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.

Gold

Medical and Medicare Part D Benefits
Premium
$0 per month

In Network

Out of Network

Maximum Out-of-Pocket
$4,800
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
$260 copay
Outpatient Rehabilitation
$20 copay per visit
Outpatient Diagnostic Services
$0-$125 copay, depending on the service
Hospital
$245 per day for days 1-6
DME
20%; 0 for CGM
Maximum Out-of-Pocket
$8,950
Primary Care Physician
30%
Specialist
30%
Emergency Room
$90 copay per visit
Urgent Care
$40 copay per visit
Outpatient Hospital
30%
Outpatient Rehabilitation
30%
Outpatient Diagnostic Services
30%
Hospital
30%
DME
30%

Extra Benefits

Dental
$0 for two preventive visits; $1,500 comprehensive
Vision
$0 copay for eyewear up to $300 per year
OTC
$85 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
N/A
Vision
N/A
OTC
N/A
Hearing Aids
N/A
Wallet
N/A

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

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%

CommunityCare Options is a PPO plan for residents of Muskogee County. In-network providers include Ascension St. John and Saint Francis health systems.

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