2022 Western Health Advantage MyCare Plus (HMO)
Western Health Advantage MyCare Plus (HMO) H2782-003 is a 2022 Medicare Advantage Plan or Part-C by Western Health Advantage available to residents in California. This plan includes additional prescription drug (Part-D) coverage. The Western Health Advantage MyCare Plus (HMO) has a monthly premium of $99.00 and has an in-network maximum out-of-pocket limit of $5,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,500 out-of-pocket. This can be a extremely nice safety net.
Western Health Advantage MyCare Plus (HMO) 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.
Western Health Advantage works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Western Health Advantage MyCare Plus (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Western Health Advantage 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 Western Health Advantage except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.
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2022 Western Health Advantage Medicare Advantage Plan Costs
Western Health Advantage MyCare Plus (HMO)
|Provider:||Western Health Advantage|
|Monthly Premium C+D:||$99.00|
|Part C Premium:||$42.70|
|Part D (Drug) Premium:||$56.30|
|Part D Supplemental Premium||$0.00|
|Total Part D Premium:||$56.30|
|Tiers with No Deductible:||0|
|Benchmark:||not below the regional benchmark|
|Type of Medicare Health:||Enhanced Alternative|
|Drug Benefit Type:||Enhanced|
|New Plan:||2023 H2782-002|
Western Health Advantage MyCare Plus (HMO) Part-C Premium
Western Health Advantage charges a $42.70 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.
H2782-003 Part-D Deductible and Premium
Western Health Advantage MyCare Plus (HMO) has a monthly drug premium of $56.30 and a $0.00 drug deductible. This Western Health Advantage plan offers a $56.30 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 Western Health Advantage 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 $56.30 . 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.
Western Health Advantage 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 Western Health Advantage plan does offer additional coverage through the gap.
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 Western Health Advantage MyCare Plus (HMO) medicare insurance offers a $23.10 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $31.40 for 75% low income subsidy $39.70 for 50% and $48.00 for 25%.
|Full LIS Premium:||$23.10|
|75% LIS Premium:||$31.40|
|50% LIS Premium:||$39.70|
|25% LIS Premium:||$48.00|
H2782-003 Formulary or Drug Coverage
Western Health Advantage MyCare Plus (HMO) 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 Western Health Advantage MyCare Plus (HMO) H2782-003 Formulary here.
2021 Western Health Advantage MyCare Plus (HMO) Summary of Benefits*This will be updated with 2022 data when available.
|Diagnostic services||Not covered|
|Non-routine services||Not covered|
|Prosthodontics, other oral/maxillofacial surgery, other services||Not covered|
|Restorative services||Not covered|
Diagnostic Tests and Procedures
|Diagnostic radiology services (e.g., MRI)||$50 copay|
|Diagnostic tests and procedures||$0 copay|
|Lab services||$0 copay|
|Outpatient x-rays||$0 copay|
|Specialist||$20 copay per visit|
Emergency care/Urgent Care
|Emergency||$90 copay per visit (always covered)|
|Urgent care||$20 copay per visit (always covered)|
Foot Care (podiatry services)
|Foot exams and treatment||$20 copay|
|Routine foot care||Not covered|
|Hearing aids - inner ear||Not covered|
|Hearing aids - outer ear||Not covered|
|Hearing aids - over the ear||Not covered|
|Hearing exam||$20 copay|
Inpatient Hospital Coverage
|$175 per day for days 1 through 5
$0 per day for days 6 through 90
|Diabetes supplies||$0 copay|
|Durable medical equipment (e.g., wheelchairs, oxygen)||20% coinsurance per item|
|Prosthetics (e.g., braces, artificial limbs)||20% coinsurance per item|
Medicare Part B Drugs
|Other Part B drugs||20% coinsurance|
Mental Health Services
|Inpatient hospital - psychiatric||$175 per day for days 1 through 5
$0 per day for days 6 through 90
|Outpatient group therapy visit||$35 copay|
|Outpatient group therapy visit with a psychiatrist||$35 copay|
|Outpatient individual therapy visit||$35 copay|
|Outpatient individual therapy visit with a psychiatrist||$35 copay|
Optional supplemental benefits
Outpatient Hospital Coverage
|$200 copay per visit|
|Dental x-ray(s)||Not covered|
|Fluoride treatment||Not covered|
|Oral exam||Not covered|
|Occupational therapy visit||$0 copay|
|Physical therapy and speech and language therapy visit||$0 copay|
Skilled Nursing Facility
|$0 per day for days 1 through 20
$150 per day for days 21 through 100
|Contact lenses||$0 copay|
|Eyeglass frames||$0 copay|
|Eyeglass lenses||$0 copay|
|Eyeglasses (frames and lenses)||$0 copay|
|Routine eye exam||$20 copay|
Wellness Programs (e.g. fitness nursing hotline)
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Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for Western Health Advantage MyCare Plus (HMO)
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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.