Whatdoes Security Blue Hmo for 2018 Allegheny County Deluxe Covet

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1. PA
2. Highmark Inc.
3. Plan

Security Blue HMO-POS Deluxe (HMO-POS)

Medicare Plan Details (2022 Plan)

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Monthly Premium

by Highmark Inc.

Additional Coverage

Hearing Vision Dental

Overall Government Star Rating

5.0

out of 5 stars

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Ready to Enroll Online?

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Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D

Health Portion of Premium

Health Plan Max Out-of-Pocket

$10,000 In and Out-of-network
$4,500 In-network

Nationwide Coverage included

Hearing Coverage included

Doctor Services

Primary doctor visit

In-network: $0 copay
Out-of-network: $0 copay

Specialist visit

In-network: $25 copay per visit
Out-of-network: $25 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures

In-network: $0-10 copay
Out-of-network: $15 copay

Lab services

In-network: $0-10 copay
Out-of-network: $15 copay

Diagnostic radiology services (like MRI)

In-network: $100 copay
Out-of-network: $150 copay

Outpatient x-rays

In-network: $15 copay
Out-of-network: $30 copay

Emergency care

$90 copay per visit (always covered)

Urgent care

$50 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage

In-network: $210 per stay
Out-of-network: $260 per stay

Outpatient hospital coverage

In-network: $200 copay per visit
Out-of-network: $250 copay per visit

Skilled nursing facility

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$188 per day for days 21 through 100
Out-of-network: Not Applicable

Preventive services

Preventive services

In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance

In-network: $160 copay
Out-of-network: No Data

Therapy services

Occupational therapy visit

In-network: $25 copay
Out-of-network: $30 copay

Physical therapy & speech & language therapy visit

In-network: $25 copay
Out-of-network: $30 copay

Mental health services

Outpatient group therapy with a psychiatrist

In-network: $25 copay
Out-of-network: $30 copay

Outpatient individual therapy with a psychiatrist

In-network: $25 copay
Out-of-network: $30 copay

Outpatient group therapy visit

In-network: $25 copay
Out-of-network: $30 copay

Outpatient individual therapy visit

In-network: $25 copay
Out-of-network: $30 copay

Opioid treatment services

Opioid treatment services

Other services

Durable medical equipment (like wheelchairs & oxygen)

In-network: 20% coinsurance per item
Out-of-network: No Data

Prosthetics (like braces, artificial limbs)

In-network: 20% coinsurance per item
Out-of-network: No Data

Diabetes supplies

In-network: 0-20% coinsurance per item
Out-of-network: No Data

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Tiers	Initial coverage phase	Gap coverage phase1	Catastrophic coverage phase
Preferred Generic	$0.00 copay	$0.00 copay	Generic drugs : $3.95 copay or 5% (whichever costs more) Brand-name drugs : $9.85 copay or 5% (whichever costs more)
Generic	$13.00 copay	$13.00 copay
Preferred Brand	$42.00 copay
Non-Preferred Drug	$100.00 copay
Specialty Tier	33%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

Chemotherapy drugs

In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Other Part B drugs

In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Hearing

Hearing exam

In-network: $25 copay
Out-of-network: $25 copay

Hearing aids - All types

In-network: $499-799 copay
Out-of-network: No Data

Preventive Dental

Oral exam

Covered under office visit

Cleaning

Covered under office visit

Dental x-rays

In-network: $15 copay
Out-of-network: No Data

Comprehensive dental

Prosthodontics, other oral/maxillofacial surgery, other services

Vision

Routine eye exam

In-network: $0 copay
Out-of-network: No Data

Contact lenses

In-network: $0 copay
Out-of-network: No Data

Eyeglasses (frames & lenses)

Eyeglass frames (only)

In-network: $0 copay
Out-of-network: No Data

Eyeglass lenses (only)

In-network: $0 copay
Out-of-network: No Data

Upgrades

In-network: $0 copay
Out-of-network: No Data

Other benefits

Over the counter drug benefits

Home and bathroom safety devices

Summary rating of health plan quality

Staying healthy: screenings, tests, & vaccines

Managing chronic (long term) conditions

Member experience with health plan

Member complaints & changes in the health plan's performance

Health plan customer service

Summary rating of drug plan quality

Drug plan customer service

Member complaints & changes in the drug plan's performance

Member experience with the drug plan

Drug safety & accuracy of drug pricing

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Source: https://healthplanradar.com/medicare_plans/pa/highmark-inc/H3957-046-1/security-blue-hmo-pos-deluxe-hmo-pos