2022 Asuris Esteem (PPO)


Asuris Esteem (PPO) H5010-001 is a 2022 Medicare Advantage Plan or Part-C by Asuris Northwest Health available to residents in Washington. This plan does not provide additional prescription drug (Part-D) coverage. The Asuris Esteem (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,000 out-of-pocket. This can be a extremely nice safety net.

Asuris Esteem (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.

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




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2022 Asuris Northwest Health Medicare Advantage Plan Costs

Name:
Asuris Esteem (PPO)
Plan ID:
H5010-001
Provider:Asuris Northwest Health
Year:2022
Type: Local PPO *
Monthly Premium C+D: $0
Part C Premium:
MOOP: $5,000
Similar Plan: H5010-002
New Plan: 2023 H5010-002




2021 Asuris Esteem (PPO) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


No



Comprehensive Dental


Diagnostic services $0 copay
Diagnostic services 50% coinsurance (Out-of-Network)
Endodontics 50% coinsurance
Endodontics 50% coinsurance (Out-of-Network)
Extractions 50% coinsurance (Out-of-Network)
Extractions 50% coinsurance
Non-routine services 50% coinsurance (Out-of-Network)
Non-routine services $0 copay
Periodontics 50% coinsurance (Out-of-Network)
Periodontics 50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services 50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services 50% coinsurance (Out-of-Network)
Restorative services 50% coinsurance
Restorative services 50% coinsurance (Out-of-Network)



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) 20% coinsurance
Diagnostic radiology services (e.g., MRI) 30% coinsurance (Out-of-Network)
Diagnostic tests and procedures 30% coinsurance (Out-of-Network)
Diagnostic tests and procedures $10 copay
Lab services $0-10 copay
Lab services 30% coinsurance (Out-of-Network)
Outpatient x-rays $10 copay
Outpatient x-rays 30% coinsurance (Out-of-Network)



Doctor Visits


Primary $5 copay per visit
Primary 30% coinsurance per visit (Out-of-Network)
Specialist 30% coinsurance per visit (Out-of-Network)
Specialist $40 copay per visit



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $40 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment 30% coinsurance (Out-of-Network)
Foot exams and treatment $40 copay
Routine foot care Not covered



Ground Ambulance


$275 copay
$275 copay (Out-of-Network)



Hearing


Fitting/evaluation Not covered
Hearing aids $699-999 copay
Hearing aids $699-999 copay (Out-of-Network)
Hearing exam $40 copay
Hearing exam 30% coinsurance (Out-of-Network)



Inpatient Hospital Coverage


$360 per day for days 1 through 4
$0 per day for days 5 through 90
30% per day for days 1 and beyond (Out-of-Network)



Medical Equipment/Supplies


Diabetes supplies 30% coinsurance per item (Out-of-Network)
Diabetes supplies $0 copay
Durable medical equipment (e.g., wheelchairs, oxygen) 30% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 30% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Chemotherapy 30% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance
Other Part B drugs 30% coinsurance (Out-of-Network)



Mental Health Services


Inpatient hospital - psychiatric $360 per day for days 1 through 4
$0 per day for days 5 through 90
Inpatient hospital - psychiatric 30% per day for days 1 through 190 (Out-of-Network)
Outpatient group therapy visit $40 copay
Outpatient group therapy visit 30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $40 copay
Outpatient group therapy visit with a psychiatrist 30% coinsurance (Out-of-Network)
Outpatient individual therapy visit 30% coinsurance (Out-of-Network)
Outpatient individual therapy visit $40 copay
Outpatient individual therapy visit with a psychiatrist $40 copay
Outpatient individual therapy visit with a psychiatrist 30% coinsurance (Out-of-Network)



MOOP


$10,000 In and Out-of-network
$5,000 In-network



Option


Yes, contact plan for further details



Optional supplemental benefits


No



Outpatient Hospital Coverage


$40-350 copay per visit
30% coinsurance per visit (Out-of-Network)



Preventive Care


30% coinsurance (Out-of-Network)
$0 copay



Preventive Dental


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



Rehabilitation Services


Occupational therapy visit 30% coinsurance (Out-of-Network)
Occupational therapy visit $40 copay
Physical therapy and speech and language therapy visit $40 copay
Physical therapy and speech and language therapy visit 30% coinsurance (Out-of-Network)



Skilled Nursing Facility


$0 per day for days 1 through 20
$160 per day for days 21 through 100
30% per day for days 1 through 100 (Out-of-Network)



Transportation


Not covered



Vision


Contact lenses 0-50% coinsurance (Out-of-Network)
Contact lenses $0 copay
Eyeglass frames $0 copay
Eyeglass frames 0-50% coinsurance (Out-of-Network)
Eyeglass lenses $0 copay
Eyeglass lenses 0-50% coinsurance (Out-of-Network)
Eyeglasses (frames and lenses) Not covered
Other Not covered
Routine eye exam 30% coinsurance (Out-of-Network)
Routine eye exam $0 copay
Upgrades Not covered



Wellness Programs (e.g. fitness nursing hotline)


Covered




CMS Star Ratings for Asuris Esteem (PPO) H5010



2021 Overall Rating
Part C Summary Rating
Part-D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Asuris Esteem (PPO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for Asuris Esteem (PPO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Asuris Esteem (PPO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes



Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST




Coverage Area for Asuris Esteem (PPO)

(Click county to compare all available Advantage plans)

State: Washington
County: Chelan

Spokane



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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

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