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Plan Details

Network Health Prime (MSA)

Ideal for those who prefer no monthly premium and want to control their health care costs.

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Premium

$0 a month

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  • Medical coverage for people who want control over their health care dollars with a medical savings account and high deductible health plan
  • $1,500 deposited by Medicare in your Medicare Medical Savings Account
  • You pay nothing for Medicare-covered services after you meet your deductible
  • $0 monthly premium
  • $4,600 medical deductible

Medical Savings Account (MSA) Plan Benefits

NetworkPrime (MSA) Benefits

Monthly Premium
$0
Annual Medical Deductible
$4,600
Annual Maximum Out-of-Pocket
$4,600
Primary Care Provider Visit
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Specialist Visit
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Preventive Care
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Annual Medicare Wellness Visit
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Medicare-Covered Vaccines

Flu
Pneumonia
COVID-19

Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Part B Vaccines

Hepatitis B, all other Part B vaccines

Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Inpatient Hospital Services

Per admission

Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Outpatient Hospital Services
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Ambulatory Surgical Center
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Labs
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Diagnostic Tests

Such as ultrasound, EKG, stress test

Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
X-rays
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Diagnostic Radiology Services– Advanced Imaging
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Urgent Care Visit
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Emergency Room Visit
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Air and Ground Ambulance Services
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Durable Medical Equipment

Such as insulin pumps, CPAP machines, prosthetic devices

Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Physician Telehealth Services
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Virtual Visit with MDLIVE®

For medical services1

Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Travel within the United States

Any doctor or hospital in the United States that accepts Medicare beneficiaries should accept your Network Prime plan.

Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Pick Your Perks
Not Included
Preventive Dental Services
Not included
Medicare-Covered Dental Services
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Optional Dental Benefit with Say Cheese Dental Network
$45 monthly premium
Annual Maximum: $1,000
Vision Services and Exams
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Hearing Services and Exams
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Outpatient Mental Health

Individual or group therapy

Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Inpatient Mental Health
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Opioid Treatment Services
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Substance Abuse Services

Outpatient individual or group therapy

Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Skilled Nursing Facility
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Outpatient Physical, Occupational, Speech Therapy
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Chiropractic Services

Manipulation of the spine to correct misalignment of one or more of the bones of your spine

Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Medicare-Covered Acupuncture

For chronic low back pain only, up to 12 visits in 90 days and no more than 20 visits per year

Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Medicare-Covered Home Health Care Visits
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Medicare Part B Drugs and Chemotherapy
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Radiation Therapy
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Diabetes Supplies and Services

One Touch™ and FreeStyle™ test strips | Continuous glucose monitoring supplies limited to eligible FreeStyle Libre® and Dexcom® obtained through your pharmacy. All other brands are not covered.

Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
Non-Emergency Transportation
Not Included
Part B Insulin
Until you meet your annual deductible of $4,600, you pay up to 100% of the Medicare-approved amount. After you meet your annual deductible, you pay $0 for Medicare-covered services. No prior authorization required. For a complete listing of Medicare covered services, visit Medicare.gov.
1Visit networkhealth.com/medicare/extra-benefits for more information.

Network Prime (MSA) Drug Costs

Annual Drug Deductible
This plan does not include drug coverage
INITIAL COVERAGE Amount shown is the maximum you will pay, you may pay less.
This plan does not include drug coverage
Catastrophic Coverage
This plan does not include drug coverage

This plan does not include prescription drug coverage. However, you can combine it with a Stand Alone Prescription Drug Plan. You can also use your savings account to help pay for prescription drug coverage.This information is not a complete description of benefits. Call 800-378-5237 (TTY 800-947-3529) for more information. Out-of-network/non-contracted providers are under no obligation to treat Network Health members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. You must file Form 1040, ‘US Individual Income Tax Return,’ along with Form 8853, Archer MSA and Long-Term Care Insurance Contracts’ with the Internal Revenue Service (IRS) for any distributions made from your Medicare MSA account to ensure you aren’t taxed on your MSA account withdrawals. You must file these tax forms for any year in which an MSA account withdrawal is made, even if you have no taxable income or other reason for filing a Form 1040. MSA account withdrawals for qualified medical expenses are tax free, while account withdrawals for non-medical expenses are subject to both income tax and a fifty (50) percent tax penalty. Tax publications are available on the IRS website at http://www.irs.gov or from 1-800-TAX-FORM (1-800-829-3676).

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