Asuris Esteem (PPO) H5010-001-0 Plan Details
Asuris Esteem (PPO) H5010-001-0 Plan Details
When selecting a Medicare Advantage plan for 2025, it's important to compare all your options. Asuris Esteem (PPO) is among the plans you can review side-by-side with others, ensuring you find the coverage that suits your needs. You can easily enroll online or reach out to a licensed agent for personalized guidance.
Asuris Esteem Overview
| Plan ID H5010-001-0 Overview | |
|---|---|
| Health Plan ID: | H5010-001-0 |
| Medicare Advantage Plan Type: | Local PPO |
| Plan Year: | 2024 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $5,000 |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Not Included |
| Part D Gap Coverage: | No |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | See List |
| Insured By: | Asuris Northwest Health |
Explore Asuris Esteem Benefits
Asuris Esteem is a Medicare Advantage Preferred Provider Organization (PPO) plan that combines flexibility with comprehensive healthcare coverage. With a monthly premium of $0.00, this plan covers all the essential benefits of Medicare Part A and Part B, giving you access to vital medical services. As a PPO plan, Asuris Esteem offers the freedom to visit any Medicare-approved provider, with lower costs when you use providers within the network.
Keep in mind that Asuris Esteem does not include a Medicare prescription drug plan. If you need drug coverage, you can explore standalone Part D plans. Asuris Esteem also provides financial protection with an annual maximum out-of-pocket (MOOP) limit of $5,000. Once you reach this limit, the plan covers 100% of your in-network healthcare costs for the remainder of the year. This makes Asuris Esteem a solid option for those who value flexibility and financial security in their healthcare coverage.
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Out-of-Pocket Costs
Asuris Esteem includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services. The table below outlines the most common in-network out-of-pocket costs for plan H5010-001-0.
| Service | Enrollee Cost |
|---|---|
| Doctor's Office Visit (In-Network) | |
| Primary: | $5 Copay |
| Specialist: | $40 Copay |
| Wellness & Preventive Programs: | Web/Phone-based technologies |
| Preventive care: | $0 Copay |
| Foot Care (In-Network) | |
| Foot Exams and Treatments (Medicare-covered): | $40 Copay |
| Routine Foot Care: | Not Covered |
| Chiropractic Treatment (In-Network) | |
| Medicare-covered chiropractic: | $20 Copay |
| Routine chiropractic: | Not Covered |
| Emergency and Urgent Care | |
| Emergency room care: | $120 Copay |
| Urgent care: | $40 Copay |
| Ground ambulance: | $250 Copay |
| Inpatient hospital care: | $350.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
| Outpatient hospital care: | $300 Copay Prior Authorization Required |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 through 46 $0.00 per day for days 47 and beyond |
| Optional supplemental benefits: | |
| Mental Health Services (In-Network) | |
| Outpatient individual therapy: | $30 Copay |
| Outpatient group therapy: | $30 Copay |
| Inpatient psychiatric hospital care: | $350.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
| Outpatient group therapy: | $30 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: | $0 Copay Prior Authorization Required |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
| Diagnostics, Lab Services, and Imaging (In-Network) | |
| Diagnostic radiology services: | $300 Copay Prior Authorization Required |
| Lab services: | $10 Copay Prior Authorization Required |
| Outpatient x-rays: | $10 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $10 Copay Prior Authorization Required |
| Medicare Part B Drugs (In-Network) | |
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by Asuris Esteem as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Asuris Northwest Health offers with this plan:
| Supplemental Healthcare Service | Member Cost |
|---|---|
| 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) | $0 Copay Limitations Apply |
| Hearing aids (In-Network) | Covered Limits may apply |
| Hearing exam (In-Network) | $0 Copay |
| Vision | Maximum vision benefit: | Non Specified |
| Eyeglasses (frames and lenses) (In-Network) | Not Covered |
| Routine eye exam (In-Network) | $0 Copay |
| Contact lenses (In-Network) | Covered Limits may apply |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
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 |
|---|---|
| 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 |
Plan Availability
Asuris Esteem (H5010-001-0) is available in the following locations (click to open):
Am I Eligible for Asuris Esteem?
To qualify for enrollment in Asuris Esteem, 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 Asuris Esteem and enjoy the extensive healthcare benefits it offers.
Enrollment Periods for Asuris Esteem
Understanding the right time to enroll in Asuris Esteem is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
Steps to Enroll in Asuris Esteem
Enrolling in Asuris Esteem is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Asuris Esteem through the official Medicare website.
- Directly with Asuris Esteem: You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Contact Asuris Northwest Health
| Website: | http://www.asuris.com/medicare |
|---|---|
| Formulary: | http://www.asuris.com/medicare |
| Pharmacy: | Asuris Northwest Health Pharmacy Page |
| New Members: | (888)369-3172 |
| TTY Users: | (800)735-2900 |
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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