Our Plans and Benefits

Baptist Health Plan Advantage (HMO) offers a complete Medicare Advantage plan that serves southern and central Kentucky.

Service Area
Counties in the Baptist Health Plan Advantage (HMO) Central Region Service Area:
Bourbon, Boyd, Clark, Estill, Fayette, Garrard, Greenup, Jessamine, Larue, Lawrence, Madison, Nelson, Oldham, Scott, Shelby, Woodford

Counties in the Baptist Health Plan Advantage (HMO) Southern Region Service Area:
Allen, Barren, Butler, Calloway, Edmonson, Graves, Henderson, Hopkins, Logan, Marshall, McCracken, Muhlenberg, Pulaski, Simpson, Union, Warren, Whitley

With Baptist Health Plan Advantage, you get all the hospital and medical benefits of Original Medicare (Parts A and B), as well as preventive care, prescription drug coverage, routine vision and other benefits.

Baptist Health Plan Advantage is focused on helping you stay well and live better. That’s why we offer coverage and benefits that fit your lifestyle and your budget.

Contact us to learn more about these benefits and enroll today.

Baptist Health Plan Advantage (HMO) Plan and Benefits - Central Region

Baptist Health Plan Advantage (HMO)

We have chosen some of the most important plan features to help you view our plan. Not all benefits are listed in these grids.

Benefit Baptist Health Plan Advantage (HMO) – Central Region
Monthly Plan Premium $0 in addition to your Medicare Part B premium*
Annual Out-of-Pocket Maximum (The total amount you will have to pay each year for copays and coinsurance.) $5,900 for all Medicare-covered benefits
Doctor Office Visit – Primary Care Physician (PCP) and Specialist $5 for each primary care physician visit
$45 for each specialist visit
$40 for each Mental Health visit
Urgent Care $30 for each visit
Emergency Care $75 for each visit
Inpatient Hospital Care and Inpatient Mental Health Care $275 per day (days 1-7) / Acute
$250 per day (days 1-6) / Mental Health
Skilled Nursing Facility (SNF) Care $0 per day (days 1-20)
$160 per day (days 21-100)
Outpatient Rehabilitation Services (e.g., physical, occupational and speech therapy) $40 for each therapy visit
Outpatient Surgery Outpatient Hospital Facility – $290 for each surgery
Ambulatory Surgical Center – $245 for each surgical visit
Durable Medical Equipment 20% of the cost of each item
Diabetic Supplies 20% of the cost of each item
Lab Services, X-rays and Advanced Imaging Radiology Services $0 for lab services
$0 for general X-rays
$200 per advanced imaging radiology service (e.g., radiology CT scans, MRIs, MRAs, PET scans, Nuclear Medicine and Stress tests)
Preventive Services $0 for annual wellness exam, routine physical exam, immunizations (e.g., flu and pneumonia) and preventive screenings, including mammograms, Pap, pelvic, prostate, colorectal exams and bone mass measurement
Routine Vision $0 for one routine eye exam per year
$45 copay for medically necessary eye exams
$175 allowance toward the cost of glasses (frames and lenses) or contact lenses per year
Hearing Exam and Hearing Aids $0 for one routine exam per year
$1500 allowance toward the cost of a hearing aid every 3 years
Routine Dental (Preventive) $0 for routine oral exam and cleaning every six months
$0 for one fluoride treatment per year
$0 for one dental X-ray per year
Over-the-Counter (OTC) Items $14 allowance each month towards the purchase of OTC medications and health-related items from the Plan’s online store
Fitness Benefit $0 copay when using a network fitness center/gym
Nurse Advice Line Free access to healthcare advice and information from experienced registered nurses, 24 hours a day, 7 days a week

* You must continue to pay your Part B premium. For complete benefit information please see the Summary of Benefits.

 

Baptist Health Plan Advantage (HMO) Prescription Drug Coverage Benefits - Central Region

The Baptist Health Plan Advantage (HMO) plan combines medical and Part D prescription drug coverage into one plan. Our plan has six levels of drug benefits: Preferred Generic, Generic, Preferred Brand and some Generic, Non-Preferred Brand and some Generic, Specialty, and Select Care drugs.

Baptist Health Plan Advantage (HMO)
In-Network Retail Pharmacy
and Mail-Order Prescription Drug Benefits
Prescription Drug Level (Tier) One-Month Supply (up to 30-days) Three-Month Supply (up to 90-days)
Annual Prescription Drug Deductible $150
Prescription Drug Deductible Applies to Tiers 3, 4 and 5
Tier 1 – Preferred Generic Drugs $3 copay $9 copay
Tier 2 – Generic Drugs $15 copay $45 copay
Tier 3 – Preferred Brand and Some Generic Drugs $47 copay $141 copay
Tier 4 – Non-Preferred Brand and Some Generic Drugs. $100 copay $300 copay
Tier 5 – Specialty Drugs
(one month supply only)
30% of the cost per prescription N/A
Tier 6 – Select Care Drugs
(one month supply only)
0%
Initial Coverage Limit (ICL) $3,700
Out-of-Pocket Threshold $4,950
Coverage Gap After  your total yearly drug costs reach $3,700, you will receive a discount on brand-name drugs and some coverage for generic drugs. You pay 40% of the negotiated price and a portion of the dispensing fee for brand drugs and no more than 51% of the cost for generic drugs until your yearly out-of-pocket drug costs reach $4,950.
Catastrophic Coverage After  your yearly out-of-pocket drug costs reach $4,950, you pay the greater of: 5% coinsurance or $3.30 copay for generic drugs or a drug that is treated like a generic or $8.25 copay for all other drugs.

 

Baptist Health Plan Advantage (HMO) Plan and Benefits - Southern Region

Baptist Health Plan Advantage (HMO)

We have chosen some of the most important plan features to help you view our plan. Not all benefits are listed in these grids.

Benefit Baptist Health Plan Advantage (HMO) – Southern Region
Monthly Plan Premium $39 in addition to your Medicare Part B premium*
Annual Out-of-Pocket Maximum (The total amount you will have to pay each year for copays and coinsurance.) $6,500 for all Medicare-covered benefits
Doctor Office Visit – Primary Care Physician (PCP) and Specialist $5 for each primary care physician visit
$40 for each specialist visit
$40 for each Mental Health visit
Urgent Care $30 for each visit
Emergency Care $75 for each visit
Inpatient Hospital Care and Inpatient Mental Health Care $295 per day (days 1-6) / Acute
$250 per day (days 1-5) / Mental Health
Skilled Nursing Facility (SNF) Care $0 per day (days 1-20)
$160 per day (days 21-100)
Outpatient Rehabilitation Services (e.g., physical, occupational and speech therapy) $40 for each therapy visit
Outpatient Surgery Outpatient Hospital Facility – $295 for each surgery
Ambulatory Surgical Center (ASC) – $245 for each surgical visit
Durable Medical Equipment 20% of the cost of each item
Diabetic Supplies 20% of the cost of each item
Lab Services, X-rays and Advanced Imaging Radiology Services 20% of the cost for lab services
$15 for general X-rays
$200 per advanced imaging radiology service (e.g., radiology CT scans, MRIs, MRAs, PET scans, Nuclear Medicine and Stress tests)
Preventive Services $0 for annual wellness exam, routine physical exam, immunizations (e.g., flu and pneumonia) and preventive screenings, including mammograms, Pap, pelvic, prostate, colorectal exams and bone mass measurement
Routine Vision $0 for one routine eye exam per year
$40 copay for medically necessary eye exams
$175 allowance toward the cost of glasses (frames and lenses) or contact lenses per year
Hearing Exam $0 for one routine exam per year
Routine Dental $0 for routine oral exam and cleaning every six months
$0 for one fluoride treatment per year
$0 for one dental X-ray per year
Over-the-Counter (OTC) Items $14 allowance each month towards the purchase of OTC medications and health-related items from the Plan’s online store
Fitness Benefit $0 copay when using a network fitness center/gym
Nurse Advice Line Free access to healthcare advice and information from experienced registered nurses, 24 hours a day, 7 days a week

* You must continue to pay your Part B premium. For complete benefit information please see the Summary of Benefits.

 

Baptist Health Plan Advantage (HMO) Prescription Drug Coverage Benefits - Southern Region

The Baptist Health Plan Advantage (HMO) plan combines medical and Part D prescription drug coverage into one plan. Our plan has six levels of drug benefits: Preferred Generic, Generic, Preferred Brand and some Generic, Non-Preferred Brand and some Generic, Specialty, and Select Care drugs.

Baptist Health Plan Advantage (HMO)
In-Network Retail Pharmacy
and Mail-Order Prescription Drug Benefits
Prescription Drug Level (Tier) One-Month Supply
(up to 30 days)
Three-Month Supply
(up to 90 days)
Annual Prescription Drug Deductible $150
Prescription Drug Deductible Applies to Tiers 3, 4 and 5
Tier 1 – Preferred Generic Drugs $3 copay $9 copay
Tier 2 – Generic Drugs $15 copay $45 copay
Tier 3 – Preferred Brand and Some Generic Drugs $47 copay $141 copay
Tier 4 – Non-Preferred Brand and Some Generic Drugs $100 copay $300 copay
Tier 5 – Specialty Drugs
(one-month supply only)
30% of the cost per prescription N/A
Tier 6 – Select Care Drugs $0
Initial Coverage Limit (ICL) $3,700
Out-of-Pocket Threshold $4,950
Coverage Gap After your total yearly drug costs reach $3,700, you will receive a discount on brand-name drugs and some coverage for generic drugs. You pay 40% of the negotiated price and a portion of the dispensing fee for brand drugs and no more than 51% of the cost for generic drugs until your yearly out-of-pocket drug costs reach $4,950.
Catastrophic Coverage After your yearly out-of-pocket drug costs reach $4,950, you pay the greater of: 5% coinsurance or $3.30 copay for generic drugs or a drug that is treated like a generic or $8.25 copay for all other drugs.

 



DISCLAIMERS
Baptist Health Plan Advantage is a HMO plan with a Medicare contract. Enrollment in this plan depends on contract renewal with CMS. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on Jan. 1 of each year. You must continue to pay your Medicare Part B premium. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.


H8289_WEB2017 Approved

 



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Last Updated: 09/30/2016, 03:08 pm