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 Benefit28 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.


Important Plan Documents to Download

COVID-19 vaccinations for those 65 years of age and older are available through Michigan local health departments.
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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