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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, 2018 to Dec 31, 2018

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


$320 - Hospital

$250 copay - Ambulatory Surgery Center


$320 - Hospital

$250 copay - Ambulatory Surgery Center


$320 - Hospital

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.

2018 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, 2018 to Dec 31, 2018

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 $29
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 6–90)
Outpatient Surgery and Hospital Service

$250 copay - Ambulatory Surgery Center


$320 - Hospital

$250 copay - Ambulatory Surgery Center


$320 - Hospital

$250 copay - Ambulatory Surgery Center


$320 - Hospital

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 & SELECT
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 $10 $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 $3,750 Your costs will be no more than 44% of the cost for generic drugs. You pay 35% of the cost of brand name drugs.
Catastrophic Coverage Stage After you have paid $5,000 out-of-pocket You pay the greater of 5% of the cost of the drug or $3.35 for generics/ $8.35 for brand names.
Gap Coverage You pay the same cost sharing for Tier 1 drugs that you paid in the Initial Coverage Stage or 44% of the cost, 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 $40 copay (covered under Original Medicare)
Routine Vision Exam You pay nothing for up to 1 visit per year
Routine Eyewear Benefit $40 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 Select
Podiatry Services – Foot Care $25 copay (covered under original Medicare)
Routine Vision Exam You pay nothing for up to 1 visit per year
Routine Eyewear Benefit $35 copay for frames and lenses; 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

* 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.