844.985.0552 (TTY: 711)*

Comparison Table Test

PHP Advantage
(HMO-POS)		 PHP Advantage Plus
(HMO-POS)
Medical & Hospital
Monthly Premium $0 $25
Maximum Out-of-Pocket Limit $3,800 Per Year $3,800 Per Year
Annual Deductible $0 $0
Preventative Care/Screenings $0 Copay $0 Copay
Primary Care Physician Visits $5 $5
Specialist Doctor Visits $30 Copay $30 Copay
Urgent Care $60 Copay $60 Copay
Emergency Care $90 Copay $90 Copay
Lab Services $10 Copay $10 Copay
Home Health Care 100% Coverage 100% Coverage
Chiropractic Care $20 Copay $20 Copay
Inpatient Hospital $200 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond		 $200 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond
Outpatient Surgery at Hospital $150 Copay $150 Copay
Outpatient Surgery at Ambulatory Surgery Center $100 Copay $100 Copay
Part D Prescription Drug Coverage
Annual Deductible
  • Preferred Pharmacies – $0
  • Other Network Pharmacies – $0
  • Preferred Pharmacies – $0
  • Other Network Pharmacies – $0
Tier 1
Preferred Generic
  • Preferred Pharmacies – $0 Copay
  • Other Network Pharmacies – $5 Copay
  • Preferred Pharmacies – $0 Copay
  • Other Network Pharmacies – $5 Copay
Tier 2
Non-Preferred Generics
  • Preferred Pharmacies – $0 Copay
  • Other Network Pharmacies – $10 Copay
  • Preferred Pharmacies – $0 Copay
  • Other Network Pharmacies – $10 Copay
Tier 3
Preferred Brand Names
  • Preferred Pharmacies – $40 Copay
  • Other Network Pharmacies – $45 Copay
  • Preferred Pharmacies – $40 Copay
  • Other Network Pharmacies – $45 Copay
Tier 4
Non-Preferred Brand Names
  • Preferred Pharmacies – $90 Copay
  • Other Network Pharmacies – $95 Copay
  • Preferred Pharmacies – $90 Copay
  • Other Network Pharmacies – $95 Copay
Tier 5
Specialty Drugs
  • Preferred Pharmacies – 33% Co-insurance
  • Other Network Pharmacies – 33% Co-insurance
  • Preferred Pharmacies – 33% Co-insurance
  • Other Network Pharmacies – 33% Co-insurance
Initial Coverage Limits
  • Preferred Pharmacies – $4,020 Per Year
  • Other Network Pharmacies – $4,020 Per Year
  • Preferred Pharmacies – $4,020 Per Year
  • Other Network Pharmacies – $4,020 Per Year
What Medications are Covered
View Covered Medications
View Covered Medications
Extra Benefits
Vision Care
  • $25 Copay for routine eye exam
  • $0 Copay for a pair of eyeglass frames or contact lenses (2 six packs)
  • $25 Copay for routine eye exam
  • $0 Copay for a pair of eyeglass frames or contact lenses (2 six packs)
Preventive Dental Care $0 Copay $0 Copay
Comprehensive Dental Care Not Covered
  • $100 Deductible
  • $1,000 maximum benefit per year
Over-the-Counter (OTC) Items<
  • $55 Per Quarter
  • Up to 2 orders per quarter; no rollovers
  • $80 Per Quarter
  • Up to 2 orders per quarter; no rollovers
Hearing
  • $25 Copay for hearing exam
  • $1,000 allowance for up to 2 hearing aids every 2 years (both ears combined)
  • $25 Copay for hearing exam
  • $1,500 allowance for up to 2 hearing aids every 2 years (both ears combined)
Transportation Assistance $0 Copay for 20 one-way trips to approved locations per year $0 Copay for 30 one-way trips to approved locations per year
Fitness Membership SilverSneakers® included at no cost SilverSneakers® included at no cost
Travel Benefits Emergency or urgent care coverage if you are making a trip out of state or country Emergency or urgent care coverage if you are making a trip out of state or country
View Complete Plan Benefits
View Complete Plan Benefits
PHP Advantage
(HMO-POS)		 PHP Advatange Plus
(HMO-POS)
Medical & Hospital
Monthly Premium
$0 $25
Maximum Out-of-Pocket Limit
$3,800 Per Year
Annual Deductible
$0
Preventive Care/Screenings
$0 Copay
Primary Care Physician Visits
$5 Copay
Specialist Doctor Visits
$30 Copay
Urgent Care
$60 Copay
Emergency Care
$90 Copay
Lab Services
$10 Copay
Home Health Care
100% Coverage
Chiropractic Care
$20 Copay
Inpatient Hospital Care
$200 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond
Outpatient Surgery at Hospital
$150 Copay
Outpatient Surgery at Ambulatory Surgery Center
$100 Copay
Part D Prescription Drug Coverage
Annual Deductible
  • Preferred Pharmacies – $0
  • Other Network Pharmacies – $0
Tier 1
Preferred Generic
  • Preferred Pharmacies – $0 Copay
  • Other Network Pharmacies – $5 Copay
Tier 2
Non-Preferred Generics
  • Preferred Pharmacies – $0 Copay
  • Other Network Pharmacies – $10 Copay
Tier 3
Preferred Brand Names
  • Preferred Pharmacies – $40 Copay
  • Other Network Pharmacies – $45 Copay
Tier 4
Non-Preferred Brand Names
  • Preferred Pharmacies – $90 Copay
  • Other Network Pharmacies – $95 Copay
Tier 5
Specialty Drugs
  • Preferred Pharmacies – 33% Co-insurance
  • Other Network Pharmacies – 33% Co-insurance
Initial Coverage Limits
  • Preferred Pharmacies – $4,020 Per Year
  • Other Network Pharmacies – $4,020 Per Year
What Medications are Covered
View Covered Medications
Extra Benefits
Vision Care
  • $25 Copay for routine eye exam
  • $0 Copay for a pair of eyeglass frames or contact lenses (2 six packs)
Preventive Dental Care
$0 Copay
Comprehensive Dental Care
Not Covered
  • $100 Deductible
  • $1,000 maximum benefit per year
Over-the-Counter (OTC) Items
  • $55 Per Quarter
  • Up to 2 orders per quarter; no rollovers
  • $80 Per Quarter
  • Up to 2 orders per quarter; no rollovers
Hearing
  • $25 Copay for hearing exam
  • $1,000 allowance for up to 2 hearing aids every 2 years (both ears combined)
  • $25 Copay for hearing exam
  • $1,500 allowance for up to 2 hearing aids every 2 years (both ears combined)
Transportation Assistance
$0 Copay for 20 one-way trips to approved locations per year $0 Copay for 30 one-way trips to approved locations per year
Fitness Membership
SilverSneakers® included at no cost
Travel Benefits
Emergency or urgent care coverage if you are making a trip out of state or country
View Complete Plan Benefits
View Complete Plan Benefits

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Visit the Michigan Coronavirus Vaccine information web page for a list of health departments offering the vaccine and to schedule your vaccine appointment.

Learn more about how PHP Medicare is helping members through the COVID-19 outbreak.

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