Bright Advantage (HMO)

Medicare Advantage Plan for Arizona

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderBright Health
Plan IDH4853-1-0
CMS RatingNot Rated1
Plan TypeHMO
Annual Deductible$0.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
Yes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$3,750 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
$185 for days 1 through 7
$0 for days 8 through 90
Outpatient hospital coverage
$50-250 per visit
Doctor visits
Primary:$0 copay
Specialist:$30 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:$75 per visit (always covered)
Urgent care:$30 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:20%
Lab services:$10
Diagnostic radiology services (e.g., MRI):20%
Outpatient x-rays:$10
Mental health services
$185 for days 1 through 7
$0 for days 8 through 90
Outpatient group therapy visit with a psychiatrist:$10
Outpatient individual therapy visit with a psychiatrist:$40
Outpatient group therapy visit:$10
Outpatient individual therapy visit:$40
Skilled Nursing Facility
$0 for days 1 through 20
$145 for days 21 through 100
Rehabilitation services
Occupational therapy visit:$25
Physical therapy and speech and language therapy visit:$25
Ambulance
$200
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:$25
Routine foot care:Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):20% per item
Prosthetics (e.g., braces, artificial limbs):20% per item
Diabetes supplies:$0 copay
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:20%
Other Part B drugs:20%

Coverage Area for Bright Advantage (HMO)

StateArizona
CountyYuma

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds$2 copayNot offered
Tier 2: Non-Preferred GenericNot offered$8 copayNot offered
Tier 3: Preferred Brand NameNot offered$45 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$95 copayNot offered
Tier 5: Specialty TierNot offered33% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$6 copayNot offered
Tier 2: Non-Preferred GenericNot offered$24 copayNot offered
Tier 3: Preferred Brand NameNot offered$135 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$285 copayNot offered
Tier 5: Specialty TierNot offered33% coinsuranceNot offered

Physician Finder

Physicians that accept Bright Advantage (HMO) for Arizona

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