2022 Paramount Elite Preferred PPO (PPO)

Paramount Elite Preferred PPO (PPO) H5232-001 is a 2022 Medicare Advantage Plan or Part-C by Paramount Elite Medicare Plans available to residents in Ohio. This plan includes additional prescription drug (Part-D) coverage. The Paramount Elite Preferred PPO (PPO) has a monthly premium of $65.00 and has an in-network maximum out-of-pocket limit of $6,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,000 out-of-pocket. This can be a extremely nice safety net.

Paramount Elite Preferred PPO (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.

Paramount Elite Medicare Plans works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Paramount Elite Preferred PPO (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Paramount Elite Medicare 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 Paramount Elite Medicare 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 Paramount Elite Medicare Plans Medicare Advantage Plan Costs

Paramount Elite Preferred PPO (PPO) Part-C Premium

Paramount Elite Medicare Plans charges a $11.60 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.

H5232-001 Part-D Deductible and Premium

Paramount Elite Preferred PPO (PPO) has a monthly drug premium of $53.40 and a $0.00 drug deductible. This Paramount Elite Medicare Plans plan offers a $53.40 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 Paramount Elite Medicare Plans 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 $53.40 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Paramount Elite Medicare Plans Gap Coverage

In 2022 once you and your plan provider have spent $4430 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 Paramount Elite Medicare Plans plan does offer additional coverage through the gap.

Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Paramount Elite Preferred PPO (PPO) medicare insurance offers a $19.90 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $28.20 for 75% low income subsidy $36.60 for 50% and $45.00 for 25%.

H5232-001 Formulary or Drug Coverage

Paramount Elite Preferred PPO (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 Paramount Elite Preferred PPO (PPO) H5232-001 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$0
Tier 2	NA	$10
Tier 3	NA	$45
Tier 4	NA	$100
Tier 5	NA	33%

*Initial Coverage Phase and 30 day supply

2021 Paramount Elite Preferred PPO (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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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

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Deductible

$500 annual deductible

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	10% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$150 copay
Diagnostic tests and procedures	$50 copay
Diagnostic tests and procedures	10% coinsurance (Out-of-Network)
Lab services	10% coinsurance (Out-of-Network)
Lab services	$0-10 copay
Outpatient x-rays	10% coinsurance (Out-of-Network)
Outpatient x-rays	$50 copay

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Doctor Visits

Primary	$40 copay per visit (Out-of-Network)
Primary	$10 copay per visit
Specialist	$40 copay per visit
Specialist	$40-60 copay per visit (Out-of-Network)

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Emergency care/Urgent Care

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

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Foot Care (podiatry services)

Foot exams and treatment	$40-60 copay (Out-of-Network)
Foot exams and treatment	$40 copay
Routine foot care	Not covered

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Ground Ambulance

$295 copay
$295 copay (Out-of-Network)

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Hearing

Fitting/evaluation	$40 copay (Out-of-Network)
Fitting/evaluation	$0 copay
Hearing aids	$699-999 copay (Out-of-Network)
Hearing aids	$699-999 copay
Hearing exam	$40 copay
Hearing exam	10% coinsurance (Out-of-Network)

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Inpatient Hospital Coverage

10% per day for days 1 and beyond (Out-of-Network)
$295 per day for days 1 through 5 $0 per day for days 6 through 90

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Medical Equipment/Supplies

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

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Medicare Part B Drugs

Chemotherapy	10-20% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance
Other Part B drugs	10-20% coinsurance (Out-of-Network)

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Mental Health Services

Inpatient hospital - psychiatric	10% per day for days 1 and beyond (Out-of-Network)
Inpatient hospital - psychiatric	$250 per day for days 1 through 5 $0 per day for days 6 through 90
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	$40-60 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40-60 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit	$40-60 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	$40-60 copay (Out-of-Network)

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MOOP

$10,000 In and Out-of-network $6,000 In-network

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Option

No

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Optional supplemental benefits

Yes

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Outpatient Hospital Coverage

10% coinsurance per visit (Out-of-Network)
$235 copay per visit

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Package #1

Deductible	$25.00
Monthly Premium	$28.20

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Preventive Care

10% coinsurance (Out-of-Network)
$0 copay

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Preventive Dental

Cleaning	$0 copay (Out-of-Network)
Cleaning	$0 copay
Dental x-ray(s)	$0 copay (Out-of-Network)
Dental x-ray(s)	$0 copay
Fluoride treatment	Not covered
Oral exam	$0 copay
Oral exam	$0 copay (Out-of-Network)

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Rehabilitation Services

Occupational therapy visit	$35 copay
Occupational therapy visit	$40-60 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$40-60 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$35 copay

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Skilled Nursing Facility

10% per day for days 1 through 100 (Out-of-Network)
$0 per day for days 1 through 20 $142 per day for days 21 through 100

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Transportation

Not covered

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Vision

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

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Wellness Programs (e.g. fitness nursing hotline)

Covered

Ready to Enroll?

Click Here

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

Coverage Area for Paramount Elite Preferred PPO (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.