2022 Network PlatinumPlus (PPO)


Network PlatinumPlus (PPO) H5215-001 is a 2022 Medicare Advantage Plan or Part-C by Network Health Medicare Advantage Plans available to residents in Wisconsin. This plan does not provide additional prescription drug (Part-D) coverage. The Network PlatinumPlus (PPO) has a monthly premium of $51.00 and has an in-network maximum out-of-pocket limit of $3,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,400 out-of-pocket. This can be a extremely nice safety net.

Network PlatinumPlus (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.

Network Health Medicare Advantage Plans works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Network PlatinumPlus (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Network Health Medicare Advantage Plans 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 Network Health Medicare Advantage Plans except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.




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2022 Network Health Medicare Advantage Plans Medicare Advantage Plan Costs

Name:
Network PlatinumPlus (PPO)
Plan ID:
H5215-001
Provider:Network Health Medicare Advantage Plans
Year:2022
Type: Local PPO *
Monthly Premium C+D: $51.00
Part C Premium:
MOOP: $3,400
Similar Plan: H5215-002
New Plan: 2023 H5215-002




2021 Network PlatinumPlus (PPO) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


No



Comprehensive Dental


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



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $25-100 copay (Out-of-Network)
Diagnostic radiology services (e.g., MRI) $25-100 copay
Diagnostic tests and procedures $5-25 copay (Out-of-Network)
Diagnostic tests and procedures $5-25 copay
Lab services $0-5 copay
Lab services $0-10 copay (Out-of-Network)
Outpatient x-rays $25 copay (Out-of-Network)
Outpatient x-rays $25 copay



Doctor Visits


Primary $15 copay per visit (Out-of-Network)
Primary $15 copay per visit
Specialist $40 copay per visit
Specialist $40 copay per visit (Out-of-Network)



Emergency care/Urgent Care


Emergency $120 copay per visit (always covered)
Urgent care $15-40 copay per visit (always covered)



Foot Care (podiatry services)


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



Ground Ambulance


$250 copay
$250 copay (Out-of-Network)



Hearing


Fitting/evaluation Not covered
Hearing aids $795-2,370 copay
Hearing aids $795-2,370 copay (Out-of-Network)
Hearing exam $25 copay
Hearing exam $25 copay (Out-of-Network)



Inpatient Hospital Coverage


$175 per day for days 1 through 5
$0 per day for days 6 and beyond (Out-of-Network)
$175 per day for days 1 through 5
$0 per day for days 6 through 90



Medical Equipment/Supplies


Diabetes supplies $0-10 copay per item (Out-of-Network)
Diabetes supplies $0 copay
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item (Out-of-Network)



Medicare Part B Drugs


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



Mental Health Services


Inpatient hospital - psychiatric $150 per day for days 1 through 10
$0 per day for days 11 through 190 (Out-of-Network)
Inpatient hospital - psychiatric $150 per day for days 1 through 10
$0 per day for days 11 through 90
Outpatient group therapy visit $35 copay
Outpatient group therapy visit $35 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $35 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $35 copay
Outpatient individual therapy visit $35 copay
Outpatient individual therapy visit $35 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $35 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $35 copay



MOOP


$3,400 In and Out-of-network
$3,400 In-network



Option


No



Optional supplemental benefits


Yes



Outpatient Hospital Coverage


$350 copay per visit (Out-of-Network)
$350 copay per visit



Package #1


Deductible $100.00
Monthly Premium $38.00



Preventive Care


$0 copay (Out-of-Network)
$0 copay



Preventive Dental


Cleaning Covered under office visit
Dental x-ray(s) Not covered
Fluoride treatment Not covered
Office visit $0 copay (Out-of-Network)
Office visit $30.00
Oral exam Covered under office visit



Rehabilitation Services


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



Skilled Nursing Facility


$20 per day for days 1 through 20
$184 per day for days 21 through 54
$0 per day for days 55 through 100
$20 per day for days 1 through 20
$184 per day for days 21 through 54
$0 per day for days 55 through 100 (Out-of-Network)



Transportation


Not covered



Vision


Contact lenses Not covered
Eyeglass frames Not covered
Eyeglass lenses Not covered
Eyeglasses (frames and lenses) Not covered
Other Not covered
Routine eye exam $0 copay (Out-of-Network)
Routine eye exam $10 copay
Upgrades Not covered



Wellness Programs (e.g. fitness nursing hotline)


Covered




CMS Star Ratings for Network PlatinumPlus (PPO) H5215



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 Network PlatinumPlus (PPO) Plans Performance

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


Health Plan Customer Service Rating for Network PlatinumPlus (PPO)

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


Network PlatinumPlus (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 Network PlatinumPlus (PPO)

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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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