2016 SelectSaver HMO-POS Medicare Advantage Plan
Our SelectSaver HMO-POS Medicare Advantage Plan offers a low monthly premium, worldwide emergency care coverage, nationwide urgent care coverage, ability to receive care from local doctors and hospitals, and no referrals.
You must live in one of the following counties to join this plan:
Not sure if this plan is right for you? Call or chat online with us and we'll help you choose the plan that’s right for you.
|2016 Monthly Premium*||$76|
|Out-of-pocket (OOP) maximum||$6,700|
|Primary doctor/specialist||$35/ $50|
|Inpatient hospital||$270 per day
$1,890 OOP limit per year
|Emergency room visit copay waived if admitted||$75|
|Vision||$50 for one routine eye exam every two years|
|Optional supplemental dental||Add to plan for additional $17 per month|
|Nationwide coverage||ER and urgent care. POS: Cost-share is 30% up to $2,500|
|Prescription drugs: (30- day supply at a retail pharmacy)
Preferred pharmacies include Walmart, Wegmans and RiteAid; see provider directory for a full list
|Tier 1 - Preferred generic||
$7 Preferred Pharmacy
$12 Standared Pharmacy
|Tier 2 - Generic||
$15 Preferred Pharmacy
$20 Standard Pharmacy
|Tier 3 - Preferred brand||
$42 Preferred Pharmacy
$47 Standard Pharmacy
|Tier 4 - Non-preferred brand||
$94 Preferred Pharmacy
$100 Standard Pharmacy
|Tier 5 - Specialty||
33% Standard Pharmacy
33% Preferred Pharmacy
*You must continue to pay your Medicare Part B premium.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B Premium.
Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
HealthNow New York Inc. is a Medicare Advantage and stand-alone PDP plan with a Medicare contract. Enrollment in HealthNow New York Inc. depends on contract renewal.
Content Last Updated January 19, 2016