Plan Details
Network Health Medicare Anywhere (PPO)
Ideal for those who prefer a monthly premium and lower copayments.
_Premium
$29 per month
Enroll Now- $29 monthly premium
- $0 medical deductible
- $0 copayment for 90-day mail order Tier 1 drugs
- $10 copayment for primary care provider visits
- $10 copayment for an annual eye exam
- $90 emergency room visit
- 100% coverage for preventive care
- Prescription drug coverage
- Travel coverage
- SilverSneakers® Fitness benefit
- Annual dental exam and cleaning
- Hearing Aid discount benefit
- Freedom to see in- and out-of-network providers
Southeast Medicare Advantage PPO Plan Benefits
Network Health Medicare Anywhere (PPO)
Combined in- and out-of-network
$4,900
Per admission
Out-of-network: $495 per day, Days 1-5 $0 Days 6 and beyond
including Ambulatory Surgical Center Services such as colonoscopies.
Out-of-network: $395
Out-of-network: $15
Out-of-network: $65 copayment
Out-of-network: $15
Copayment is waived if admitted to a U.S. hospital within 24 hours.
Out-of-network: $25
Out-of-network: $45
Out-of-network: $45
Per service
Out-of-network: 25%
Such as MRIs, CT Scans
Out-of-network: $140
Diagnostic
Out-of-network: $25
Does not include services in connection with care, treatment, filling, removal or replacement teeth.
Out-of-network: $55
Annual Maximum: $1,000
Out-of-network: $55
Out-of-network: $395 per day, Days 1-3 $0 days 4 and beyond
Out-of-network: $50
Includes comprehensive outpatient rehabilitation facility.
Out-of-network: $75
Out-of-network: 50% of the cost
Out-of-network: Not covered
Manipulation of the spine to correct when one or more of the bones in your spine move out of position.
Out-of-network: $40
One Touch™ and Accu-Chek™ All other brands are not covered
Out-of-network: $0 for up to a 90-day supply
Out-of-network: 25% of the cost
Out-of-network: $15
Includes a one-year warranty, three office visits, one pack of batteries and one year of loss and damage insurance. Maximum of two hearing aids per year.
$1,220-$1,985 per device.
Save $775–$1,215 per hearing aid.
Eyewear Discounts offered at EyeMed providers.
Network Health Medicare Anywhere (PPO) Drug Plan Costs
$250 For Tiers 4 and 5 only
30-Day Supply Preferred Pharmacy
or Mail Order Pharmacy
$2 for Tier 1 $42 for Tier 3
$8 for Tier 2 $84 for Tier 4
28% for Tier 5
30-Day Supply Standard Pharmacy
$4 for Tier 1 $47 for Tier 3
$14 for Tier 2 $91 for Tier 4
28% for Tier 5
90-Day Supply Preferred Pharmacy
$5 for Tier 1 $105 for Tier 3
$20 for Tier 2 $210 for Tier 4
Tier 5 is not available
90-Day Supply Standard Pharmacy
$10 for Tier 1 $118 for Tier 3
$35 for Tier 2 $228 for Tier 4
Tier 5 is not available
31 to 90-Day Mail Order Pharmacy
$0 for Tier 1
90-Day Mail Order Pharmacy
$0 for Tier 1 $105 for Tier 3
$20 for Tier 2 $210 for Tier 4
Tier 5 is not available
This information is not a complete description of benefits. Call 800-378-5234 (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.