Ascend Rx (HMO-POS)

H5211 - 013 - 0
4 out of 5 stars (4 / 5)

Ascend Rx (HMO-POS) is a Medicare Advantage (Part C) Plan by Security Health Plan of Wisconsin, Inc..

This page features plan details for 2024 Ascend Rx (HMO-POS) H5211 – 013 – 0 available in Central, North, Northeast, West & South Central WI.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

Ascend Rx (HMO-POS) is offered in the following locations.

Plan Overview

Ascend Rx (HMO-POS) offers the following coverage and cost-sharing.

Insurer:Security Health Plan of Wisconsin, Inc.
Health Plan Deductible:$0.00
MOOP:$4,500 In and Out-of-network
$4,500 In-network
$4,500 Out-of-network
Drugs Covered:Yes
Please Note:
  • This plan does not charge an annual deductible for all drugs. The $330.00 annual deductible only applies to drugs on certain tiers.

Ready to sign up for Ascend Rx (HMO-POS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

Ascend Rx (HMO-POS) has a monthly premium of $53.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$174.70 $0.00 $53.00 $0.00 $227.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Ascend Rx (HMO-POS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:$330.00
Initial Coverage Limit:$5,030.00
Catastrophic Coverage Limit:$8,000.00
Drug Benefit Type:Enhanced Alternative
Additional Gap Coverage:
Formulary Link: Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$53.00$

NOTE:  The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.

Initial Coverage Phase

After you pay your $330.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.

Tier Cost
All other tiers (Generic)25%
All other tiers (Brand-name)25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Ascend Rx (HMO-POS) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network Yes

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$4,500 In and Out-of-network
$4,500 In-network
$4,500 Out-of-network

Optional supplemental benefits

Yes

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network Yes, contact plan for further details

Outpatient hospital coverage

In-network $0-250 copay per visit (Authorization is required.) (Referral is not required.)
out-of-network $0-250 copay per visit (Authorization is required.) (Referral is not required.)

Doctor visits

In-network Primary$0 copay (Not applicable.) (Not applicable.)
out-of-network Primary$0 copay (Not applicable.) (Not applicable.)
In-network Specialist$50 copay per visit (Authorization is not required.) (Referral is not required.)
out-of-network Specialist$50 copay per visit (Authorization is not required.) (Referral is not required.)

Preventive care

In-network $0 copay (Authorization is not required.) (Referral is not required.)
out-of-network $0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$110 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$0-50 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

In-network Diagnostic tests and procedures$20 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic tests and procedures$20 copay (Authorization is required.) (Referral is not required.)
In-network Lab services$15 copay (Authorization is required.) (Referral is not required.)
out-of-network Lab services$15 copay (Authorization is required.) (Referral is not required.)
In-network Diagnostic radiology services (e.g., MRI)$200 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic radiology services (e.g., MRI)$200 copay (Authorization is required.) (Referral is not required.)
In-network Outpatient x-rays$20 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient x-rays$20 copay (Authorization is required.) (Referral is not required.)

Hearing

In-network Hearing exam$50 copay (Authorization is not required.) (Referral is not required.)
out-of-network Hearing exam$50 copay (Authorization is not required.) (Referral is not required.)
In-network Fitting/evaluation$50 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
out-of-network Fitting/evaluation$50 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
In-network Hearing aids$500 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Preventive dental

In-network Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Fluoride treatmentNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

Non-routine servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Diagnostic servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Restorative servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
EndodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
PeriodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
ExtractionsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)

Vision

In-network Routine eye exam$0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
out-of-network Routine eye exam$0-50 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
In-network Other$50 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
out-of-network Other$0-50 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
Contact lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglass framesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
UpgradesNot covered (Not applicable.) (Not applicable.)

Rehabilitation services

In-network Occupational therapy visit$40 copay (Authorization is required.) (Referral is not required.)
out-of-network Occupational therapy visit$40 copay (Authorization is required.) (Referral is not required.)
In-network Physical therapy and speech and language therapy visit$40 copay (Authorization is required.) (Referral is not required.)
out-of-network Physical therapy and speech and language therapy visit$40 copay (Authorization is required.) (Referral is not required.)

Ground ambulance

In-network $275 copay (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

In-network Foot exams and treatment$50 copay (Authorization is not required.) (Referral is not required.)
out-of-network Foot exams and treatment$50 copay (Authorization is not required.) (Referral is not required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

In-network Durable medical equipment (e.g., wheelchairs, oxygen)0-20% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Diabetes supplies$0 copay (Authorization is required.) (Not applicable.)

Wellness programs (e.g., fitness, nursing hotline)

Covered (Authorization is required.) (Referral is not required.)

Medicare Part B drugs

In-network Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
out-of-network Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
In-network Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
out-of-network Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
In-network Part B Insulin drugs$35 copay (Authorization is required.) (Not applicable.)
out-of-network Part B Insulin drugs0-20% coinsurance (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

In-network $320 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)
out-of-network $320 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)

Mental health services

In-network Inpatient hospital – psychiatric$320 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)
out-of-network Inpatient hospital – psychiatric$320 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient group therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
In-network Outpatient individual therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
In-network Outpatient group therapy visit$40 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient group therapy visit$40 copay (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit$40 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit$40 copay (Authorization is required.) (Referral is not required.)

Skilled Nursing Facility

In-network $0 per day for days 1 through 20
$160 per day for days 21 through 49
$0 per day for days 50 through 100 (Authorization is required.) (Referral is not required.)
out-of-network $0 per day for days 1 through 20
$160 per day for days 21 through 49
$0 per day for days 50 through 100 (Authorization is required.) (Referral is not required.)

Package #1

Monthly Premium$43.00
Deductible$100.00

Optional Benefits

Package #1

Preventive dental:Monthly Premium:$43.00
Preventive dental:Deductible:$100.00
Comprehensive dental:Monthly Premium:$43.00
Comprehensive dental:Deductible:$100.00

Ready to sign up for Ascend Rx (HMO-POS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

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