2022 Balance Medicare Advantage (HMO)

This is similar to Original Medicare; however, it includes Eastern medicine and supplemental benefits.

Prescription drug coverage is included.

2022 Balance Medicare Advantage (HMO) Benefit Overview

Additional information

Plan Premium

$33.20

Medical Deductible (Part A)

$0

Prescription Drug Deductible (Part D)

$480

Maximum-Out-of-Pocket

$5,999

Prescription Drugs (Part D)

Included*

Doctor Visits

$0 copay

Hospital Stay

$0 copay for days 1-60 | $371 copy for days 61-90

Transportation (Non-Emergency)

$0 copay | 48 trips per year (one-way)

Flexible Health and Wellness Allowance

$300 allowance every three months

Labs/X-ray

20% Coinsurance

Dental Coverage

Up to $2,500 per year

Routine Vision and Eyewear Coverage

$0 copay | $300 every year

Hearing Coverage

$0 copay | $1,500 per ear every year

Acupuncture

$0 copay

Eastern Wellness Therapies

$0 copay up to 24 services per year

*Your cost-sharing may differ depending on the pharmacy you choose (e.g., standard retail, out-of-network, mail-order) or whether you receive a 30- or 100-day supply. If you live in a long-term care facility (LTC), you pay the same amount as you would at a standard retail pharmacy for a 31-day supply of medication.

This information is not a complete description of benefits. Call (833) 388-8168 for more information.

Additional information

Plan Premium

$33.20

Medical Deductible (Part A)

$0

Prescription Drug Deductible (Part D)

$480

Maximum-Out-of-Pocket

$5,999

Prescription Drugs (Part D)

Included*

Doctor Visits

$0 copay

Hospital Stay

$0 copay for days 1-60 | $371 copy for days 61-90

Transportation (Non-Emergency)

$0 copay | 48 trips per year (one-way)

Flexible Health and Wellness Allowance

$300 allowance every three months

Labs/X-ray

20% Coinsurance

Dental Coverage

Up to $2,500 per year

Routine Vision and Eyewear Coverage

$0 copay | $300 every year

Hearing Coverage

$0 copay | $1,500 per ear every year

Acupuncture

$0 copay

Eastern Wellness Therapies

$0 copay up to 24 services per year

For more information and a detailed description of benefits, please review our downloadable plan materials.

2023 Clever Care plans also include some new benefits

Special Supplemental Benefits for the Chronically Ill (SSBCI)

Available to qualifying members with a confirmed chronic condition and who are enrolled in Clever Care’s case management program.

  • Meals for Chronic Conditions

    $0 copay for 3 meals per day for 14 days not to exceed 42 meals per year.

  • Groceries

    $0 copay for eligible food items.

  • Social Needs Benefits

    $0 copay for companionship services rendered by non-clinical personal caregivers. Services are limited to 24, four-hour shifts (96 total hours).

  • Telemonitoring Service

    $0 copay for a device to monitor medical and other health data.

  • In-home Safety Assessment

    $0 copay for up to two assessments per year.

  • In-home Support Services

    $0 copay for services to assist with activities of daily living.

  • Support for Caregivers

    $0 copay for respite care, limited to 40 hours of care giving per year.

Additional Supplemental Benefits

  • Personal Emergency Response System (PERS)

    A mobile device and monitoring service to connect you with a 24-hour response center with the push of a button.

    $0 copay for one device per year.

  • Telehealth Visits

    $0 copay for a medical visit through Teladoc®. $40 copay for a mental health visit through Teladoc®.

    $0 copay for remote visits offered through your physician's office.

  • Post-Discharge Meals

    Immediately following an inpatient hospital or a skilled nursing facility stay, this plan provides meal assistance for 28 days not to exceed 84 meals per year to help with recovery.

    $0 copay up to the maximum allowed meals per year.

  • 24-hour Nurseline

    A registered nurse is available via phone 24 hours a day, seven days a week to address medical questions or concerns.

    $0 Copay.