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Senior Health Plan Comparison

Senior Health Plan has the benefits and providers you want. Click on the plans below to learn more. Note that not all plans are available in the same counties.

Silver Plus

Medical and Prescription
Service Area
Premium
$0 per month
Maximum Out-of-Pocket
$4,200
Primary Care Physician
$0 copay per visit
Specialist
$30 copay per visit
Emergency Room
$90 copay per visit. Waived if admitted.
Urgent Care
$30 copay per visit
Outpatient Hospital
$235 copay
Outpatient Rehabilitation
$15 copay per visit
Outpatient Diagnostic Services
$0-$150 copay, depending on the service
Hospital
$240 per day for days 1-5
DME
0% for most; 15% for wheelchairs, etc.

Platinum

Medical and Prescription
Service Area
Premium
$19 per month
Maximum Out-of-Pocket
$3,900
Primary Care Physician
$0 copay per visit
Specialist
$25 copay per visit
Emergency Room
$90 copay per visit. Waived if admitted.
Urgent Care
$25 copay per visit
Outpatient Hospital
$225 copay
Outpatient Rehabilitation
$10 copay per visit
Outpatient Diagnostic Services
$0-$100 copay, depending on the service
Hospital
$235 per day for days 1-5
DME
0% for most; 15% for wheelchairs, etc.

Platinum Plus

Medical and Prescription
Service Area
Premium
$83 per month
Maximum Out-of-Pocket
$4,700
Primary Care Physician
$0 copay per visit
Specialist
$25 copay per visit
Emergency Room
$90 copay per visit. Waived if admitted.
Urgent Care
$25 copay per visit
Outpatient Hospital
$200 copay
Outpatient Rehabilitation
$20 copay per visit
Outpatient Diagnostic Services
$0 - $155 copay, depending n the service
Hospital
$220 per day for days 1-7
DME
0% for most; 15% for wheelchairs, etc.

Silver Savings

Medical Benefits Only
Service Area
Premium
$0 per month
Maximum Out-of-Pocket
$4,200
Primary Care Physician
$0 copay per visit
Specialist
$30 copay per visit
Emergency Room
$90 copay per visit. Waived if admitted.
Urgent Care
$30 copay per visit
Outpatient Hospital
$250 copay
Outpatient Rehabilitation
$20 copay per visit
Outpatient Diagnostic Services
$0 - $100 copay, depending n the service
Hospital
$265 per day for days 1-7
DME
0% for most; 15% for wheelchairs, etc.

Silver

Medical Benefits Only
Service Area
Premium
$0 per month
Maximum Out-of-Pocket
$3,400
Primary Care Physician
$0 copay per visit
Specialist
$5 copay per visit
Emergency Room
$90 copay per visit. Waived if admitted.
Urgent Care
$5 copay per visit
Outpatient Hospital
$25 copay
Outpatient Rehabilitation
$0 copay per visit
Outpatient Diagnostic Services
$0-$125 copay, depending on the service
Hospital
$25 per day for days 1-7
DME
0% for most; 15% for wheelchairs, etc.

Dual Eligibility

Medical and Prescription
Service Area
Premium
$0 per month
Maximum Out-of-Pocket
$8,850
Primary Care Physician
You pay $0 or 20%
Specialist
You pay $0 or 20%
Emergency Room
You pay $0 to 20% up to $110 per visit. Waived if admitted.
Urgent Care
You pay $0 to 20% up to $45 per visit
Outpatient Hospital
You pay $0 or 20%
Outpatient Rehabilitation
You pay $0 or 20%
Outpatient Diagnostic Services
You pay $0 or 20%
Hospital
You pay $1,676
DME
$0-20% for most Medicare-covered durable medical equipment

Extra Benefits

Dental
$0 for two preventive visits; $1,500 comprehensive; Prosthetics Endodontics Dentures 50% copay
Eyewear
$0 copay for eyewear up to $400 per year
OTC
$85 per quarter
Hearing Aids
Covered in Wallet
Wallet
Wallet benefit maximum is $500 per year. Wearable fitness devices are limited to $100.
Transportation
$0 copay up to 12 one-way trips. 50 mile one-way limit
Dental
$0 for two preventive visits; $1,500 comprehensive; Prosthetics Endodontics Dentures 50% copay
Eyewear
$0 copay for eyewear up to $400 per year
OTC
$85 per quarter
Hearing Aids
Up to $500 every 2 years
Wallet
Wallet benefit maximum is $500 per year. Wearable fitness devices are limited to $100.
Transportation
$0 copay up to 12 one-way trips. 50 mile one-way limit
Dental
$0 for two preventive visits; $1,500 comprehensive; Prosthetics Endodontics Dentures 50% copay
Eyewear
$0 copay for eyewear up to $200 per year
OTC
$40 per quarter
Hearing Aids
Up to $500 every 2 years
Wallet
Wallet benefit maximum is $300 per year. Wearable fitness devices are limited to $100.
Transportation
$0 copay up to 12 one-way trips. 50 mile one-way limit
Dental
$0 for two preventive visits; $1,500 comprehensive; Prosthetics Endodontics Dentures 50% copay
Eyewear
$0 copay for eyewear up to $300 per year
OTC
$50 per quarter
Hearing Aids
Up to $500 every 2 years
Wallet
Wallet benefit maximum is $350 per year. Wearable fitness devices are limited to $100.
Transportation
$0 copay up to 12 one-way trips. 50 mile one-way limit
Dental
$0 for two preventive visits; $1,500 comprehensive; Prosthetics Endodontics Dentures 50% copay
Eyewear
$0 copay for eyewear up to $200 per year
OTC
$40 per quarter
Hearing Aids
Up to $500 every 2 years
Wallet
Wallet benefit maximum is $350 per year. Wearable fitness devices are limited to $100.
Transportation
$0 copay up to 12 one-way trips. 50 mile one-way limit
Dental
$0 for two preventive visits; $1,500 comprehensive; Prosthetics Endodontics Dentures 50% copay
Eyewear
You pay $0 for eyewear up to $475
OTC
$240 per month
Hearing Aids
No copay up to plan benefit limit of $500 for hearing aids. Benefit can be used once every two years. Must use approved vendor for fitting and evaluation and hearing aid purchase.
Wallet
N/A
Transportation
$0 copay up to 36 one-way trips. 50 mile one-way limit

Part D

Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
$5 copay
Tier 3 - Preferred Brand Name
$47 copay
Insulin Tier
$35
Tier 4 - Non-Preferred Drugs
You pay 40%
Tier 5 - Specialty Tier
You pay 33%
Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
$5 copay
Tier 3 - Preferred Brand Name
$47 copay
Insulin Tier
$35
Tier 4 - Non-Preferred Drugs
You pay 40%
Tier 5 - Specialty Tier
You pay 33%
Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
$5 copay
Tier 3 - Preferred Brand Name
$47 copay
Insulin Tier
$35
Tier 4 - Non-Preferred Drugs
You pay 40%
Tier 5 - Specialty Tier
You pay 33%
Tier 1 - Preferred Generic
N/A
Tier 2 - Generic
N/A
Tier 3 - Preferred Brand Name
N/A
Insulin Tier
N/A
Tier 4 - Non-Preferred Drugs
N/A
Tier 5 - Specialty Tier
N/A
Tier 1 - Preferred Generic
N/A
Tier 2 - Generic
N/A
Tier 3 - Preferred Brand Name
N/A
Insulin Tier
N/A
Tier 4 - Non-Preferred Drugs
N/A
Tier 5 - Specialty Tier
N/A
Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
You pay $0
Tier 3 - Preferred Brand Name
You pay 24% Coinsurance
Insulin Tier
$35
Tier 4 - Non-Preferred Drugs
You pay 25%
Tier 5 - Specialty Tier
You pay 25%



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