Medicare Advantage plan options and details

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Enroll now with a Medicare expert

Order an enrollment kit or contact one of our Medicare experts: 

Phone:  1-833-551-0565 (TTY:711) 

Email us: WFH.MAPDSales@ssmhealth.com 

 

2022 Plans

Integrity (HMO-POS)

$
0
Monthly Premium
  • Part D coverage
    Yes
  • Part B premium reduction^
    $35
  • Out-of-network coverage
    Yes
  • In-home support services
    10 hours/month
  • Primary care
    $0*/$50**
  • Specialist
    $35*/$50**
  • Urgent care
    $35 in- & out-of-network
  • Emergency room
    $120 in- & out-of-network
  • Ambulance
    $300 in- & out of network
  • Hospital daily copay: 1-7 days
    $325*/$500**
  • Therapy: PT, OT & speech
    $35*/$60**
  • Outpatient surgery
    $275*/20%
  • Max out-of-pocket+
    In-network: $2,500; Combined in- & out-of-network: $5,000

Harmony (HMO-POS MA-only)

$
0
Monthly Premium
  • Part D coverage
    N/A
  • Part B premium reduction^
    $50
  • Out-of-network coverage
    Yes
  • In-home support services
    10 hours/month
  • Primary care
    $0*/$50**
  • Specialist
    $35*/$50**
  • Urgent care
    $35 in- & out-of-network
  • Emergency room
    $120 in- & out-of-network
  • Ambulance
    $300 in- & out of network
  • Hospital daily copay: 1-7 days
    $325*/$500** daily
  • Therapy: PT, OT & speech
    $35*/$60
  • Outpatient surgery
    $275*/20%**
  • Max out-of-pocket+
    In-network: $2,500; Combined in- & out-of-network: $5,000

*In-network; **Out-of network;
^ Benefit reduces your monthly Part B premium; + Payments for prescription drugs do not count toward annual maximum out-of-pocket limits.


2022 additional benefit overview

All plans include

$
0
Additional benefits
  • Preventive & comprehensive dental
    - No waiting period, deductibles or coinsurance - Preventive and diagnostic services: $0 copay -Gum disease maintenance and bridge/implants/dentures repairs: $45 copay - Fillings, non-surgical gum disease treatment and extractions: $95 copay - Root canals, bridges, implants, dentures, crowns, & surgical gum disease treatment: $595 copay - $1,500 in dental services covered per year
  • In-home and virtual support from Papa
    Visits in your home or virtually for up to 10 hours per month
  • Over-the-counter items
    - $60 per quarter to spend on eligible over-the-counter products like bandages, pain relievers and much more - In-store at participating retailers including Walgreens, CVS, Walmart and Dollar General stores - Online at OTCNetwork.com - Mail-order catalog
  • Hearing
    One $0 routine hearing exam and a $750 hearing aid allowance per year at in-network hearing aid providers
  • Transportation
    We partnered with Lyft to cover 24 one-way personal rides each year to medical appointments and to the pharmacy
  • Post-discharge meals
    14 meals from Mom’s Meals delivered to your door after you are discharged from the hospital or a skilled nursing facility
  • Fitness
    The Silver&Fit® program includes: - Fitness center memberships - Home fitness kit with a Fitbit, Garmin or other exercise equipment - 8,000+ on-demand videos
  • Nurse line
    Nurses are available for free 24 hours a day, 365 days a year
  • Living Healthy rewards
    Earn up to $150 in rewards for completing healthy activities like receiving a flu shot, going to the dentist and getting an annual physical

See our additional benefits page for more information


2022 Part D prescription drug coverage overview




SSM Integrity



No Part D deductible




1 month/30 days3 month/90 days

Preferred retail and mail order

Tier 1: $0
Tier 2: $5
Tier 3: $40
Tier 4: $90
Tier 5: 33% cost sharing

Tier 1: $0
Tier 2: $10
Tier 3: $100
Tier 4: $270
Tier 5:not applicable

Standard retail


Tier 1: $7
Tier 2: $12
Tier 3: $47
Tier 4: $100
Tier 5: 33% cost sharing

Tier 1: $7
Tier 2: $24
Tier 3: $117.50
Tier 4: $300
Tier 5: not applicable

Coverage gap (donut hole)


25% coinsurance


Catastrophic coverage


Generic: 5% or $3.95
Brand: 5% or $9.85

Drug dispensing fees may apply

SSM Harmony (HMO-POS) MA only: 

SSM Harmony does not offer Part D prescription drug coverage. This is an excellent choice if you already have prescription drug coverage through a State Prescription Drug Assistance Program, TRICARE for Life, the VA or an employer plan. You cannot have a Medicare Part D Prescription Drug plan if you enroll in the SSM Harmony plan.

Out-of-network services 

Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. HMO-POS members: most providers are likely to accept you with the out-of-network coverage on your plan (SSM Integrity and SSM Harmony plans). HMO members (SSM Unity and SSM Companion plans): for a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service.

Call our Customer Care Center at 1-877-301-3326 (TTY:711) or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

View our Medicare disclaimers

H8019_wellfirsthealth.com
Updated 11/23/21