Medicare Advantage Benefits at a Glance
2020 MEDICARE ADVANTAGE PLANS
Benefits at a Glance
The following is intended to be only a summary of benefits for Generations Medicare Advantage plans. For a complete list, including any limitations, exclusions, and plan restrictions, please review the GlobalHealth Evidence of Coverage for Generations Medicare Advantage plans.
Coverage effective Jan 1, 2020 to Dec 31, 2020
| MA-Only | MAPD | ||
|---|---|---|---|
| GENERATIONS VALUE (HMO) | GENERATIONS CLASSIC (HMO) | GENERATIONS SELECT (HMO) | |
| BENEFIT | YOU PAY | ||
| Premium | $0 | $0 | $28 |
| Deductible | $0 | $0 | $0 |
| MOOP | $3,000 | $3,400 | $3,400 |
| Primary Care Physician | $0 | $0 | $0 |
| Specialist | $40 copay | $40 copay | $35 copay |
| Preventative Care * | You pay nothing | You pay nothing | You pay nothing |
| Inpatient Hospital Care | $250 copay per day (Days 1–5) You pay nothing per day (Days 6–190) | $395 copay per day (Days 1–5) You pay nothing per day (Days 6–190) | $345 copay per day (Days 1–5) You pay nothing per day (Days 6–190) |
| Outpatient Surgery and Hospital Service |
$250 copay - Ambulatory Surgery Center
|
$250 copay - Ambulatory Surgery Center
|
$250 copay - Ambulatory Surgery Center
|
| Diagnostic Tests, X-rays, Lab Services and Radiology | You pay nothing for labs and x-rays; $50 copay for therapeutic radiology; $100 copay for sleep studies in outpatient facility |
You pay nothing for labs and x-rays; $50 copay for therapeutic radiology; $100 copay for sleep studies in outpatient facility |
You pay nothing for labs and x-rays; $40 copay for therapeutic radiology; $100 copay for sleep studies in outpatient facility |
| MRI, PET, CT Scan |
$180 copay in PCP, specialist, urgent care, or free-standing radiology facility; $250 copay in outpatient hospital |
$180 copay in PCP, specialist, urgent care, or free-standing radiology facility; $250 copay in outpatient hospital | $180 copay in PCP, specialist, urgent care, or free-standing radiology facility; $250 copay in outpatient hospital |
| Ambulance Service | $150 copay | $250 copay | $250 copay |
| Emergency Room | $75 copay | $120 copay | $85 copay |
| Urgent Care | $15 copay | $30 copay | $25 copay |
| Chiropractic | $20 copay | $20 copay | $20 copay |
| Home Health | You pay nothing | You pay nothing | You pay nothing |
| Diabetes Supplies | You pay nothing | You pay nothing | You pay nothing |
Prescription Drug Coverage
Effective January 1, 2020 - December 31, 2020
Generations Classic (HMO) & Generations Select (HMO)
Deductible: $0
Note: Generations Value (HMO) does not include Prescription Drug Coverage
| 30-Day Preferred Retail and Mail Order | ||
|---|---|---|
| Drug Type | Generations Classic (HMO) | Generations Select (HMO) |
| Tier 1 - Preferred Generics | $5 | $3 |
| Tier 2 - Generics | $15 | $13 |
| Tier 3 - Preferred Brand Name | $42 | $40 |
| Tier 4 - Non-Preferred | 40% | 40% |
| Tier 5 - Specialty | 33% | 33% |
| 90-Day Preferred Retail and Mail Order | ||
|---|---|---|
| Drug Type | Generations Classic (HMO) | Generations Select (HMO) |
| Tier 1 - Preferred Generics | $0 | $0 |
| Tier 2 - Generics | $0 | $0 |
| Tier 3 - Preferred Brand Name | $84 | $80 |
| Tier 4 - Non-Preferred | 40% | 40% |
|
Coverage Gap Stage After your prescription costs reach $4,020 |
Your costs will be no more than 25% of the cost for generic drugs. You pay 25% of the cost of brand name drugs plus a portion of the dispensing fee. | ||
| Catastrophic Coverage Stage After you have paid $6,350 out-of-pocket | You pay the greater of 5% of the cost of the drug or $3.60 for generics/$8.95 for brand names. | ||
| Gap Coverage | You pay the same cost sharing for Tier 1 drugs or for oral anti-diabetic drugs in Tier 3 that you paid in the Initial Coverage Stage, whichever is less, and the plan pays the rest. |
PLEASE NOTE: Please visit our website for the most up-to-date drug formulary. The formulary and/or pharmacy network may change at any time. You will receive notice when necessary.
Costs are higher at a Standard Pharmacy.
Additional Benefits Not Covered Under Original Medicare
Effective January 1, 2020 - December 31, 2020
| MA-Only | MAPD | ||
|---|---|---|---|
| GENERATIONS VALUE (HMO) | GENERATIONS CLASSIC (HMO) | GENERATIONS SELECT (HMO) | |
| BENEFIT | YOU PAY | ||
| Routine Vision Exam |
You pay nothing for up to 1 visit per year |
You pay nothing for up to 1 visit per year |
You pay nothing for up to 1 visit per year |
| Routine Eyewear Benefit |
Plan pays up to a $200 calendar year maximum |
Plan pays up to a $200 calendar year maximum |
Plan pays up to a $200 calendar year maximum |
| Dental |
Plan pays up to a $1,000 calendar year maximum for preventive and comprehensive services |
Plan pays up to a $1,000 calendar year maximum for preventive and comprehensive services | Plan pays up to a $900 calendar year maximum for preventive and comprehensive services |
| Over-the-Counter Benefit |
$50 quarterly benefit for over-the-counter (OTC) health and wellness products available through our mail order service. If $50 is not used in a quarter, the balance does not carry over. Prices include shipping, handling, and sales tax. |
$50 quarterly benefit for over-the-counter (OTC) health and wellness products available through our mail order service. If $50 is not used in a quarter, the balance does not carry over. Prices include shipping, handling, and sales tax. | $50 quarterly benefit for over-the-counter (OTC) health and wellness products available through our mail order service. If $50 is not used in a quarter, the balance does not carry over. Prices include shipping, handling, and sales tax. |
| Fitness Benefit |
You pay nothing at an in-network fitness facility or for up to 2 home fitness kits per year |
You pay nothing at an in-network fitness facility or for up to 2 home fitness kits per year | You pay nothing at an in-network fitness facility or for up to 2 home fitness kits per year |
| Routine Hearing Exam | You pay nothing for up to 1 visit per year | You pay nothing for up to 1 visit per year | You pay nothing for up to 1 visit per year |
| Hearing Aids |
Plan pays up to a $500 calendar year maximum for hearing aids and fitting |
Plan pays up to a $500 calendar year maximum for hearing aids and fitting | Plan pays up to a $500 calendar year maximum for hearing aids and fitting |
* Our plan covers many preventive services, including:
- Abdominal aortic aneurysm screening
- Alcohol misuse counseling
- Bone mass measurement
- Breast cancer screening (mammogram)
- Cardiovascular disease (behavioral therapy)
- Cardiovascular screenings
- Cervical and vaginal cancer screening
- Colonoscopy
- Colorectal cancer screenings
- Depression screening
- Diabetes screenings
- Fecal occult blood test
- Flexible sigmoidoscopy
- HIV screening
- Medical nutrition therapy services
- Obesity screening and counseling
- Prostate cancer screenings (PSA)
- Sexually transmitted infections screening and counseling
- Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease)
- Vaccines, including Flu shots, Hepatitis B shots, Pneumococcal shots
- "Welcome to Medicare" preventive visit (one-time)
- Yearly "Wellness" visit
- Any additional preventive services approved by Medicare during the contract year will be covered.
2019 MEDICARE ADVANTAGE PLANS
Benefits at a Glance
The following is intended to be only a summary of benefits for Generations Medicare Advantage plans. For a complete list, including any limitations, exclusions, and plan restrictions, please review the GlobalHealth Summary of Benefits for Generations Medicare Advantage plans.
Coverage effective Jan 1, 2019 to Dec 31, 2019
Click here for more information on Dental Benefits
| MA-Only | MAPD | ||
|---|---|---|---|
| GENERATIONS VALUE (HMO) | GENERATIONS CLASSIC (HMO) | GENERATIONS SELECT (HMO) | |
| BENEFIT | YOU PAY | ||
| Premium | $0 | $0 | $30 |
| Deductible | $0 | $0 | $0 |
| MOOP | $3,000 | $3,400 | $3,400 |
| Primary Care Physician | $0 | $0 | $0 |
| Specialist | $40 copay | $40 copay | $25 copay |
| Preventative Care * | You pay nothing | You pay nothing | You pay nothing |
| Inpatient Hospital Care | $250 copay per day (Days 1–5) You pay nothing per day (Days 6–190) | $365 copay per day (Days 1–5) You pay nothing per day (Days 6–190) | $325 copay per day (Days 1–5) You pay nothing per day (Days 6–190) |
| Outpatient Surgery and Hospital Service |
$250 copay - Ambulatory Surgery Center
|
$250 copay - Ambulatory Surgery Center
|
$250 copay - Ambulatory Surgery Center
|
| Diagnostic Tests, X-rays, Lab Services and Radiology | You pay nothing for labs and x-rays; $50 copay for therapeutic radiology; $100 copay for sleep studies in outpatient facility |
You pay nothing for labs and x-rays; $50 copay for therapeutic radiology; $100 copay for sleep studies in outpatient facility |
You pay nothing for labs and x-rays; $40 copay for therapeutic radiology; $100 copay for sleep studies in outpatient facility |
| MRI, PET, CT Scan | $150 copay | $150 copay | $100 copay |
| Ambulance Service | $100 copay | $100 copay | $100 copay |
| Emergency Room | $75 copay | $100 copay | $85 copay |
| Urgent Care | $10 copay | $35 copay | $25 copay |
| Chiropractic | $20 copay | $20 copay | $20 copay |
| Home Health | You pay nothing | You pay nothing | You pay nothing |
Prescription Drug Coverage
Generations Classic & Generations Select Deductible: $0
Note: Generations Value does not include Prescription Drug Coverage
| GENERATIONS CLASSIC (HMO) | |||
|---|---|---|---|
| Drug Type | 30-Day Supply at Preferred Retail Pharmacy | 90-Day Supply from Mail Order Pharmacy† | 30-Day Supply from Standard Retail Pharmacy |
| Tier 1 - Preferred Generics | $5 | $15 | $10 |
| Tier 2 - Generics | $15 | $45 | $20 |
| Tier 3 - Preferred Brand Name | $42 | $126 | $47 |
| Tier 4 - Non-Preferred | 40% | 40% | 50% |
| Tier 5 - Specialty | 33% | N/A | 33% |
| Tier 6 - Select Care | $5 | $0 | $10 |
| Coverage Gap Stage After your prescription costs reach $3,820 | Your costs will be no more than 37% of the cost for generic drugs. You pay 25% of the cost of brand name drugs. |
||
| Catastrophic Coverage Stage After you have paid $5,100 out-of-pocket | You pay the greater of 5% of the cost of the drug or $3.40 for generics/$8.50 for brand names. | ||
| Gap Coverage | You pay the same cost sharing for Tier 6 drugs that you paid in the Initial Coverage Stage, whichever is less, and the plan pays the rest. | ||
| GENERATIONS SELECT (HMO) | |||
|---|---|---|---|
| Drug Type | 30-Day Supply at Preferred Retail Pharmacy | 90-Day Supply from Mail Order Pharmacy† | 30-Day Supply from Standard Retail Pharmacy |
| Tier 1 - Preferred Generics | $5 | $0 | $10 |
| Tier 2 - Generics | $15 | $30 | $20 |
| Tier 3 - Preferred Brand Name | $42 | $84 | $47 |
| Tier 4 - Non-Preferred | 40% | 30% | 50% |
| Tier 5 - Specialty | 33% | N/A | 33% |
| Coverage Gap Stage After your prescription costs reach $3,820 | Your costs will be no more than 37% of the cost for generic drugs. You pay 25% of the cost of brand name drugs. |
||
| Catastrophic Coverage Stage After you have paid $5,100 out-of-pocket | You pay the greater of 5% of the cost of the drug or $3.40 for generics/$8.50 for brand names. | ||
| Gap Coverage | You pay the same cost sharing for Tier 1 drugs that you paid in the Initial Coverage Stage,whichever is less, and the plan pays the rest. | ||
PLEASE NOTE: Generations Classic and Generations Select have different drug formularies. Please visit our website for the most up-to-date drug formularies. The formulary and/or pharmacy network may change at any time. You will receive notice
when necessary.
† Costs for 90-day supply are higher at Standard Retail Pharmacy
Additional Benefits Not Covered Under Original Medicare
| Generations Value | |
|---|---|
| Podiatry Services – Foot Care | $40 copay (covered under Original Medicare) |
| Routine Vision Exam | You pay nothing for up to 1 visit per year |
| Routine Eyewear Benefit | $50 copay; plan pays up to a $200 calendar year maximum |
| Dental | You pay nothing for preventive services |
| Over-the-Counter Benefit | $50 quarterly benefit for over-the-counter (OTC) health and wellness products available through our mail order service. If $50 is not used in a quarter, the balance does not carry over. Prices include shipping, handling, and sales tax. |
| Generations Classic | |
| Podiatry Services – Foot Care | $20 copay (covered under Original Medicare) |
| Routine Vision Exam | You pay nothing for up to 1 visit per year |
| Routine Eyewear Benefit | Plan pays up to a $200 calendar year maximum |
| Dental | You pay nothing for preventive services You pay nothing for dentures; plan pays up to $750 calendar year maximum |
| Over-the-Counter Benefit | $30 quarterly benefit for over-the-counter (OTC) health and wellness products available through our mail order service. If $30 is not used in a quarter, the balance does not carry over. Prices include shipping, handling, and sales tax. |
| Generations Select | |
| Podiatry Services – Foot Care | $15 copay (covered under original Medicare) |
| Routine Vision Exam | You pay nothing for up to 1 visit per year |
| Routine Eyewear Benefit | Plan pays up to a $200 calendar year maximum |
| Dental | You pay nothing for preventive services You pay nothing for comprehensive dental services; plan pays up to $250 calendar year maximum for comprehensive dental services including: • Non-routine services, Diagnostic services, Restorative services, Endodontics, Periodontics, Extractions |
| Over-the-Counter Benefit | $30 quarterly benefit for over-the-counter (OTC) health and wellness products available through our mail order service. If $30 is not used in a quarter, the balance does not carry over. Prices include shipping, handling, and sales tax. |
| Fitness Benefit | You pay nothing at an in-network fitness facility |
* Our plan covers many preventive services, including:
- Abdominal aortic aneurysm screening
- Alcohol misuse counseling
- Bone mass measurement
- Breast cancer screening (mammogram)
- Cardiovascular disease (behavioral therapy)
- Cardiovascular screenings
- Cervical and vaginal cancer screening
- Colonoscopy
- Colorectal cancer screenings
- Depression screening
- Diabetes screenings
- Fecal occult blood test
- Flexible sigmoidoscopy
- HIV screening
- Medical nutrition therapy services
- Obesity screening and counseling
- Prostate cancer screenings (PSA)
- Sexually transmitted infections screening and counseling
- Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease)
- Vaccines, including Flu shots, Hepatitis B shots, Pneumococcal shots
- "Welcome to Medicare" preventive visit (one-time)
- Yearly "Wellness" visit
- Any additional preventive services approved by Medicare during the contract year will be covered.