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2019 : Choose Between Our $0 Core and $44 Choice Plans

These plans are available in 15 Nebraska counties: Burt, Butler, Cass, Colfax, Cuming, Dodge, Douglas, Gage, Lancaster, Otoe, Saline, Saunders, Sarpy, Seward, and Washington. With these plans, you’ll have predictable, easy-to-budget costs for doctor office visits, prescription drugs, and more. Each plan offers a different level of benefits and out-of-pocket cost, so you can choose the one that is best suited to your needs.

Hospital & Medical Benefits

Click for more details Medicare Advantage Core (HMO) Medicare Advantage Choice (HMO-POS)
Monthly Premium
n/a
$0 $44
Travel Coverage  
Travel coverage means if you travel outside of the state you will be covered similar to in-state in-network benefits.
No Yes
Maximum Out of Pocket Limit (In network / Combined In & Out network)  
Maximum out of pocket means the total amount you are responsible to pay for Medicare-covered services.
$6,400 $5,700 / $6,700
Primary Care Doctor Visits  
This is your personally selected Physician to help guide your care.
$15 $10
Physician Specialist Doctor Visits  
Physicians that have expertize and focus in one area of healhcare.
$45 $40
Inpatient Hospitial - Acute $372 per day for days 1-5
$0 per day for days 6+
$360 per day for days 1-5
$0 per day for days 6+
Outpatient Hospital Surgery $300 per day $200 per day
Urgent Care / Emergency Care $55 / $90 $55 / $90
Inpatient Skilled Nursing Facility  
These facilites have the staff and equipment to give skilled nursing care or rehab services, they could be part of a hospital or nursing home.
$0 per day for days 1-20
$172 per day for days 21-100
$0 per day for days 1-20
$169 per day for days 21-100
Routine Eye Exam  
Exam to diagnose diseases and conditions of the eye.
$20 $0
Routine Hearing Exam  
Exam to diagnose hearing and balance problems.
$20 $0
Fitness Benefit  
Specialized fitness program designed for seniors.
SilverSneakers SilverSneakers

 

Prescription Drug Benefits

  Medicare Advantage Core (HMO) Medicare Advantage Choice (HMO-POS)
30-day Retail Supply 90-day Mail Order 30-day Retail Supply 90-day Mail Order
Preferred Cost Sharing Standard Cost Sharing Preferred Cost Sharing Standard Cost Sharing
Tier 1: Preferred Generic Drugs $4 $14 $0 $2 $12 $0
Tier 2: Generic Drugs $8 $18 $24 $8 $18 $24
Tier 3: Preferred Brand Drugs $37 $47 $111 $37 $47 $111
Tier 4: Non-Preferred Drugs 45% 45% 45% 45% 45% 45%
Tier 5: Specialty Drugs 27% 27% N/A 30% 30% N/A
Additional Gap Coverage No No

 

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