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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