Medicare Open Enrollment begins on October 15th and continues through December 7th. Effective dates of new plans or changes to existing policies will be January 1st. Pa residents can apply for Part D prescription drug coverage, and also change from a Medicare Advantage contract to original Medicare benefits, or enroll in an Advantage plan, and terminate an existing Supplement contract. Of course, you can also leave all existing plans in place and make no changes.
The single payer concept for Seniors pays about 80% or expenses, leaving the balance to be paid by the applicant. There are four portions to Medicare. Part A consists of hospitalization and related expenses, including your room and surgery charges. Part B is standard medical insurance benefits. Part D is prescription drug benefits, and is provided in several ways. Part C is Medicare Advantage plan coverage, which replaces original Medicare benefits and can provide drug prescription benefits, depending on the contract.
Cover Your Out-Of-Pocket Expenses
Private insurers offer Medigap plans to help pay for may of the out-of-pocket expenses that may not be covered under original government-provided coverage. Prescription drug benefits are provided separately (Part D), although many Advantage contracts include the coverage. NOTE: If your prescriptions changed during 2016 (or new ones were added), reviewing existing drug plans is highly recommended. Also, prescriptions are classified as Tier1, Tier 2, Tier 3, Tier 4, and Specialty (Generic, preferred generic, non-preferred brand, and preferred brand). The choice of which type your physician chooses can greatly impact your cost.
Your two “payers” (original Medicare and the private carrier providing the supplement) follow “coordination of benefits” rules to determine which expenses are paid by whom. The “primary” payor is the first to pay expenses up to the limits of the policy. The “secondary” payor pays the balance, although some bills still may be uncovered. A comparison of Medigap plans in Pennsylvania also provides details about which expenses are paid.
Expenses that are medically necessary are generally paid, along with portions of copays, deductibles, and coinsurance. Many preventative expenses are also paid, including (but not limited to) mammograms, lung cancer screenings, nutrition therapy, testing for Glaucoma, and prostrate cancer screenings.
Pennsylvania Senior Medigap Open Enrollment Begins October 15th
Standard Enrollment Period
When you reach age 65 or become eligible for Medicare Parts A and B, your initial Open Enrollment period begins. Otherwise, as previously mentioned, from October 15th through December 7th is the regular period. During this time, you can change your original Medicare coverage to a Medicare Advantage plan. You can also change from an Advantage plan back to original Medicare.
You may also change Advantage plans if your current policy does not include prescription drug benefits, and the new plan does include them. Also, you can change from a plan that offers prescription drug benefits to a plan that omits it. You can also apply for original Part D prescription drug coverage, change to another Part D plan, or simply terminate an existing plan without picking up a new one.
Second Enrollment Period
Generally, if the standard deadline of December 7th is missed, you will have to wait until the following year to request a change from an existing plan. But there is a second Open Enrollment period that begins on January 1st and continues to February 14th. It benefits current Medicare Advantage policyholders since they are allowed to terminate their existing plan, and change to an original Medicare contract. You are not required to remain with the same company.
Also, if you change to original Medicare benefits, a deadline of February 14th is provided to enroll in a Medicare prescription drug plan. Typically, the effective date of benefits is the first day of the month following the date your application is processed.
Medicare Part D Plans Provide Prescription Drug Coverage
Prescription Drug Plans
If you are already enrolled in Part D (prescription drug) coverage, you can continue that plan, unless it is no longer offered. You may also compare other offered options in your area to determine if a more cost-effective policy is available. Many Advantage contracts include these benefits already. Shown below are 12 of the popular prescription drug plans from approved carriers. For this example, we used Allegheny County (Pittsburgh area). Additional information is provided by the Pa DOI.
Humana Walmart Rx Plan
Aetna Medicare RX Saver
Humana Preferred Rx Plan
Symphonix Value Rx
EnvisionRx Plus Silver
EnvisionRx Plus Clear Choice
Express Scripts Medicare Value
First Health Part D Value Plus
Magellan Rx Medicare Basic
AARP MedicareRx Saver Plus
Watch Your Mail
In October, you generally will start receiving materials and information regarding next year’s options, and changes that may have occurred since the last enrollment. As previously mentioned, you are not obligated to change plans. And if you are not notified that your existing plan was terminated or no longer available, the policy will continue if you do not take any action.
However, you should quickly review any paperwork you receive, either from your existing company, or from the Center for Medicare and Medicaid Services (CMS). For instance, The ANOC (Annual Notice Of Change) and EOC (Evidence Of Coverage) correspondence should always be promptly viewed.
Many tools are also available that help you find providers in your area. Often, specialists are more difficult to locate, but with the assistance from our website (and government websites), you can view available different doctors, hospitals, suppliers of medical equipment and other needed supplies, dialysis treatment facilities, home health services, and nursing homes.
APPRISE is a free state-supported program that aids Seniors with counseling and free information. Both paid employees and volunteers are provided to answer questions about various programs, including Medicare, Medicaid, Medigap coverage, and Long-Term Care plans. Presentations are also offered to various groups and organizations. However, since the volunteers are generally not licensed with the Pa Department of Insurance, it remains prudent to continue to utilize reputable and experienced websites like ours, and the independent brokers we represent.
NOTE: We do not endorse specific plans or carriers for Senior products. Also, we are not affiliated with CMS or the Medicare program.
The Pennsylvania Health Insurance Marketplace (Exchange) provides Pa residents the opportunity to purchase affordable high-quality medical plans. No medical questions. No hassle. No denials or cancellations. We know you have questions, so here are some of the answers:
What Is The “Marketplace?”
It’s actually just another name for the Pa Health Insurance Exchange. The two terms are interchangeable. Typically, in a “marketplace,” you shop for the best deals from a variety of different companies. After learning and comparing, you have a much better understanding of the product choices. We help you find the most cost-efficient plans, and we also greatly simplify the enrollment process.
Included in the operation are websites, online resources, and customer service call centers. More than 1 million residents in the state are without coverage, and we are here to help, by providing free comparisons, determining if your medical providers are “in-network,” and also calculating your federal subsidy.
How Do I Find Available Plans?
There are a few ways. Of course, going directly to the .gov website is one option, although delays and logjams have made the enrollment process almost impossible for thousands of visitors. Perhaps the easiest way to view policies is to utilize our free quote feature, and you can view and compare plans in your area.
Remember that different parts of the state will feature different carriers and plans. For example, while Capital Blue Cross may be available in Lebanon, Lancaster, and Harrisburg, you won’t find any of their plans offered in Pittsburgh. The same applies to Geisinger products. However, Aetna and UnitedHealthcare are typically available in most areas.
When Does 2017 Open Enrollment Begin?
On November 1, 2016, enrollment begins for plans with 2017 effective dates. It ends on January 31st, although if you qualify for a Special Enrollment Period exception, you can purchase coverage at any time throughout the year.
How Much Does It Cost To Use These Services?
There are never any costs or fees for utilizing the newly-hired navigators, the 1-800 phone numbers that the government provides or any broker or assistance provided by our website. Any person that attempts to charge a fee is likely not authorized to assist you.
We Help You With Pa Marketplace Plan Selections
For example, we have helped consumers find, compare and understand their best options for more than 35 years and have never collected any fees. However, instead of the three-day training that is required to become a navigator, we have more than three decades of experience assisting consumers obtain quality insurance coverage. That’s why most consumers prefer the free help we provide, instead of using a “navigator” or attempting to contact the government website.
Who Are The Companies That Have Been Approved To Sell Policies Through The Pa Marketplace?
The following carriers are offering policies:
Capital Blue Cross
Independence Blue Cross (Keystone and QCC)
Which Companies Have The Cheapest Pa Health Insurance Rates?
That depends where you live. For example, if you live in the Pittsburgh area (Allegheny or Westmoreland County), Highmark and UPMC will offer the least expensive Exchange options. However, if you live in Lancaster County, Geisinger, Capital Blue Cross and Highmark may be the best choices. And in Montgomery County, Independence Blue Cross has the most competitive prices.
As evidenced by the wide variation in pricing, it’s important to selectively shop (which is what we do best) so you are matched with the policies that best fit within your personal budget. If you move from one county to another, your options will change. Also, since rates change each year, choosing a new plan during Open Enrollment is quite common.
Listed below are several of the least expensive 2017 Pa Marketplace plans. Policies are not offered in all Counties.
UPMC Advantage Bronze $6,950/$35
Highmark my Connect Blue 6500B
Highmark my Community Blue Flex PPO 6800B
Highmark Major Events PPO Blue 7150
Geisinger Marketplace HMO 30/60/3500
Independence Blue Cross Personal Choice Bronze Basic
Independence Blue Cross Personal Choice PPO Bronze Reserve
First Priority Health my Priority Blue Flex HMO 6800B
Capital Advantage Silver PPO 4500/0/10
I Have A Pa COBRA plan. Can I Cancel The Coverage and Buy An Exchange Plan ?
You can not own both a COBRA plan and another policy at the same time. So, as long as you cancel COBRA benefits at the same time your Exchange contract goes into effect, during Open Enrollment, you can change. It is important to know in advance what your exact premium, federal subsidy, benefits and out-of-pocket costs will be. Also, if you are losing dental or vision benefits, you can choose if you want to replace them. Individual dental policies are offered by many companies outside of the Marketplace.
Will My Policy Go Into Effect Right Away?
If the application is completed by December 15th, you can receive an effective date of January 1st. The deadline for a February 1 effective date is January 15th. And the deadline for a March 1 effective date is January 31st. If you wait until after January 31st to attempt to enroll, you will need an SEP exception to secure a plan. Otherwise, many non-compliant options are available, although coverage may be limited.
I’m Staying With The Same Company. Will I Still Be Able To Use My Physician?
Probably, but it’s important you find out before enrolling. Many doctors and specialists are not participating in all policy plans. We can provide that information, or you can contact your physician or provider. Online directories are helpful, but often are not fully updated until March or April. Also, many carriers (UPMC for example), have several different networks that are applicable to specific plans.
Most Pa Plans Cover Generic And Non-Generic Drugs
I Currently Take Two Generic Medications And Two Non-Generic Medications. Are They Covered?
Each policy must provide a list or link of the formulary drugs that are covered. There is other additional information regarding usage, availability, mail-order and of course, cost. You can view a link to this list at the time you are viewing specific details about each plan.
Generic prescriptions generally do not have a high out-of-pocket cost. But if you take multiple non-generic prescriptions, it is important to discuss the specific policies that offer the lowest copays and/or deductibles. Appeals are possible if you are prescribed a drug that is not listed under your benefits. NOTE: Bronze-tier contracts usually place a deductible on non-generic prescriptions.
I Am On Medicare. Am I Affected By These Changes?
No. If you are covered by Medicare, you can not apply for Exchange plans. And the legislation that requires that qualified coverage to be purchased is not applicable. However, you can review and compare Supplemental and Advantage plans (Medigap) that will cover many of the gaps in coverage. Senior plans can be customized to match your specific needs, and Part D plans (prescription drug benefits) can also be personalized to best limit your out-of-pocket costs.
Fall Open Enrollment for Medigap plans begins October 15th and ends on December 7th. You can change your existing coverage or purchase an Advantage contract. January 1 will be the effective date of the new policy.
Do I Have To Buy A Policy That Is Through The Exchange?
No. You can purchase coverage inside or outside the Exchange. Plans issued outside of the Marketplace will not receive any subsidy reimbursement so they should only be considered in upper-income households. However, these “outside” plans do have some appealing features.
Applications are much more streamlined and approvals are generally quicker. It’s also possible that the number of available physicians and hospitals may be higher, if an alternative provider-network is used. And for persons that don’t want an “Obamacare” plan, the “off” options are issued directly by the insurance companies with no government involvement or privacy issues. Although specific mandated benefits are still required, we can avoid utilizing the .gov healthcare website.
UPDATES FROM THE PAST:
Anthem and Cigna have agreed to merge, which will create the largest health insurer in the US. Neither carrier issues a significant amount of group or individual plans in Pennsylvania. So why does the American Hospital Association believe that prices in our state (and many others) could potentially increase because of reduced competition?
The fear is that several other mergers may now occur, which would impact premiums of other Pa carriers. Also, state regulators could recommend that specific services be eliminated because of monopoly concerns. This merger follows that Aetna-Humana agreement, which has a larger effect on local households, since Aetna has a fairly large local market share.
With the Presidential election in three months, changes may be coming. The current system is floundering, with several carriers (including UnitedHealthcare) planning on staying away from many State and Federal Exchanges. Other companies suffered massive underwriting losses and have requested large rate increases for 2017 plans. Also, C0-Ops have continued to perform poorly, and we expect several more to fail within the next 12 months.
Affordable Pa Medicare Advantage plans for Seniors are available. We review and compare the highest-rated policies from all major companies. Part C benefits provided by private carriers in Pennsylvania, provide high-quality coverage at extremely low rates. Premiums are typically much less than standard Supplement options, and often out-of-pocket expenses are lower, with dental and vision benefits included. The online quotes you view are the lowest available rates from each carrier.
As an alternative to traditional Medicare, plans cover preventive care, hospital and physician services, lab tests, x-rays, and conventional Medigap benefits. Part D prescription and drug coverage is also generally included. Top-rated companies offer policy options in Pittsburgh, Philadelphia, Harrisburg and all areas of the Keystone State. Applying and enrolling is quick and easy. And about half of all plans feature a $0 premium. You can’t get rates any lower!
Many policy options offer prescription benefits. Referred to as Medicare Advantage Prescription Drug Plans (MAPDS), your healthcare and drug coverage are included in one contract. NOTE: We also reviewed Medigap plans in Pennsylvania. Since these contracts do not replace original benefits, premiums are typically higher than Advantage plan options.
Different Types Of Available MA Plans
PPO Plans Offer Flexibility When Choosing Providers
PPO – The Preferred Provider Organization concept is quite simple. If you utilize “in-network” physicians, specialists, and hospitals, you pay less. If you go “outside” the network, you pay more. Typically, there is a wide selection of doctors and other medical facilities, and a referral is not required to see a specialist. Many plans include drug benefits, and several additional optional riders are available.
HMO – Health Maintenance Organizations are more restrictive than a PPO, since you need a referral from your primary care physician (pcp) to see a specialist. Also, the list of available providers may be less extensive than a PPO, since the service area is smaller. Many qualified preventative expenses, such as mammograms, do not require a referral. NOTE: Occasionally, an HMO Point Of Service (HMOPOS) contract is available, that provides out-of-network services.
Private Fee-For-Service – PFFS plans are issued by private insurers. They are classified as a type of Medicare Advantage coverage (Part C). The dollar amount paid to doctors, specialists, and hospitals is per-determined along with the out-of-pocket costs you will pay. If prescription benefits are not included, you are permitted to obtain a Medicare drug plan.
Special Needs Plans – SNPs are designed to provide affordable coverage for persons with specific diseases, live in a nursing home, require home nursing care, or have certain disabling diseases. Several examples are chronic heart failure, dementia, HIV, or End-Stage Renal Disease (ESRD). Being enrolled in Medicare AND Medicaid also qualifies.
Medical Savings Account Plans – An MSA option allows you to pay qualified expenses from a separate account that receives deposits from Medicare. Two separate policies are included in coverage. The high deductible health plan (Part C) has a large deductible to meet. The “savings account” portion (similar to an HSA for persons under age 65) uses funds deposited into the account to pay for medical costs prior to reaching your deductible.
Companies Offering PA Advantage Coverage
Many highly-rated licensed and registered carriers offer policies for Keystone State residents. Shown below are reputable and reliable companies that feature popular and affordable policy options. Not every carrier is listed and many plans are not available in all counties. Additional Pa Medicare Advantage plan information is provided by the federal government through brochures and website data.
Highmark Senior Health
Keystone Health Plan Central
Affordable UPMC Senior Medicare Plans Are Available
Although there are many available policies offered by major top-rated carriers in the Keystone State, many plans are offered only in specific regions. For example, UPMC contracts are available in the Western part of the state along with other nearby areas. Keystone contracts are offered in the five-county Philadelphia area. Upon request, we can provide the counties/zip codes that the options listed below are available.
Also, benefits discussed below are typically referring to “in-network” treatment. A separate list is shown further below for plans with prescription coverage. An additional resource is found here. The DOI helps protect consumers that are applying for Senior coverage.
Pa Advantage Plans Without Prescription Drugs
Highmark Freedom Blue PPO Basic – Unlimited days covered for an inpatient hospital stay with a single $351 copay. Customer pays nothing per day after first 90 days. Primary-care physician copay is $15 ($30 out-of network) while specialist copay is $35 ($45 out-of-network). MRIs and CT Scans are subject to only a $125 copay, and lab services are generally subject to only a $5-$15 copay.
The ER copay is $75, but is waived if admitted to the hospital within three days. The Urgent Care and ambulance service copays are $50 and $125 respectively. Eight chiropractic visits per year are covered with a $20 copay as well as 190 lifetime days of inpatient mental health treatment at a psychiatric hospital. 10 routine foot care visits are included in the policy along with limited dental services. Hearing ($35 copay for exams) and vision (annual routine eye exam) benefits are also included.
Geisinger Gold Classic Advantage – Available in Central Pennsylvania and several surrounding counties. Unlimited inpatient hospital stay coverage with $125 copay for first five days. Office visit copays are very low ($5 and $20) with diagnostic testing and x-ray copays only $5. Outpatient x-rays cost $25. Emergency care is subject to a $75 copay.
Urgent Care visits cost just $20 while ambulance services have a $100 copay. Occupational, physical, and speech/language therapy are subject to only a $10 copay. Four free foot care visits are provided at no charge. Limited dental services are provided and one hearing exam per year ($20 copay). Up to $800 every three years is available to purchase hearing aids. Annual vision exams have a $20 copay and $200 every two years is provided for glasses and contact lenses.
Keystone 65 Preferred Medical Only – Available on Bucks, Montgomery, Philadelphia, Chester, and Delaware counties. Bucks and Philadelphia county rates are lower than the other three counties. Inpatient hospital stay out-of-pocket expenses are $240 per day for the first six days. The primary-care physician copay is only $5, although the specialist copay is $40.
There is no out-of-pocket expense for lab fees, diagnostic tests, and x-rays, and the ER copay is $75. Urgent Care visit copays range from $5-$40. Outpatient individual and group therapy for mental health care expenses is $40. Limited dental services and one routine hearing exam every three years are covered. Vision benefits cover one exam ($40 copay) every two years with a pair of glasses or contact lenses (up to $100).
Erickson Advantage Signature Without Drugs – Available in Bucks and Delaware Counties, the Erickson plan is one of the highest-rated options in the Philadelphia area. Out-of-network hospital-care is subject to 30% copay. PCP visits are covered at 100% while specialist visits have a low $35 copay.
Diagnostic radiology services and emergency care subject to $50 copay and $150 copay for ambulance services. Chiropractic services are covered and each visit has an out-of-pocket cost of $20. Contact lenses and eyeglasses have no out-of-pocket expense, although are limited to one every two years. If following cataract surgery, also covered at 100%.
Highmark Security Blue HMO Basic – Available in many Western and nearby Pa Counties. Maximum out-of-pocket expenses of $6,700. $350 copay per hospital stay and office visit copays of $5 and $30. MRIs and CAT scans have $100 copay and $75 copay for ER visits. Ambulance and Urgent care have $125 and $50 copays.
Six chiropractic visits per year are allowed subject to a $20 copay. Outpatient group and individual substance abuse therapy visits are covered with only a $30 copay. Occupational, physical, and speech/language therapy are are subject to the same copay. Like most other companies, some dental, vision, and hearing services are provided.
UPMC For Life – Available in Western Pa, along with many other counties, such as Lancaster, McKean, Potter, Elk, and Cameron. There is no deductible to meet and the maximum out-of-pocket expenses are $3,400. Office visit copays are $5 and $45 with a $350 copay per stay for hospital visits. MRIs and CAT scans are subject to only a $110 copay.
Diagnostic tests, procedures, and lab tests are typically paid with a copay of $5 0r less and outpatient x-rays cost $30. The ER copay is $75, ambulance service copay is $125, and Urgent Care copay is $50. Outpatient therapy visits cost $40. Dental, vision, and hearing services are similar to other available plans.
HealthAmerica Advantra Basic Medical – Available in Western and Central Pa, this Advantra HMO plan features a $6,700 deductible with $10 and $50 office visit copays. A $295 copay applies to diagnostic radiology services with $25 and $35 copays applied to lab services and outpatient x-rays respectively.
Outpatient surgeries cost $350 at an ambulatory surgical center and $400 at a hospital. Urgent care and ER visits are subject to $50 and $75 copays. Inpatient hospital stays result in a $225 charge for the first seven days. Four routine foot-care visits are allowed per year ($50 copay) along with limited dental and hearing services (also a $50 copay). One free annual routine eye exam is also allowed.
Aetna Medicare Basic Plan – Maximum out-of-pocket expenses of $6,700 with $279 per day hospital co-pay for the first seven days. Office visit copays are $35 and $50. A $50 copay also applies to diagnostic tests, x-rays, and lab services.
$75 copay for emergency room visits and a $300 copay for ambulance services. Most outpatient therapy visits are subject to a $40 copay and some dental, vision, and hearing benefits are included.
Humana Gold Choice – Available in 33 counties with $6,200 maximum out-of-pocket expenses. $295 per day copay for six days for hospital visits. Office visit copays are $15 and $40, and diagnostic tests/x-rays will cost between $0 and $105, depending on the procedure.
ER copay is $75 with $300 copay for ambulance services. Typically, copay is $45 for basic vision, dental and hearing services. Like most other plans, home health services and hospice are fully covered.
Personal Choice 65 Medical Only – Available in Bucks and Philadelphia counties. $6,200 maximum out-of-pocket expenses with low $900 copay per hospital stay. Office visit copays are $15 and $40. In-network diagnostic tests and lab services are covered at 100%.
Urgent Care copay is generally between $15 and $40 with a $75 copay for ER visit. Dental, vision, and dental services are generally subject to a $40 copay.
Cigna-HealthSpring Advantage – Available in the following counties: Philadelphia, York, Northampton, Montgomery, Lehigh, Lancaster, Delaware, Chester, Berks, Cumberland, and Bucks. Policy offers a $0 deductible with $6,700 maximum out-of-pocket expenses.
The hospital copay is $279 for the first seven days and the office visit cops are $10 and $50. Lab services are covered at 100% and the Urgent care copay is $50.
Many Pa Medicare Advantage Plans Include Drug Coveragee
Pa Advantage Plans With Prescription Drugs
Erickson Advantage Champion – Available in Bucks and Delaware counties. $0 deductible and no out-of-pocket expenses for in-network hospital care. Office visit copays are $0 and $35. ER and Urgent Care copays are $50 and $30 respectively. Tier 1 drugs are covered at 100% along with Tier 2 mail order. Tier 3 drugs (mail order) have a $125 copay (90 days).
Erickson Advantage Freedom – Less expensive than previous plan because of $3,400 maximum out-of-pocket expenses and $200 copay per day (seven days) for in-hospital visits. Office visit copays are also higher ($20 and $50), and drug coverage has slightly higher costs. NOTE: “Guardian” and “Signature With Drugs” plans also available from Erickson.
AARP (UnitedHealthcare) MedicareComplete Choice Plan 1 – Available in Erie, Lehigh, and Northampton counties. Deductibles are $230 and maximum out-of-pocket expenses are $6,700. In-hospital copay is $345 for the first five days, and office visit copays are $15 and $45. ER and Urgent Care copays are $75 and $40. Tier 1 and Tier 2 drugs have a $0 copay for mail-order. NOTE: AARP Plan 2, and Choice plans also available.
Aetna Medicare Premier – Available in Berks, Carbon, Lancaster, Lebanon, Lehigh, Monroe, Northampton, and Schuylkill counties. $0 deductible with $6,700 maximum out-of-pocket expenses. in-hospital copay is $275 for the first six days. Office visit copays are $5 and $35. A $35 copay also applies to diagnostic tests and procedures, although lab services are covered at 100%. ER copay is $75 and Urgent Care copay will vary. Tier 1 drug 90-day cost sharing copay is only $30, but Tier 2 is $141. Tier 3 is 50%.
Community Blue Medicare HMO Signature – Available in many counties, although rate varies. $0 deductible with $6,700 maximum out-of-pocket costs. In-hospital copays range from $200-$275 for the first 5-7 days. Office visit copays are $0 or $5 and $45. ER and Urgent Care copays are $75 and $50 respectively. Prescription drug copays vary. NOTE: The Community Blue HMO Prestige plan is also offered with much lower in-hospital copay ($100). However, premium is significantly higher.
Highmark Freedom Blue PPO Classic – Available in many counties, including Allegheny, Butler, Jefferson, Somerset, Warren and several others. $0 deductible with $6,700 maximum out-of-pocket expenses. In-hospital expenses of $15 per day for five days. Office visit copays are $5 and $25 while diagnostic tests and lab fees are covered at 100%. Drug standard mail-order cost-sharing copays (90 days) are $7.50, $37.50, and $117.50 for Tier 1, 2, and 3 prescriptions respectively. NOTE: Select, Standard, and ValueRX plans are also offered.
Geisinger Gold Classic Advantage Rx – Available in Central Pennsylvania and some surrounding areas. Six policy options are offered, depending upon where you live. Deductible is $0 with $3,400 maximum out-of-pocket expenses. In-hospital copay is $125 for five days. Office visit copays are only $5 and $20 while the ER and Urgent Care copays are $75 and $20. Chiropractic visits are also subject to only a $20 copay. Standard 90-day mail order cost-sharing drug copays are $9, $60, and $141 for Tiers 1, 2, and 3.
Geisinger Gold Complete Rx – $0 deductible with $5,900 maximum out-of-pocket expenses. Attractive $o premium although in-hospital expenses are $180 per day for the first nine days. Office visit copays are $5 and $30, while the ER and Urgent care copay are $75 and $30. Drug coverage is similar to prior Geisinger plan above.
Keystone 65 Select RX – Available in Bucks, Philadelphia, Chester, Delaware, and Montgomery Counties. Deductible is $320 with $5,500 maximum out-of-pocket expenses. In-hospital copay is $290 for the first six days while office visit copays are $20 and $45. Diagnostic tests/procedures and lab services are covered at 100%. The ER copay is $75 and the Urgent Care copay varies from $20-$45. Standard 90-day mail order cost-sharing drug copays are $6, $24, and $94.
Highmark Security Blue HMO Standard – $0 deductible and $6,700 maximum out-of-pocket expenses. The in-hospital copay is $325 per stay and office visit copays are $10 and $30. Diagnostic tests/procedures and lab services are covered at 100%. Outpatient x-rays are covered with a $25 copay. The ER and Urgent Care copays are $75 and $50. Standard 90-day mail order cost-sharing drug copays are $7.50, $37.50, and $112.50.