2023 Texas LoneStar Valor (HMO-POS)

Texas LoneStar Valor (HMO-POS) H6062-012 is a 2023 Medicare Advantage Plan or Part-C by GlobalHealth available to residents in Texas. This plan does not provide extra prescription drug (Part-D) coverage. GlobalHealth Texas LoneStar Valor (HMO-POS) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $3,900 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $3,900 out-of-pocket. This can be an extremely nice safety net.

GlobalHealth works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Texas LoneStar Valor (HMO-POS) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from GlobalHealth 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 GlobalHealth except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Texas.



2023 GlobalHealth Medicare Advantage Plan Overview

Name:Texas LoneStar Valor (HMO-POS)
Plan ID:H6062 012 0
Provider:GlobalHealth
Year:2023
Type:Local HMO *
Combined Premium (C+D):$0/mo
MOOP:$3,900/yr
Similar Plan: H6062-001




What type of plan is Texas LoneStar Valor (HMO-POS)

Texas LoneStar Valor (HMO-POS) 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 primary care physician 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 primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.

With a HMO-POS point-of-service you have the option to go out-of-network or see a specialist without a referral. But, you may pay more for out-of-network care you receive than from an in-network provider.

How much does Texas LoneStar Valor (HMO-POS) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. GlobalHealth charges a $0 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.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Texas LoneStar Valor (HMO-POS) by GlobalHealth MOOP is $3,900. Once you spend $3,900 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.





2023 Summary of Benefits


The benefit information provided is a summary of what Texas LoneStar Valor (HMO-POS) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from GlobalHealth 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


Out-of-Network Vision$0 copay
In-Network Vision$0 copay



Eyeglass frames


In-Network Vision$0 copay
Out-of-Network Vision$0 copay



Eyeglass lenses


Out-of-Network Vision$0 copay
In-Network Vision$0 copay



Eyeglasses (frames and lenses)


In-Network Vision$0 copay
Out-of-Network Vision$0 copay



Other


VisionNot covered



Routine eye exam


In-Network Vision$0 copay



Upgrades


VisionNot covered




In-Network Transportation$0 copay
In-Network Skilled Nursing Facility$0 per day for days 1 through 20
$184 per day for days 21 through 100
Out-of-Network Skilled Nursing Facility$225 per day for days 1 through 25
$0 per day for days 26 through 100



Occupational therapy visit


In-Network Rehabilitation services$20 copay



Physical therapy and speech and language therapy visit


In-Network Rehabilitation services$20 copay



Cleaning


In-Network Preventive dental$0 copay



Dental x-ray(s)


In-Network Preventive dental$0 copay



Fluoride treatment


In-Network Preventive dental$0 copay



Oral exam


In-Network Preventive dental$0 copay




In-Network Preventive care$0 copay
In-Network Outpatient hospital coverage$250 copay per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo



Inpatient hospital - psychiatric


In-Network Mental health services$295 per day for days 1 through 7
$0 per day for days 8 through 90
Out-of-Network Mental health services$345 per day for days 1 through 7
$0 per day for days 8 through 90



Outpatient group therapy visit


In-Network Mental health services$35 copay



Outpatient group therapy visit with a psychiatrist


In-Network Mental health services$35 copay



Outpatient individual therapy visit


In-Network Mental health services$35 copay



Outpatient individual therapy visit with a psychiatrist


In-Network Mental health services$35 copay



Chemotherapy


In-Network Medicare Part B drugs20% coinsurance



Other Part B drugs


In-Network Medicare Part B drugs20% coinsurance



Diabetes supplies


In-Network Medical equipment/supplies$0 copay



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


In-Network Medical equipment/supplies20% coinsurance per item



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


In-Network Medical equipment/supplies20% coinsurance per item




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$6,900 In and Out-of-network
$3,900 In-network
In-Network Inpatient hospital coverage$295 per day for days 1 through 7
$0 per day for days 8 through 90
Out-of-Network Inpatient hospital coverage$345 per day for days 1 through 7
$0 per day for days 8 through 90



Fitting/evaluation


In-Network Hearing$0 copay



Hearing aids


In-Network Hearing$0 copay



Hearing exam


In-Network Hearing$0-35 copay




Health plan deductible$0
In-Network Ground ambulance$240 copay
Out-of-Network Ground ambulance$240 copay



Foot exams and treatment


In-Network Foot care (podiatry services)$35 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$15 copay per visit (always covered)



Primary


In-Network Doctor visits$0 copay



Specialist


In-Network Doctor visits$35 copay per visit
Out-of-Network Doctor visits$45 copay per visit



Diagnostic radiology services (e.g., MRI)


In-Network Diagnostic procedures/lab services/imaging$0-250 copay



Diagnostic tests and procedures


In-Network Diagnostic procedures/lab services/imaging$0-100 copay



Lab services


In-Network Diagnostic procedures/lab services/imaging$5 copay



Outpatient x-rays


In-Network Diagnostic procedures/lab services/imaging$0 copay



Diagnostic services


In-Network Comprehensive dental$0 copay



Endodontics


In-Network Comprehensive dental20% coinsurance



Extractions


In-Network Comprehensive dental20% coinsurance



Non-routine services


In-Network Comprehensive dental20% coinsurance



Periodontics


In-Network Comprehensive dental0-20% coinsurance



Prosthodontics, other oral/maxillofacial surgery, other services


In-Network Comprehensive dental0-20% coinsurance



Restorative services


In-Network Comprehensive dental0-20% coinsurance




In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No




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 Texas LoneStar Valor (HMO-POS) requires you to live in that plan’s service area. The service area is listed below:



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How much does Texas LoneStar Valor (HMO-POS) cost?

GlobalHealth charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Texas LoneStar Valor (HMO-POS) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Texas LoneStar Valor (HMO-POS) by GlobalHealth MOOP is $3,900. Once you spend $3,900 you will pay nothing for Part A or Part B covered services.

What type of plan is Texas LoneStar Valor (HMO-POS)?

Texas LoneStar Valor (HMO-POS) is a Local HMO *. With a health maintenance organization you will be required to receive most of your health care from an in-network provider. HMOs require that you select a primary care physician (PCP).

With a HMO-POS point-of-service you have the option to go out-of-network or see a specialist without a referral. But, you may pay more for out-of-network care you receive than from an in-network provider.



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 extra 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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