trinity Health Plan Of New England
Additional Coverage
HearingVisionDental
Overall Government Star Rating
No Rating (new plan)
Plan Name
Trinity Health Plan Of New England Choice (PPO)
Insurance Carrier
Trinity Health Plan Of New England
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Trinity Health Plan Of New England Choice (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Connecticut and offered by the health insurance company Trinity Health Plan Of New England. 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
$40 copay per visit
ER visit
$90 copay per visit (always covered)
Trinity Health Plan Of New England Choice (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $5,900 In and Out-of-network
$5,900 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 Trinity Health Plan Of New England Choice (PPO) are defined below.
Yes
Part D Prescription Drug Coverage
Trinity Health Plan Of New England Choice (PPO) 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. Trinity Health Plan Of New England Choice (PPO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Trinity Health Plan Of New England Choice (PPO) 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
$5,900 In and Out-of-network
$5,900 In-network
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: $0 copay
Out-of-network: $20 copay per visit
Specialist visit
In-network: $40 copay per visit
Out-of-network: $55 copay per visit
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $40 copay
Out-of-network: 30% coinsurance
Lab services
In-network: $0 copay
Out-of-network: $15 copay
Diagnostic radiology services (like MRI)
In-network: $195 copay
Out-of-network: 30% coinsurance
Outpatient x-rays
In-network: $20 copay
Out-of-network: 30% coinsurance
Emergency care
$90 copay per visit (always covered)
Urgent care
$40 copay per visit (always covered)
Hospital Services
Inpatient hospital coverage
In-network: $375 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: 30% per stay
Outpatient hospital coverage
In-network: $0-250 copay per visit
Out-of-network: 30% coinsurance per visit
Skilled nursing facility
Skilled nursing facility
In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 56
$0 per day for days 57 through 100
Out-of-network: 30% per stay
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance
In-network: $250 copay
Out-of-network: $250 copay
Therapy services
Occupational therapy visit
In-network: $40 copay
Out-of-network: $55 copay
Physical therapy & speech & language therapy visit
In-network: $40 copay
Out-of-network: $55 copay
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $35 copay
Out-of-network: $55 copay
Outpatient individual therapy with a psychiatrist
In-network: $35 copay
Out-of-network: $55 copay
Outpatient group therapy visit
In-network: $35 copay
Out-of-network: $55 copay
Outpatient individual therapy visit
In-network: $35 copay
Out-of-network: $55 copay
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Diabetes supplies
In-network: $0 copay per item
Out-of-network: 30% coinsurance per item
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Gap coverage phase1 | Catastrophic coverage phase |
---|
Preferred Generic | $10.00 copay | $10.00 copay |
Generic drugs :
$0 copay Brand-name drugs :
$0 copay |
Generic | $20.00 copay | |
Preferred Brand | $47.00 copay | |
Non-Preferred Drug | $100.00 copay | |
Specialty Tier | 33% | |
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. |
Part B Drugs
Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: $35 copay or 0-30% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: $35 copay or 0-30% coinsurance
Hearing
Hearing exam
In-network: $40 copay
Out-of-network: $60 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $60-899 copay
Hearing aids - All types
In-network: $599-899 copay
Out-of-network: $60-899 copay
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: $0 copay or 50-70% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: $0 copay or 50-70% coinsurance
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay or 50-70% coinsurance
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay or 50-70% coinsurance
Comprehensive dental
Diagnostic services
In-network: $0 copay
Out-of-network: $0 copay or 50-70% coinsurance
Restorative services
In-network: 50% coinsurance
Out-of-network: $0 copay or 50-70% coinsurance
Endodontics
In-network: 70% coinsurance
Out-of-network: $0 copay or 50-70% coinsurance
Periodontics
In-network: 70% coinsurance
Out-of-network: $0 copay or 50-70% coinsurance
Extractions
In-network: 50% coinsurance
Out-of-network: $0 copay or 50-70% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services
Vision
Routine eye exam
In-network: $0 copay
Out-of-network: $0-50 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0-50 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0-50 copay
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: $0-50 copay
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: $0-50 copay
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