In-network with Ascension St. John, Hillcrest, OSU Medical and Saint Francis (other providers are available in our network).
EOBs for plan members are temporarily unavailable to view online. If you have questions about plan benefits, please contact the CommunityCare customer service team for assistance.

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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