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Updated: 7/17/2021Y0131_2021 Webpages_M
CommunityCare is proud to offer Senior Health Plan, a program created especially for Medicare beneficiaries. Senior Health Plan has four Medicare Advantage Plans to fit the varying needs of Medicare beneficiaries.
| Plan Premium | Medical Maximum out of pocket | Additional Benefits (these are benefits not covered by Medicare) | $0 You must continue to pay your Medicare Part B premium | $4,700 |
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| New for 2021 – Wallet Benefit |
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| Your wallet includes benefits for gym memberships, comprehensive dental, home & bathroom safety devices and more.Learn more about your wallet benefit here! |
Common Medical benefits and your copays - remember that if you reach your Medical Maximum Out of Pocket limit, the rest of your Medicare-covered medical services are paid by CommunityCare.
| Doctors Visits | $0 for Primary Care $35 for Specialist |
| Emergency & Urgent Care – Worldwide coverage | $90 for Emergency Room - waived if admitted $35 for Urgent Care |
| Outpatient Hospital | $295 copay |
| Outpatient Rehab (such as Physical Therapy) | $20 copay per visit |
| Outpatient Diagnostic Services | $0-$100 copay, depending on the service |
| Inpatient Hospital | $295 copay each day for days 1-7 |
This plan includes Part D (outpatient prescription drug coverage) - your copay will depend on what Tier level your prescription is. Copays can change if you move out of the Initial Coverage level.
| Initial Coverage Level Copays | 30-day Supply |
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| Tier 1 - Preferred Generic | $5 copay - * $0 copay for an extended day supply |
| Tier 2 - Generic | $13 copay - * $0 copay for an extended day supply |
| Tier 3 - Preferred Brand Name | $40 copay |
| Tier 4 - non-Preferred Drugs | $95 copay |
| Tier 5 - Specialty Tier | 33% of the cost |
* An extended day supply is 100 days or more – a great option for members who rely on maintenance drugs to manage ongoing health conditions. Extended day supply information.
We also have mail order through CVS or Walgreens where you can purchase a 90-day supply of available drugs for a reduced cost. Mail order information.
You can call our Medicare team at (918) 594-5275, TTY/TDD (800)722-0353, for more information on this plan or other options. We are available Monday through Friday from 8:00 to 6:00.
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