July 23, 2020
Star RatingPremium$0Part B GivebackNoPCP in-network$0Specialist in-network$35Inpatient Hospital$380 (days 1-5) ; $0 (days 6-90)Outpatient Hospital Services$35- $275: SURMedical Deductible$0MOOP in-network$6,700 Rx Deductible$150Prescription drug coverage (at preferred pharmacies)Tier continue reading
July 23, 2020
Star RatingPremium$0Part B GivebackNoPCP in-network$0Specialist in-network$30Inpatient Hospital$300 (days 1-5) ; $0 (days 6-90)Outpatient Hospital Services$30- $200: SURMedical Deductible$0MOOP in-network$6,700 Rx Deductible$0Prescription drug coverage (at preferred pharmacies)Tier continue reading
July 23, 2020
Star RatingPremium$0Part B GivebackNoPCP in-network$0Specialist in-network$40Inpatient Hospital$320 (days 1-5) ; $0 (days 6-90)Outpatient Hospital Services$40- $275: SURMedical Deductible$0MOOP in-network$6,700 Rx Deductible$0Prescription drug coverage (at preferred pharmacies)Tier continue reading
July 23, 2020
Star RatingPremium$0Part B GivebackYesPCP in-network$0Specialist in-network$30Inpatient Hospital$365 (days 1-4) ; $0 (days 5-90)Outpatient Hospital Services$30- $350: SURMedical Deductible$​0MOOP in-network$7,500 Rx Deductible$150Prescription drug coverage (at preferred pharmacies)Tier continue reading
July 23, 2020
Star RatingPremium$0Part B GivebackNoPCP in-network$0Specialist in-network$20Inpatient Hospital​$750 per stayOutpatient Hospital Services$20- $295: SURMedical Deductible$1,000MOOP in-network$7,500 Rx Deductible$0Prescription drug coverage (at preferred pharmacies)Tier 1: Preferred Generics: $0Tier continue reading
July 23, 2020
Star RatingPremium$0Part B GivebackNoPCP in-network$0Specialist in-network$30Inpatient Hospital$365 (days 1-4) ; $0 (days 5-90)Outpatient Hospital Services$30- $350: SURMedical Deductible$0MOOP in-network$7,500 Rx Deductible​$0Prescription drug coverage (at preferred pharmacies)Tier continue reading
July 23, 2020
Star RatingPremium$0Part B GivebackNoPCP in-network$0Specialist in-network$35Inpatient Hospital$250 (days 1-5) ; $0 (days 6-90)Outpatient Hospital Services$35- $250: SURMedical Deductible$0MOOP in-network$7,500 Rx DeductibleN/APrescription drug coverage (at preferred pharmacies)Tier continue reading
July 23, 2020
Star RatingNot AvailableMedicare Zero Dollar Cost SharingYesPCP0%Specialist in-network0%MOOP in-network$7,550 Rx Deductible$130Copayments may vary depending on your level of ExtraHelp®Tier 1: Preferred Generics (standard) : $0Tier 1: continue reading
July 23, 2020
Star RatingNot AvailableMedicare Zero Dollar Cost SharingYesPCP0%Specialist in-network0%MOOP in-network$7,550 Rx Deductible$130Copayments may vary depending on your level of ExtraHelp®Tier 1: Preferred Generics (standard) : $0Tier 1: continue reading
July 23, 2020
Star RatingNot AvailableMedicare Zero Dollar Cost SharingYesPCP0%Specialist in-network0%MOOP in-network$7,550 Rx Deductible$220Copayments may vary depending on your level of ExtraHelp®Tier 1: Preferred Generics (standard) : $5Tier 1: continue reading
July 23, 2020
Star RatingPremium$28Part B GivebackNoPCP in-network$10Specialist in-network$40Inpatient Hospital$195 (days 1-10) ; $0 (days 11-90)Outpatient Hospital Services$40- $200: SURMedical Deductible​$0MOOP in-network$7,550 Rx Deductible$150Prescription drug coverage (at preferred pharmacies)Tier continue reading
July 23, 2020
Star RatingPremium$0Part B GivebackNoPCP in-network$5Specialist in-network$35Inpatient Hospital$270 (days 1-7) ; $0 (days 8-90)Outpatient Hospital Services$35- $225: SURMedical DeductibleN/AMOOP in-network$7,000 Rx Deductible$200Prescription drug coverage (at preferred pharmacies)Tier continue reading
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