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Medicare Advantage 2017

Compare Medicare Advantage Plans

 

Use this chart to compare Memorial Hermann Advantage plans side by side or call our customer service representatives at (877) 258-9408 (TTY 711) for assistance. They can walk you through the differences between Memorial Hermann Advantage HMO and Memorial Hermann Advantage PPO so you can decide which one is best for your medical needs and budget.



Plan BenefitMemorial Hermann
Advantage HMO
Memorial Hermann
Advantage PPO
Monthly Plan Premium$0*$0*
Maximum Out-of-Pocket Limit$6,700$6,700 In-Network
$9,500 Out-of-Network (OON)/combined
Inpatient Hospital$550 copay per stay$300 per day for days 1–5
$0 for days 6–90
Primary Care Provider Services$5 copay$5 copay (OON–40%)
Physician Specialist Services$40 copay$40 copay (OON–40%)
Ambulatory Surgical Center$150 copay$225 copay (OON–40%)
Outpatient Hospital Services$150 copay$225 copay (OON–40%)
Skilled Nursing FacilityDays 1–20: $0 copay per day
Days 21–100: $160 copay per day
Days 1–20: $0 copay per day
Days 21–100: $160 copay per day
(OON–40%)
Durable Medical Equipment20% coinsurance20% coinsurance (OON–40%)
Lab & Diagnostic Services

$0 copay for labs

$10 copay for procedures

$0 copay for labs (OON

–40%)

$10 copay for procedures (OON - 40%)

Outpatient X-Rays$15 copay$15 copay (OON–40%)
Medicare-Covered Therapeutic
Radiological Services
$25 copay$25 copay (OON–40%)
Medicare-Covered Diagnostic
Radiological Services
$175 copay for high-end services such as CT scan and MRI$300 copay for high-end services such as CT scan and MRI (OON–40%)
Urgently Needed Care$40 copay$40 copay
Emergency Care$75 copay$75 copay
Home Health Care$0 copay$0 copay (OON–40%)
Annual Preventive Services: Bone
Mass Measurement, Colorectal
Screening Exam, Pneumonia &
Flu Vaccine, Screening
Mammogram, Pap Smear & Pelvic
Exam, Prostate Screening
$0 copay$0 copay (OON–40%)
Hearing Benefit

$0 copay for basic hearing and balance exam performed by primary care provider

$40 copay for hearing exam and

Medicare covered visit.

$250 allowance for hearing aids every year.

$0 copay for basic hearing and balance exam performed by primary care provider (OON - 40%)

$40 copay for hearing exam and

Medicare covered visit
(OON–40%)

$250 allowance for hearing aids every year (INN/OON)
Vision Benefit$0 copay for one routine eye exam

performed by Optician/Optometrist

$40 copay for routine eye exam performed by Ophthalmologist

$50 allowance for eyewear every year

$0 copay for one routine eye exam
performed by Optician/Optometrist(OON

– 40%)

$40 copay for routine eye exam performed by Ophthalmologist (OON - 40%)

$50 allowance for eyewear every year

Readmission Prevention Care (Requires Authorization)$10 copay$10 copay
(OON–40%)
Part B
Prescription Drug Coverage
Memorial Hermann
Advantage HMO
Memorial Hermann
Advantage PPO
All Part B Drugs Including
Chemotherapy
20% coinsurance20% coinsurance (OON–40%)
Part D
Prescription Drug Coverage
Both Memorial Hermann Advantage HMO & Memorial Hermann Advantage PPO
Deductible$300 Deductible applies for Tiers 4-5
Initial Coverage Limit$3,700
Tier 1: Preferred Generic$5 copay for 30-day supply
Tier 2: Non-preferred Generic$15 copay for 30-day supply
Tier 3: Preferred Brand$45 copay for 30-day supply
Tier 4: Non-Preferred Brand$99 copay for 30-day supply
Tier 5: Specialty Tier Drugs27% coinsurance for 30-day supply
Mail Order Availability

 

Tier

Mail Order Copay (90 day supply)

Tier 1 (Preferred Generic)

$10

Tier 2 (Non-Preferred Generic)

$30

Tier 3 (Preferred Brand)

$90

Tier 4 (Non-Preferred Brand)

$198

Tier 5 (Specialty)

Not available

 

Coverage Gap
Most Medicare plans have a coverage gap (also called the “donut hole”).  This means there’s a temporary change in what you will pay for your drugs.  The coverage gap begins afer the total yearly drug cost (including what our plan has paid and what you have paid) reaches $3,700.  After you enter the coverage gap, you pay 40% of the price for brand name drugs (plus a portion of the dispensing fee) and 51% of the price for generic drugs.  Not everyone will enter the coverage gap.

 

Catastrophic Coverage RxAfter your total yearly drug costs reach $4,950, you will pay the  greater of: 5% of the cost or $3.30 copay for generic or a preferred multi-source drug (including brand drugs treated as generic) and $8.25 for all other drugs.

Memorial Hermann Advantage HMO and Memorial Hermann Advantage PPO are health plans with a Medicare contract. Enrollment in these plans depends on contract renewal.

*You must continue to pay your Medicare Part B premium.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.


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