The Health Plan SecureChoice - Option II (PPO) 2025 Plan Details for Brown County, Ohio Residents
The Health Plan SecureChoice - Option II (PPO) 2025 Plan Details for Brown County, Ohio Residents
Navigating your Medicare Advantage options in Brown County for 2025 can be overwhelming, but we're here to help. With The Health Plan SecureChoice - Option II (PPO) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
The Health Plan SecureChoice - Option II Overview
Plan ID H8604-010-0 Overview | |
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Health Plan ID: | H8604-010-0 |
Medicare Advantage Plan Type: | Local PPO |
Plan Year: | 2024 |
Monthly Premium: | $93.40 Plus your Medicare Part B premium. |
Health Plan Deductible: | $1,500.00 |
Annual Out-of-Pocket Maximum: | $6,700 |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced, $100.00 deductible |
Part D Gap Coverage: | No |
Supplemental Benefits: | Vision |
Availability: | Brown County, OH |
Insured By: | The Health Plan |
Explore The Health Plan SecureChoice - Option II Benefits
The Health Plan SecureChoice - Option II is a Medicare Advantage Prescription Drug (MAPD) Preferred Provider Organization (PPO) plan that offers both flexibility and comprehensive coverage. With a monthly premium of $93.40, this plan includes all the essential benefits of Medicare Part A and Part B, plus additional services like prescription drug coverage. The annual Part D deductible is $100.00. As a PPO plan, you can visit providers both in and out of the network, although staying in-network usually means lower costs.
The Health Plan SecureChoice - Option II also provides financial protection with an annual maximum out-of-pocket (MOOP) limit of $6,700. After reaching this limit, the plan covers 100% of your in-network healthcare costs for the remainder of the year. This feature makes The Health Plan SecureChoice - Option II an excellent option for those who value both comprehensive coverage and the ability to choose their providers.
We're Here to Help You Enroll |
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Cost-Sharing Overview
With The Health Plan SecureChoice - Option II, you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan H8604-010-0.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $5 Copay |
Specialist: | $45 Copay Prior Authorization Required |
Wellness & Preventive Programs: | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $45 Copay Prior Authorization Required |
Routine Foot Care: | $45 Copay Prior Authorization Required |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $15 Copay Prior Authorization Required |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $100 Copay |
Urgent care: | $40 Copay |
Ground ambulance: | $200 Copay |
Inpatient hospital care: | $295.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient hospital care: | $275 Copay Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $150.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $40 Copay |
Outpatient group therapy: | $40 Copay |
Inpatient psychiatric hospital care: | $295.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient group therapy: | $40 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $40 Copay Prior Authorization Required |
Occupational therapy: | $40 Copay Prior Authorization Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $150 Copay |
Lab services: | $0 |
Outpatient x-rays: | $50 Copay |
Diagnostic tests and procedures: | $50 Copay |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by The Health Plan SecureChoice - Option II as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that The Health Plan offers with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Not Covered |
Hearing aids (In-Network) | Not Covered |
Hearing exam (In-Network) | Not Covered |
Vision | Maximum vision benefit: | $150.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | Covered Limits may apply |
Contact lenses (In-Network) | Covered Limits may apply |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
The Health Plan SecureChoice - Option II includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
While the prescription drug plan (Part D) premium is included in the overall plan cost, some plans may have additional costs or provide assistance through the Low-Income Subsidy (LIS) program. Also known as Extra Help, LIS is a Social Security program that assists individuals with limited income and resources in reducing or eliminating Part D expenses.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $10.90 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $10.90 |
Part D Premium with Full LIS Assistance: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $100.00. You must pay this amount at the pharmacy before The Health Plan begins paying its share.
NOTE: The deductible does not apply to one or more drug tiers in this plan (see "Prescription Drug Plan Out-of-Pocket Costs" below).
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, The Health Plan SecureChoice - Option II has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | $3.00 copay (deductible does not apply) | $13.00 copay (deductible does not apply) |
2 (Generic) | $10.00 copay | $20.00 copay |
3 (Preferred Brand) | $47.00 copay | $47.00 copay |
4 (Non-Preferred Drug) | $100.00 copay | $100.00 copay |
5 (Specialty Tier) | 31% | 31% |
CMS 5-Star Rating Overview
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
CMS Measure | Star Rating |
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2024 Overall 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 | Not enough data available |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
Am I Eligible for The Health Plan SecureChoice - Option II?
To qualify for enrollment in The Health Plan SecureChoice - Option II, you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
- Not have End-Stage Renal Disease (ESRD), except under certain conditions.
If you fulfill these criteria, you can enroll in The Health Plan SecureChoice - Option II and enjoy the extensive healthcare benefits it offers.
When Can I Enroll in The Health Plan SecureChoice - Option II?
Knowing when you can enroll in The Health Plan SecureChoice - Option II is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) for expert guidance from a licensed insurance agent.
How to Enroll in The Health Plan SecureChoice - Option II
Joining The Health Plan SecureChoice - Option II is straightforward. Here are the steps you can take:
- Online: Use our online enrollment partner's Secure Online Enrollment Form to sign up.
- By Phone: Reach out to HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Through Medicare.gov: Enroll directly through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the steps to join The Health Plan SecureChoice - Option II.
- Direct Enrollment: You can also choose to enroll directly with The Health Plan SecureChoice - Option II. The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
Contact The Health Plan
Website: | http://www.healthplan.org/medicare |
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Formulary: | http://www.healthplan.org |
Pharmacy: | The Health Plan Pharmacy Page |
New Members: | (877)847-7915 |
TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
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