PHP Advantage Plus (HMO-POS)
Complete Coverage With One Plan From One Company
Unlike Original Medicare, PHP Advantage Plus bundles your medical, hospital and prescription drug coverage together in one comprehensive plan. The plan comes with valuable extra benefits that save you even more.
$25 Monthly Premium and NO Deductibles
PHP Advantage Plus is available for a $25 monthly premium. There are also no annoying deductibles to meet. Your coverage begins right away.
Low Copay on Generic Prescriptions
Save even more money on your prescription drugs when you fill your prescription at preferred pharmacies. PHP Advantage Plus members can get generic prescriptions for low copays and reduced copays on brand-name medications at any participating preferred pharmacy.
Important Financial Protection
PHP Advantage Plus protects your savings and retirement by putting an annual limit on what you have to pay out of your own pocket for your covered medical expenses – important protection not offered by Original Medicare plans.
Important Travel Coverage
Whether you are making a trip out of the state or out of the country, we have you covered. If you ever get sick or injured when away from home, you can rest easy knowing you have in-network emergency or urgent care coverage.
Valuable Extra Benefits That Save You Money
Every PHP Advantage Plus plan comes with important extra benefits for no additional premium including dental, vision, transportation to and from Doctor appointments, free memberships to health clubs through the popular SilverSneakers® program and coverage on over-the-counter products such as non-prescription drugs and health-related items.
Benefits at a Glance:
We Have Got You Covered From Head to Toe
The following table highlights just some of the many in-network benefits available to you as a valued PHP Advantage member. For more details and a complete list of benefits, please review our Summary of Benefits or Evidence of Coverage which can be downloaded by clicking the links below.
Medical & Hospital Coverage
Your PHP Advantage plan provides comprehensive medical and hospital coverage with no annual deductible and low copayments for in-network providers.
| PHP Advantage Plus (HMO-POS) | |
| Monthly Premium | $25 |
| Maximum Out-of-Pocket Limit (What’s this?)This means you will never pay more than $3,800 per year for covered medical expenses, even if you have an unexpected illness or injury. If you reach this limit, you will no longer have to pay any copays or co-insurance. | $3,800 Per Year |
| Annual Medical Deductible | $0 Per Year |
| Preventive Care/Screenings | $0 Copay |
| Primary Care Doctor Visits | $5 Copay |
| Specialty Care Doctor Visits | $30 Copay |
| NEW for 2021! | No referrals for in-network specialist visits! |
| Urgent Care | $60 Copay |
| Emergency Care | $90 Copay |
| Lab Services | $10 Copay |
| Home Healthcare | 100% Coverage |
| Chiropractic Services | $20 Copay |
| Inpatient Hospital Care | $200 Copay Per Day for Days 1-7, $0 Per Day for Days 8 and beyond |
| Outpatient Surgery at Hospital | $150 Copay |
| Outpatient Surgery at Ambulatory Surgical Center | $100 Copay |
Part D Drug Coverage
This table shows the drug tiers associated with your plan, and the copayments or co-insurance that you will pay in each tier. A drug formulary provides a list of drugs that are covered by our plan.
| PHP Advantage Plus (HMO-POS) | ||
| Preferred Pharmacies | Other Network Pharmacies | |
| Annual Part D Deductible | $0 Per Year | $0 Per Year |
| Tier 1 – Preferred Generics | $0 Copay | $5 Copay |
| Tier 2 – Generics | $0 Copay | $10 Copay |
| Tier 3 – Preferred Brands | $40 Copay | $45 Copay |
| Tier 4 – Non-Preferred Brands | $90 Copay | $95 Copay |
| Tier 5 – Specialty Drugs | 33% Co-insurance | 33% Co-insurance |
| Initial Coverage Limit | $4,130 Per Year | $4,130 Per Year |
Part D drug expenses are not covered under the maximum out-of-pocket limit.
Extra Benefits
Your PHP Advantage Plus plan offers many valuable extras not offered by Original Medicare or Medicare supplement plans–at no additional cost to you.
| PHP Advantage Plus (HMO-POS) | |
| Vision Care | $25 Copay for routine eye exam $0 Copay for a pair of eye glass frames or contact lenses (2 six packs) |
| Preventative Dental Care | $0 Copay |
| Comprehensive Dental Care | $100 Deductible $1,000 maximum benefit per year |
| Over-the-Counter (OTC) Items | $75 per quarter Up to 2 orders per quarter; no rollover |
| Hearing | $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 30 one-way trips to approved locations per year |
| SilverSneakers® Fitness Benefits (What’s this?)PHP Advantage Plus wants to help you achieve and maintain long-lasting health and wellness. SilverSneakers® is a fun, energizing program that helps people with Medicare take greater control of their health by encouraging physical activity and offering social events…and it includes a fitness center membership to any participating location across the country at no extra cost to you! | Included at no additional cost |
| Travel Coverage | Emergency or urgent care coverage if you are making a trip out of state or country |
| Meal Benefit | 28 meals (2 meals/day for 14 days) delivered to your home after discharge from inpatient acute care or a skilled nursing facility (limit 2 discharges annually) |
Extra benefit expenses are not covered under the maximum out-of-pocket limit.
