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 17, 2020
Premium Part B Giveback$0Total Premium (Part C Part D)$0 In-Network Plan DeductibleN/AMOOP$5,900 Inpatient Hospital - Acute$372 (days 1-5) ; $0 (days 6-90)PCP Office Visits$5Specialist Office Visits$45OTC Items$60 continue reading
July 17, 2020
Premium Part B Giveback$0Total Premium (Part C Part D)$0In-Network Plan DeductibleN/AMOOP$7,550 Inpatient Hospital - Acute$360 (days 1-5) ; $0 (days 6-90)PCP Office Visits$0Specialist Office Visits$40OTC Items$75 continue reading
July 17, 2020
Premium Part B Giveback$0Total Premium (Part C Part D)$0 In-Network Plan DeductibleN/AMOOP$3,400 Inpatient Hospital - Acute$275 (days 1-8) ; $0 (days 9-90)PCP Office Visits$0Specialist Office Visits$35OTC Items$125 continue reading
July 17, 2020
Premium Part B Giveback$0Total Premium (Part C Part D)$20.40In-Network Plan DeductibleMedicare Defined Part B Deductible amountMOOP$3,000 Inpatient Hospital - Acute​$2,524 Copay per stayPCP Office Visits20%Specialist Office continue reading
July 17, 2020
Premium Part B Giveback$0Total Premium (Part C Part D)$0In-Network Plan Deductible$0MOOP$3,450 Inpatient Hospital - Acute​$0 copay up to 90 days per admissionPCP Office Visits$0Specialist Office Visits$0OTC continue reading
July 17, 2020
Premium Part B Giveback$0Total Premium (Part C Part D)$12In-Network Plan DeductibleN/AMOOP$3,450 Inpatient Hospital - Acute$250 (days 1-7) ; $0 (days 8-90)PCP Office Visits$0Specialist Office Visits$25OTC Items$125 continue reading
July 17, 2020
Premium Part B Giveback$0Total Premium (Part C Part D)$90In-Network Plan DeductibleN/AMOOP$2,500 IN/OONInpatient Hospital - Acute$200 (days 1-5) ; $0 (days 6-90) IN/OONPCP Office Visits$0 IN/OONSpecialist Office continue reading
July 17, 2020
Premium Part B Giveback$0Total Premium (Part C Part D)$30In-Network Plan DeductibleN/AMOOP$6,000 IN/OONInpatient Hospital - Acute$275 (days 1-7) ; $0 (days 8-90) IN/OONPCP Office Visits$5 IN/OONSpecialist Office continue reading
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