2019 Bright Advantage (HMO) H2011-1-0 in TN from Bright Health | HealthPocket

Bright Advantage (HMO)

$0/mo

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Zip Code37013
Applicant9/16/1984 Male
Coverage Start9/17/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderBright Health
Plan IDH2011-1-0
Plan Year2019
CMS RatingNot Rated
Plan TypeHMO
Annual Deductible$100.00

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

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$0.00
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$5,700 In-network
Optional Supplemental BenefitsYes

Benefits

SERVICECOST
Inpatient hospital coverage$275 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage$300 per visit
Doctor visitsPrimary:$0 copay
Specialist:$30 per visit
Preventive care$0 copay
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$35 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:20%
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):20%
Outpatient x-rays:$15
Mental health servicesInpatient hospital - psychiatric:$275 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit with a psychiatrist:$30
Outpatient individual therapy visit with a psychiatrist:$40
Outpatient group therapy visit:$30
Outpatient individual therapy visit:$40
Skilled Nursing Facility$0 per day for days 1 through 20
$172 per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:$15
Physical therapy and speech and language therapy visit:$15
Ground ambulance$200
Transportation$0 copay. There may be limits on how much the plan will provide.
Foot care (podiatry services)Foot exams and treatment:$35
Routine foot care:Not covered
Medical equipment/suppliesDurable 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 drugsChemotherapy:20%
Other Part B drugs:20%

Benefits Services

Hearing
Hearing exam$0 copay
Fitting/evaluation$0 copay. There may be limits on how much the plan will provide.
Hearing aids$0 copay. There may be limits on how much the plan will provide.
Preventive Dental
Oral exam$0 copay. There may be limits on how much the plan will provide.
Cleaning$0 copay. There may be limits on how much the plan will provide.
Fluoride treatment$0 copay. There may be limits on how much the plan will provide.
Dental x-ray(s)$0 copay. There may be limits on how much the plan will provide.
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye exam$0 copay. There may be limits on how much the plan will provide.
OtherNot covered
Contact lenses$0-60There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)$25There may be limits on how much the plan will provide.
Eyeglass framesNot covered
Eyeglass lensesNot covered
UpgradesNot covered

Coverage Area for Bright Advantage (HMO)

StateTennessee
CountyDavidson

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 offered31% 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 offered31% coinsuranceNot offered

Physicians that accept Bright Advantage (HMO) for Tennessee

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)