2020 Bright Advantage Choice (HMO-POS) H7853-003 By Bright Health.

2020 Medicare Advantage Plan Services for
Bright Advantage Choice (HMO-POS)


Bright Advantage Choice (HMO-POS) H7853-003 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by Bright Health available to residents in Colorado. This plan includes additional Medicare prescription drug (Part-D) coverage. The Bright Advantage Choice (HMO-POS) has a monthly premium of $- and has an in-network Maximum Out-of-Pocket limit of $4,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,500 out of pocket. This can be a extremely nice safety net.

Bright Advantage Choice (HMO-POS) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

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 Choice (HMO-POS) 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.





2020 Bright Health Medicare Advantage Plan Details

Name:
Bright Advantage Choice (HMO-POS)
ID:
H7853-003
Provider:Bright Health
Year:2020
Type: Local HMO
Monthly Premium C+D: $-
Part C Premium:$0.00
MOOP: $4,500
Part D (Drug) Premium:$0.00
Part D Supplemental Premium$0.00
Total Part D Premium:$0.00
Drug Deductible:$150.00
Tiers with No Deductible:1
Gap Coverage:Yes
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 Choice (HMO-POS) has a monthly drug premium of $0.00 and a $150.00 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 Choice (HMO-POS) 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 2020 once you and your plan provider have spent $4020 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 prescription drugs unless your plan offers additional coverage. This Bright Health plan does offer additional coverage through the gap.



Bright Health Drug Coverage and Formulary

A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 Bright Advantage Choice (HMO-POS) H7853-003 Formulary here.

Drug Tier Copay
Preferred
Copay
Nonpreferred
1 NA $0
2 NA $8
3 NA $47
4 NA $100
5 NA 30%
6 NA $0
*Initial Coverage Phase and 30 day supply

See the 2020 Bright Health Formulary





2019 Plan Services

(*2020 Plan services will be added when available)




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 In-Network 20%
Lab services Out-of-Network 35%
Lab services In-Network $0 copay
Diagnostic radiology services (e.g., MRI) In-Network 20%
Outpatient x-rays Out-of-Network 35%
Outpatient x-rays In-Network $0 copay



Hearing


Hearing exam In-Network $0 copay
Fitting/evaluation In-Network $0 copay
Hearing aids In-Network $0 copay



Preventive dental


Oral exam In-Network $10
Cleaning In-Network $10
Fluoride treatment In-Network $15
Dental x-ray(s) In-Network $15



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 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 Not Applicable
Inpatient hospital - psychiatric In-Network $295 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit with a psychiatrist In-Network $10
Outpatient individual therapy visit with a psychiatrist In-Network $40
Outpatient group therapy visit In-Network $10
Outpatient individual therapy visit In-Network $40



Skilled Nursing Facility


Out-of-Network Not Applicable
In-Network $0 per day for days 1 through 20
$172 per day for days 21 through 100



Rehabilitation services


Occupational therapy visit In-Network $35
Physical therapy and speech and language therapy visit In-Network $35



Ground ambulance


In-Network $220



Other health plan deductibles?


In-Network No



Transportation


Not covered



Foot care (podiatry services)


Foot exams and treatment In-Network $45
Routine foot care Not covered



Medical equipment/supplies


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



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


Not covered



Medicare Part B drugs


Chemotherapy In-Network 20%
Other Part B drugs In-Network 20%



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


$4,500 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 Not Applicable
In-Network $295 per day for days 1 through 5
$0 per day for days 6 through 90



Outpatient hospital coverage


In-Network $280 per visit



Doctor visits


Primary Out-of-Network 35% per visit
Primary In-Network $0 copay
Specialist Out-of-Network 35% per visit
Specialist In-Network $40 per visit



Preventive care


In-Network $0 copay




Coverage Area for Bright Advantage Choice (HMO-POS)

(Click county to compare all available Advantage plans)



Go to top

Source: CMS.
Data as of September 4, 2019.
Star Rating as of October 10, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change as contracts are finalized. For 2020, 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 2020 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!