2019 Bright Advantage Flex (PPO) H9878-001 By Bright Health

2019 Medicare Advantage Plan Services for
Bright Advantage Flex (PPO)


Bright Advantage Flex (PPO) H9878-001 is a 2019 Medicare Advantage or Medicare Part-C plan by Bright Health available to residents in Ohio. This plan includes additional Medicare prescription drug (Part-D) coverage. The Bright Advantage Flex (PPO) has a monthly premium of $- and has an in-network Maximum Out-of-Pocket limit of $4,600 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,600 out of pocket. This can be a extremely nice safety net.

Bright Advantage Flex (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Bright Health works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Bright Advantage Flex (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Bright Health and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Bright Health except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



COMPARE AND SAVE ON MEDICARE INSURANCE




2019 Bright Health Medicare Advantage Plan Details

Name:
Bright Advantage Flex (PPO)
ID:
H9878-001
Provider:Bright Health
Year:2019
Type: Local PPO
Monthly Premium C+D: $-
Part C Premium:$0.00
MOOP: $4,600
Part D (Drug) Premium:$0.00
Part D Supplemental Premium$0.00
Total Part D Premium:$0.00
Drug Deductible:$0.00
Tiers with No Deductible:0
Gap Coverage:No
Initial Coverage Limit:$3820
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced






Part-C Premium

Bright Health plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.



Part-D Deductible and Premium

Bright Advantage Flex (PPO) has a monthly drug premium of $0.00 and a $0.00 drug deductible. This Bright Health plan offers a $0.00 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Bright Health above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.



Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Bright Advantage Flex (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $0.00 for 75% low income subsidy $0.00 for 50% and $0.00 for 25%.



Full LIS Premium:$0.00
75% LIS Premium:$0.00
50% LIS Premium:$0.00
25% LIS Premium:$0.00


Gap Coverage

In 2019 once you and your plan provider have spent $3820 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for brand-name drugs and 37% on generic drugs unless your plan offers additional coverage. This Bright Health plan does not offer additional coverage through the gap.





Plan Services




Health plan deductible


$0



Emergency care/Urgent care


Emergency $90 per visit (always covered)
Urgent care $35 per visit (always covered)



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures Out-of-Network 45%
Diagnostic tests and procedures In-Network 20%
Lab services Out-of-Network 45%
Lab services In-Network $10
Diagnostic radiology services (e.g., MRI) Out-of-Network 45%
Diagnostic radiology services (e.g., MRI) In-Network 20%
Outpatient x-rays Out-of-Network 45%
Outpatient x-rays In-Network $15



Hearing


Hearing exam Out-of-Network 45%
Hearing exam In-Network $0 copay
Fitting/evaluation Out-of-Network 45%
Fitting/evaluation In-Network $0 copay
Hearing aids Out-of-Network $0 copay
Hearing aids In-Network $0 copay



Preventive dental


Oral exam Out-of-Network 30%
Oral exam In-Network $0 copay
Cleaning Out-of-Network 30%
Cleaning In-Network $0 copay
Fluoride treatment Out-of-Network 30%
Fluoride treatment In-Network $0 copay
Dental x-ray(s) Out-of-Network 30%
Dental x-ray(s) In-Network $0 copay



Comprehensive dental


Non-routine services Not covered
Diagnostic services Not covered
Restorative services Not covered
Endodontics Not covered
Periodontics Not covered
Extractions Not covered
Prosthodontics, other oral/maxillofacial surgery, other services Not covered



Vision


Routine eye exam Out-of-Network $0 copay
Routine eye exam In-Network $0 copay
Other Not covered
Contact lenses Not covered
Eyeglasses (frames and lenses) Not covered
Eyeglass frames Not covered
Eyeglass lenses Not covered
Upgrades Not covered



Mental health services


Inpatient hospital - psychiatric Out-of-Network 45% per day for days 1 through 90
Inpatient hospital - psychiatric In-Network $285 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit with a psychiatrist Out-of-Network 45%
Outpatient group therapy visit with a psychiatrist In-Network $40
Outpatient individual therapy visit with a psychiatrist Out-of-Network 45%
Outpatient individual therapy visit with a psychiatrist In-Network $40
Outpatient group therapy visit Out-of-Network 45%
Outpatient group therapy visit In-Network $40
Outpatient individual therapy visit Out-of-Network 45%
Outpatient individual therapy visit In-Network $40



Skilled Nursing Facility


Out-of-Network 45% per day for days 1 through 100
In-Network $0 per day for days 1 through 20
$172 per day for days 21 through 100



Rehabilitation services


Occupational therapy visit Out-of-Network 45%
Occupational therapy visit In-Network $35
Physical therapy and speech and language therapy visit Out-of-Network 45%
Physical therapy and speech and language therapy visit In-Network $35



Ground ambulance


Out-of-Network $210
In-Network $210



Other health plan deductibles?


In-Network No



Transportation


Not covered



Foot care (podiatry services)


Foot exams and treatment Out-of-Network 45%
Foot exams and treatment In-Network $40
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 45% per item
Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 45% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Diabetes supplies Out-of-Network 45% per item
Diabetes supplies In-Network $0 copay



Wellness programs (e.g., fitness, nursing hotline)


Covered



Medicare Part B drugs


Chemotherapy Out-of-Network 45%
Chemotherapy In-Network 20%
Other Part B drugs Out-of-Network 45%
Other Part B drugs In-Network 20%



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$10,000 In and Out-of-network
$4,600 In-network



Optional supplemental benefits


Yes



Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?


In-Network No



Inpatient hospital coverage


Out-of-Network 45% per day for days 1 and beyond
In-Network $285 per day for days 1 through 5
$0 per day for days 6 through 90



Outpatient hospital coverage


Out-of-Network 45% per visit
In-Network $285 per visit



Doctor visits


Primary Out-of-Network 45% per visit
Primary In-Network $0 copay
Specialist Out-of-Network 45% per visit
Specialist In-Network $35 per visit



Preventive care


Out-of-Network 45%
In-Network $0 copay






Coverage Area for Bright Advantage Flex (PPO)

(Click county to compare all available Advantage plans)



Go to top

Source: CMS.
Data as of September 2, 2018.
Star Rating as of October 10, 2018.
For More Information on Ratings Please See the CMS Tech Notes.
Notes: Data are subject to change as contracts are finalized. For 2019, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Includes 2019 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

Call For A licensed Sales Agent

1-855-492-4169

  • Mon-Fri 8:30am-8:00pm


Or Enroll Online Here

Call to Enroll!