Members

Your Plan’s Benefits

Health Pointe Direct Complete Plan (HMO I-SNP) covers all of the benefits of your original Medicare, plus provides a devoted Personal Health Team, Part D prescription drug coverage, and other additional healthcare benefits. Below is a description of some of the benefits offered by the plan:

• Plan Premium $0
• In-Network Deductible $185/year
• Part D Prescription Drugs Deductible $415/year
• Part D Premium $39.30
• Primary Care Physician visit $0 Copay – You Pay Nothing
• Routine Foot Care 20% coinsurance – May require prior authorization
• Hearing 20% coinsurance of the Medicare approved amount for covered exams. Part B deductible applies.
• Occupational and physical therapy, and speech-language pathology 20% coinsurance for occupational and physical therapy, as well as speech-language pathology
• Vision $0 Copay – You Pay Nothing for a routine  eye exam and glaucoma test every year. Plan pays up to $350 for eyewear every two years
• Dental 20% coinsurance – Dental services approved by Medicare during the contract year will be covered
• Diabetic supplies You pay 20% for diabetic supplies
• Skilled Nursing $0 Copay for days 1-20, $170.50 coinsurance per day for day 21-100 in a Skilled Nursing Facility (SNF)
• Enhanced Part D $0 Deductible. Tier 1: $5.75, Tier 2: You pay 25% of cost
• In-Network Maximum Out-of-Pocket Amount (per year) $6,700.00

Click here (PDF) if you would like to see the complete summary of benefits for the Health Pointe Direct Complete Plan.