Medicare Advantage Benefits at a Glance
2017 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, 2017 to Dec 31, 2017
Click here for more information on Dental Benefits
| MA-Only | MAPD | |||
|---|---|---|---|---|
| GENERATIONS VALUE (HMO) | GENERATIONS CLASSIC (HMO) | GENERATIONS SELECT (HMO) | GENERATIONS PREMIER (HMO) | |
| BENEFIT | YOU PAY | |||
| Premium | $0 | $0 | $30 | $111.30 |
| Deductible | $0 | $0 | $0 | $0 |
| MOOP | $3,000 | $3,300 | $3,400 | $4,500 |
| Primary Care Physician | $0 | $0 | $0 | $0 |
| Specialist | $25 copay | $40 copay | $45 copay | $30 copay |
| Preventative Care * | You pay nothing | You pay nothing | You pay nothing | You pay nothing |
| Inpatient Hospital Care | $250 copay per day (Days 1–6) You pay nothing per day (Days 7–190) | $365 copay per day (Days 1–5) You pay nothing per day (Days 6–190) | $300 copay per day (Days 1–8) You pay nothing per day (Days 9–90) | $275 copay per day (Days 1–3) You pay nothing per day (Days 4–190 |
| Outpatient Surgery and Hospital Service | $250 copay | $250 copay – Ambulatory or Preferred Facility $320 copay – Non-Preferred Facility | $250 copay – Ambulatory or Preferred Facility $350 copay – Non-Preferred Facility | $125 copay – Ambulatory or Preferred Facility $250 copay – Non-Preferred Facility |
| Diagnostic Tests, X-rays, Lab Services and Radiology | 20% coinsurance | $10 copay for labs and x-rays; $40 copay for therapeutic radiology | You pay nothing for labs and x-rays; 20% coinsurance for therapeutic radiology | You pay nothing for labs and x-rays; $30 copay for therapeutic radiology |
| MRI, PET, CT Scan | 20% coinsurance | $150 copay | $150 copay | $150 copay |
| Ambulance Service | $100 copay | $100 copay | $250 copay | $50 copay |
| Emergency Room | $75 copay | $75 copay | $75 copay | $50 copay |
| Urgent Care | $25 copay | $30 copay | $45 copay | $35 copay |
Prescription Drug Coverage
Generations Classic, Generations Select, Generations Premier Deductible: $0
Note: Generations Value does not include Prescription Drug Coverage
| GENERATIONS CLASSIC, SELECT & PREMIER | |||
|---|---|---|---|
| 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 | $15 | $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 $3,700 | Your costs will be no more than 51% of the cost for generic drugs. You pay 40% of the cost of brand name drugs. | ||
| Catastrophic Coverage Stage After you have paid $4,950 out-of-pocket | You pay the greater of 5% of the cost of the drug or $3.30 for generics/ $8.25 for brand names. | ||
Additional Benefits Not Covered Under Original Medicare
| Generations Value | |
|---|---|
| Routine Vision Exam | You pay nothing for up to 1 visit per year |
| Routine Eyeware Benefit | You pay nothing; plan pays up to a $200 calendar year maximum |
| Dental/Dentures | You pay nothing for preventive services. |
| Generations Classic | |
| Routine Vision Exam | $20 copay for up to 1 visit per year |
| Routine Eyeware Benefit | 20% coinsurance; plan pays up to a $205 calendar year maximum |
| Dental/Dentures | You pay nothing for cleaning and x-rays. $5 copay for oral exams |
| Generations Select | |
| Routine Vision Exam | $45 copay for up to 1 visit per year |
| Routine Eyeware Benefit | $45 copay for frames and lenses; play pays up to a $200 calendar year maximum |
| Dental/Dentures | You pay nothing for cleaning and x-rays $5 copay for oral exams |
| Generations Premier | |
| Routine Vision Exam | $45 copay for up to 1 visit per year |
| Routine Eyeware Benefit | You pay nothing; play pays up to a $200 calendar year maximum |
| Dental/Dentures | You pay nothing for preventive services; 50% coinsurance for dentures; plan pays up to a $500 calendar year maximum |
Click here to print the 2017 Benefits at a Glance.
* 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.
† Costs for 90-day supply are higher at Standard Retail Pharmacy