2023 Banner Medicare Advantage Plus (PPO)

Banner Medicare Advantage Plus (PPO) H7273-001 is a 2023 Medicare Advantage Plan or Part-C by Banner Medicare Advantage Plus available to residents in Arizona. This plan includes additional prescription drug (Part-D) coverage. Banner Medicare Advantage Plus Banner Medicare Advantage Plus (PPO) has a monthly premium of $25.00 and has an in-network maximum out-of-pocket limit of $4,350 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $4,350 out-of-pocket. This can be an extremely nice safety net.

Banner Medicare Advantage Plus works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Banner Medicare Advantage Plus (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Banner Medicare Advantage Plus and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Banner Medicare Advantage Plus except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Arizona.




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2023 Banner Medicare Advantage Plus Medicare Advantage Plan Overview

Name:Banner Medicare Advantage Plus (PPO)
Plan ID:H7273 001 0
Provider:Banner Medicare Advantage Plus
Year:2023
Type:Local PPO
Combined Premium (C+D):$25.00/mo
Part C Premium:$0/mo
MOOP:$4,350/yr
Part D (Drug) Premium:$25.00/mo
Part D Supplemental Premium$0/mo
Total Part D Premium:$25.00/mo
Drug Deductible:$0/yr
Tiers with No Deductible:0
Gap Coverage:Yes
Benchmark:Not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H7273-002




What type of plan is Banner Medicare Advantage Plus (PPO)

Banner Medicare Advantage Plus (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.



How much does Banner Medicare Advantage Plus (PPO) cost?


Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Banner Medicare Advantage Plus charges a $25.00 consolidated premium. The Part C premium is $0 this charge 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

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. Banner Medicare Advantage Plus (PPO) has a monthly drug premium of $25.00 and a $0 drug deductible. This Banner Medicare Advantage Plus plan offers a $25.00 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. This Premium covers any enhanced plan benefits offered by Banner Medicare Advantage Plus 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 $25.00. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.


Banner Medicare Advantage Plus Gap Coverage

In 2023 once you and your plan provider have spent $4660 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 Banner Medicare Advantage Plus plan does offer additional coverage through the gap.


Extra Help Premium Assistance

The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The Banner Medicare Advantage Plus (PPO) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.20 for 75% low-income subsidy $12.50 for 50% and $18.70 for 25%.


Full Assistance Premium:$0
75% Assistance Premium:$6.20
50% Assistance Premium:$12.50
25% Assistance Premium:$18.70


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Banner Medicare Advantage Plus (PPO) by Banner Medicare Advantage Plus MOOP is $4,350. Once you spend $4,350 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.



Formulary and Drug Coverage

Banner Medicare Advantage Plus (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.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 NA $0
Tier 2 NA $5
Tier 3 NA $47
Tier 4 NA $100
Tier 5 NA 33%

The complete Banner Medicare Advantage Plus (PPO) Formulary.
*Initial Coverage Phase and 30 day supply





2023 Summary of Benefits


The benefit information provided is a summary of what Banner Medicare Advantage Plus (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Banner Medicare Advantage Plus helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

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



Contact lenses


In-Network Vision$0 copay
Out-of-Network Vision40% coinsurance



Eyeglass frames


VisionNot covered



Eyeglass lenses


VisionNot covered



Eyeglasses (frames and lenses)


In-Network Vision$0 copay
Out-of-Network Vision40% coinsurance



Other


VisionNot covered



Routine eye exam


In-Network Vision$0 copay
Out-of-Network Vision40% coinsurance



Upgrades


VisionNot covered




TransportationNot covered
In-Network Skilled Nursing Facility$0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-Network Skilled Nursing Facility$195 per stay
$195 per day for days 1 through 100



Occupational therapy visit


In-Network Rehabilitation services$40 copay
Out-of-Network Rehabilitation services40% coinsurance



Physical therapy and speech and language therapy visit


Out-of-Network Rehabilitation services40% coinsurance
In-Network Rehabilitation services$40 copay



Cleaning


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental40% coinsurance



Dental x-ray(s)


Out-of-Network Preventive dental40% coinsurance
In-Network Preventive dental$0 copay



Fluoride treatment


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental40% coinsurance



Oral exam


Out-of-Network Preventive dental40% coinsurance
In-Network Preventive dental$0 copay




Out-of-Network Preventive care40% coinsurance
In-Network Preventive care$0 copay
Out-of-Network Outpatient hospital coverage40% coinsurance per visit
In-Network Outpatient hospital coverage$250 copay per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsYes



Inpatient hospital - psychiatric


Out-of-Network Mental health services40% per day for days 1 through 90
In-Network Mental health services$275 per day for days 1 through 5
$0 per day for days 6 through 90



Outpatient group therapy visit


Out-of-Network Mental health services$40 copay
In-Network Mental health services$30 copay



Outpatient group therapy visit with a psychiatrist


In-Network Mental health services$30 copay
Out-of-Network Mental health services$40 copay



Outpatient individual therapy visit


In-Network Mental health services$30 copay
Out-of-Network Mental health services$40 copay



Outpatient individual therapy visit with a psychiatrist


Out-of-Network Mental health services$40 copay
In-Network Mental health services$30 copay



Chemotherapy


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs40% coinsurance



Other Part B drugs


Out-of-Network Medicare Part B drugs40% coinsurance
In-Network Medicare Part B drugs20% coinsurance



Diabetes supplies


In-Network Medical equipment/supplies$0 copay
Out-of-Network Medical equipment/supplies40% coinsurance per item



Durable medical equipment (e.g., wheelchairs, oxygen)


Out-of-Network Medical equipment/supplies50% coinsurance per item
In-Network Medical equipment/supplies20% coinsurance per item



Prosthetics (e.g., braces, artificial limbs)


Out-of-Network Medical equipment/supplies50% coinsurance per item
In-Network Medical equipment/supplies20% coinsurance per item




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$8,700 In and Out-of-network
$4,350 In-network
$8,700 Out-of-network
In-Network Inpatient hospital coverage$275 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network Inpatient hospital coverage40% per day for days 1 through 90



Fitting/evaluation


Out-of-Network Hearing40% coinsurance
In-Network Hearing$0 copay



Hearing aids


Out-of-Network Hearing40% coinsurance
In-Network Hearing$0 copay



Hearing exam


In-Network Hearing$0 copay
Out-of-Network Hearing40% coinsurance




Health plan deductible$0
In-Network Ground ambulance$250 copay
Out-of-Network Ground ambulance$250 copay



Foot exams and treatment


Out-of-Network Foot care (podiatry services)40% coinsurance
In-Network Foot care (podiatry services)$30 copay



Routine foot care


Foot care (podiatry services)Not covered



Emergency


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



Urgent care


Emergency care/Urgent care$0 copay



Primary


Out-of-Network Doctor visits$35 copay per visit
In-Network Doctor visits$0 copay



Specialist


Out-of-Network Doctor visits$70 copay per visit
In-Network Doctor visits$30 copay per visit



Diagnostic radiology services (e.g., MRI)


In-Network Diagnostic procedures/lab services/imaging$125 copay
Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance



Diagnostic tests and procedures


Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance
In-Network Diagnostic procedures/lab services/imaging$10 copay



Lab services


In-Network Diagnostic procedures/lab services/imaging$10 copay
Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance



Outpatient x-rays


Out-of-Network Diagnostic procedures/lab services/imaging$27 copay
In-Network Diagnostic procedures/lab services/imaging$20 copay



Diagnostic services


Comprehensive dentalNot covered



Endodontics


Comprehensive dentalNot covered



Extractions


Comprehensive dentalNot covered



Non-routine services


Comprehensive dentalNot covered



Periodontics


Comprehensive dentalNot covered



Prosthodontics, other oral/maxillofacial surgery, other services


Comprehensive dentalNot covered



Restorative services


Comprehensive dentalNot covered




In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?Yes, contact plan for further details





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Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Banner Medicare Advantage Plus (PPO) requires you to live in that plan’s service area. The service area is listed below:



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How much does Banner Medicare Advantage Plus (PPO) cost?

Banner Medicare Advantage Plus charges a $25.00 consolidated monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage of Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Banner Medicare Advantage Plus (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Banner Medicare Advantage Plus (PPO) by Banner Medicare Advantage Plus MOOP is $4,350. Once you spend $4,350 you will pay nothing for Part A or Part B covered services.

What type of plan is Banner Medicare Advantage Plus (PPO)?

Banner Medicare Advantage Plus (PPO) is a Local PPO. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, 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 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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