In-network with Ascension St. John, Hillcrest, OSU Medical and Saint Francis (other providers are available in our network).

Brokers

Medicare Brokers - Plans Overview

Choose the Senior Health Plan tab, the INTEGRIS Health Partners+ tab, or the CommunityCare Options to view the common benefits & copays for these plans. Included are the links to the specific additional benefits pages.

Deluxe

Medical and Medicare Part D Benefits
Premium
$0 per month
Maximum Out-of-Pocket
$5,300
Primary Care Physician
$0 copay per visit
Specialist
$40 copay per visit
Emergency Room
$90 copay per visit
Urgent Care
$40 copay per visit
Outpatient Hospital
$300 copay
Outpatient Rehabilitation
$20 copay per visit
Outpatient Diagnostic Services
$15-$150 copay, depending on the service
Hospital
$300 per day for days 1-7
DME
20%; 0 for CGM

Premier

Medical and Medicare Part D Benefits
Premium
$21.10 per month
Maximum Out-of-Pocket
$4,700
Primary Care Physician
$0 copay per visit
Specialist
$35 copay per visit
Emergency Room
$90 copay per visit
Urgent Care
$35 copay per visit
Outpatient Hospital
$250 copay
Outpatient Rehabilitation
$20 copay per visit
Outpatient Diagnostic Services
$0-$100 copay, depending on the service
Hospital
$245 per day for days 1-5
DME
20%; 0 for CGM

Choice

Medical Benefits Only
Premium
$0 per month
Maximum Out-of-Pocket
$5,300
Primary Care Physician
$0 copay per visit
Specialist
$35 copay per visit
Emergency Room
$90 copay per visit
Urgent Care
$35 copay per visit
Outpatient Hospital
$250 copay
Outpatient Rehabilitation
$20 copay per visit
Outpatient Diagnostic Services
$0-$100 copay, depending on the service
Hospital
$245 per day for days 1-5
DME
20%; 0 for CGM

Extra Benefits

Dental
$0 for two preventive visits; $1,500 comprehensive
Vision
$0 copay for eyewear up to $300 per year
OTC
$60 per quarter
Hearing Aids
Covered in Wallet
Wallet
Flex Card limit up to $350 for fitness, hearing aids, PERS, home & bathroom safety & non-Medicare DME
Dental
$0 for two preventive visits; $1,500 comprehensive
Vision
$0 copay for eyewear up to $300 per year
OTC
$60 per quarter
Hearing Aids
Covered in Wallet
Wallet
Flex Card limit up to $500 for fitness, hearing aids, PERS, home & bathroom safety & non-Medicare DME
Dental
$0 for two preventive visits; $1,500 comprehensive
Vision
$0 copay for eyewear up to $200 per year
OTC
$50 per quarter
Hearing Aids
Covered in Wallet
Wallet
Flex Card limit up to $500 for fitness, hearing aids, PERS, home & bathroom safety & non-Medicare DME

Part D

Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
$5 copay
Tier 3 - Preferred Brand Name
$40 copay
Insulin Tier
$35
Tier 4 - Non-Preferred Drugs
$95 copay
Tier 5 - Specialty Tier
33% of the cost
Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
$5 copay
Tier 3 - Preferred Brand Name
$40 copay
Insulin Tier
$35
Tier 4 - Non-Preferred Drugs
$95 copay
Tier 5 - Specialty Tier
33% of the cost
Tier 1 - Preferred Generic
N/A
Tier 2 - Generic
N/A
Tier 3 - Preferred Brand Name
N/A
Insulin Tier
N/A
Tier 4 - Non-Preferred Drugs
N/A
Tier 5 - Specialty Tier
N/A

Copays in GAP

Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
$5 copay
Other Tiers
25%
Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
$5 copay
Other Tiers
25%
Tier 1 - Preferred Generic
N/A
Tier 2 - Generic
N/A
Other Tiers
N/A

INTEGRIS Health Partners+ is owned by INTEGRIS Health and administered by CommunityCare.

The INTEGRIS Health Partners+ service area is: Canadian, Cleveland, Kingfisher, Lincoln, Logan, Oklahoma and Pottawatomie counties.

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