Ascension Complete Via Christi Reward (HMO) is a Medicare Advantage (Part C) Plan by Ascension Complete.
This page features plan details for 2022 Ascension Complete Via Christi Reward (HMO) H5398 – 001 – 0 available in Butler, Harvey and Sedgwick Counties.
Ascension Complete Via Christi Reward (HMO) is offered in the following locations.
Ascension Complete Via Christi Reward (HMO) offers the following coverage and cost-sharing.
Insurer: | Ascension Complete |
Health Plan Deductible: | $0 |
MOOP: | $2,900.00 |
Drugs Covered: | Yes |
Ready to sign up for Ascension Complete Via Christi Reward (HMO) ?
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
Ascension Complete Via Christi Reward (HMO) qualifies for a monthly Medicare Give Back Benefit of $100.00.
Premium Reduction: | $100.00 |
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$170.10 | $0.00 | $0.00 | $100.00 | $70.10 |
Ascension Complete Via Christi Reward (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $480.00 |
Initial Coverage Limit: | $4,430.00 |
Catastrophic Coverage Limit: | $7,050.00 |
Drug Benefit Type: | Enhanced |
Gap Coverage: | No |
Formulary Link: | Formulary Link |
Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
---|---|---|---|---|
$0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
After you pay your $480.00 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 $4,430.00. Once you reach that amount, you will enter the next coverage phase.
After your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00, you will pay no more than the amounts below for any drug tier until you reach $7,050.00.
Drug Type | Cost Share |
---|---|
Generic drugs | 25% |
Brand-name drugs | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
Tier | Cost |
---|---|
Generic | $4.15 copay or 5% (whichever costs more) |
Brand-name | $10.35 copay or 5% (whichever costs more) |
Ascension Complete Via Christi Reward (HMO) also provides the following benefits.
In-Network: No |
Diagnostic services: | $0 copay (limits may apply) (authorization required) |
Endodontics: | Not covered |
Extractions: | Not covered |
Non-routine services: | $0 copay (limits may apply) (authorization required) |
Periodontics: | Not covered |
Prosthodontics, other oral/maxillofacial surgery, other services: | Not covered |
Restorative services: | Not covered |
Cleaning: | $0 copay (limits may apply) (authorization required) |
Dental x-ray(s): | $0 copay (limits may apply) (authorization required) |
Fluoride treatment: | $0 copay (limits may apply) (authorization required) |
Oral exam: | $0 copay (limits may apply) (authorization required) |
Diagnostic radiology services (e.g., MRI): | $0-350 copay (authorization required) |
Diagnostic tests and procedures: | $0-100 copay (authorization required) |
Lab services: | $0-35 copay (authorization required) |
Outpatient x-rays: | $40 copay (authorization required) |
Primary: | $0 copay |
Specialist: | $50 copay per visit |
Emergency: | $120 copay per visit (always covered) |
Urgent care: | $45 copay per visit (always covered) |
Foot exams and treatment: | $50 copay |
Routine foot care: | $50 copay |
$320 copay |
$0.00 |
In-Network: No |
Fitting/evaluation: | Not covered |
Hearing aids – inner ear: | Not covered |
Hearing aids – outer ear: | Not covered |
Hearing aids – over the ear: | Not covered |
Hearing exam: | $50 copay (authorization required) |
$500 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) |
$350 copay per visit (authorization required) |
$2,900 In-network |
Diabetes supplies: | $0 copay per item (authorization required) |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% coinsurance per item (authorization required) |
Prosthetics (e.g., braces, artificial limbs): | 20% coinsurance per item (authorization required) |
Chemotherapy: | 20% coinsurance (authorization required) |
Other Part B drugs: | 20% coinsurance (authorization required) |
Inpatient hospital – psychiatric: | $465 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) |
Outpatient group therapy visit with a psychiatrist: | $40 copay |
Outpatient group therapy visit: | $40 copay |
Outpatient individual therapy visit with a psychiatrist: | $40 copay |
Outpatient individual therapy visit: | $40 copay |
Yes |
$0 copay |
Occupational therapy visit: | $40 copay (authorization required) |
Physical therapy and speech and language therapy visit: | $40 copay (authorization required) |
$0 per day for days 1 through 20 $188 per day for days 21 through 100 (authorization required) |
$0 copay (limits may apply) (authorization required) |
Contact lenses: | Not covered |
Eyeglass frames: | Not covered |
Eyeglass lenses: | Not covered |
Eyeglasses (frames and lenses): | Not covered |
Other: | Not covered |
Routine eye exam: | Not covered |
Upgrades: | Not covered |
Covered |
Preventive dental: | Monthly Premium: | $23.00 |
Preventive dental: | Deductible: | N/A |
Comprehensive dental: | Monthly Premium: | $23.00 |
Comprehensive dental: | Deductible: | N/A |
Eye exams: | Monthly Premium: | $23.00 |
Eye exams: | Deductible: | N/A |
Eyewear: | Monthly Premium: | $23.00 |
Eyewear: | Deductible: | N/A |
Ready to sign up for Ascension Complete Via Christi Reward (HMO) ?
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
SMID: MULTIPLAN_HCIHNDOGMED01_M
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