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Medicare & Medicaid Dual Eligibility Plan
Medicare & Medicaid Dual Eligibility Plan
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Senior Health Plan - Plans Overview
CommunityCare is proud to offer Senior Health Plan, a program created especially for Medicare beneficiaries. Senior Health Plan has seven Medicare Advantage Plans to fit the varying needs of Medicare beneficiaries.
Dual Eligibility
Medical and Prescription
Premium
$0 per month
Maximum Out-of-Pocket
$9,250
Primary Care Physician
$0 or 20% of the cost
Specialist
$0 or 20% of the cost
Emergency Room
$0 to $115 copay per visit. Waived if admitted.
Urgent Care
$0 to 20%; up to $40 copay per visit
Outpatient Hospital
$290 copay
Outpatient Rehabilitation
$20 copay per visit
Outpatient Diagnostic Services
$0 to 20% copay, depending on the service
Hospital
$0 to $1,676 per benefit period
DME
$0-20% for most Medicare-covered durable medical equipment
Extra Benefits
Dental
$1,000 allowance; $0 copay for covered preventive and comprehensive services; 50% copay for Prosthetics/Endodontics/Dentures
Eyewear
You pay $0– 20% for eyewear up to $475
OTC
$180 per month
Hearing Aids
No copay up to plan benefit limit of $500 for hearing aids. Benefit can be used once every two years. Must use approved vendor for fitting and evaluation and hearing aid purchase.
Fitness Plus Benefit
N/A
Transportation
$0 copay up to 36 one-way trips. 60 mile one-way limit
Part D
Deductible - Tiers 2,3,4,5
$615
Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
25% Coinsurance
Tier 3 - Preferred Brand Name
25% Coinsurance
Insulin Tier
$35
Tier 4 - Non-Preferred Drugs
25% Coinsurance
Tier 5 - Specialty Tier
25% Coinsurance
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Service Area
Craig, Creek, Mayes, Muskogee, Nowata, Okmulgee, Osage, Rogers, Tulsa, Wagoner, and Washington
