Bright Advantage Harmony Choice Plan (HMO C-SNP) is a Medicare Advantage (Part C) Special Needs Plan by Bright Health.
This page features plan details for 2022 Bright Advantage Harmony Choice Plan (HMO C-SNP) H4853 – 018 – 0 available in Phoenix and Tucson Area.
Bright Advantage Harmony Choice Plan (HMO C-SNP) is offered in the following locations.
Bright Advantage Harmony Choice Plan (HMO C-SNP) offers the following coverage and cost-sharing.
Special Needs Plan Type: | Chronic or Disabling Condition |
Conditions Covered: |
Insurer: | Bright Health |
Health Plan Deductible: | $0 |
MOOP: | $7,550 In-network |
Drugs Covered: | Yes |
Ready to sign up for Bright Advantage Harmony Choice Plan (HMO C-SNP) ?
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$170.10 | $0.00 | $40.00 | $0.00 | $210.10 |
Bright Advantage Harmony Choice Plan (HMO C-SNP) 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: | Some Generics |
Formulary Link: | Formulary Link |
Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
---|---|---|---|---|
$40.00 | $30.00 | $20.00 | $10.00 | $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.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | |||
6 (Select Care Drugs) | $0.00 copay |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
6 (Select Care Drugs) | $0.00 copay | $0.00 copay |
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 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) |
Bright Advantage Harmony Choice Plan (HMO C-SNP) also provides the following benefits.
In-Network: No |
Diagnostic services: | $0 copay (authorization required) (referral required) |
Endodontics: | $0 copay (authorization required) (referral required) |
Extractions: | $0 copay (authorization required) (referral required) |
Non-routine services: | $0 copay (authorization required) (referral required) |
Periodontics: | $0 copay (authorization required) (referral required) |
Prosthodontics, other oral/maxillofacial surgery, other services: | $0-350 copay (authorization required) (referral required) |
Restorative services: | $0 copay (authorization required) (referral required) |
Cleaning: | $0 copay (limits may apply) |
Dental x-ray(s): | $0 copay (limits may apply) |
Fluoride treatment: | Not covered |
Oral exam: | $0 copay (limits may apply) |
Diagnostic radiology services (e.g., MRI): | 20% coinsurance (authorization required) (referral required) |
Diagnostic tests and procedures: | 20% coinsurance (authorization required) (referral required) |
Lab services: | $0 copay (authorization required) (referral required) |
Outpatient x-rays: | 20% coinsurance (authorization required) (referral required) |
Primary: | 20% coinsurance per visit |
Specialist: | 20% coinsurance per visit (authorization required) (referral required) |
Emergency: | $90 copay per visit (always covered) |
Urgent care: | $0 copay |
Foot exams and treatment: | 20% coinsurance (authorization required) (referral required) |
Routine foot care: | Not covered |
20% coinsurance |
$0.00 |
In-Network: Yes |
Fitting/evaluation: | $0 copay (limits may apply) |
Hearing aids: | $699-999 copay (limits may apply) (authorization required) |
Hearing exam: | $0 copay |
Contact plan for details (authorization required) (referral required) |
20% coinsurance per visit (authorization required) (referral required) |
$7,550 In-network |
Diabetes supplies: | $0 copay (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: | Contact plan for details (authorization required) (referral required) |
Outpatient group therapy visit with a psychiatrist: | $0 copay (authorization required) (referral required) |
Outpatient group therapy visit: | $0 copay (authorization required) (referral required) |
Outpatient individual therapy visit with a psychiatrist: | $0 copay (authorization required) (referral required) |
Outpatient individual therapy visit: | $0 copay (authorization required) (referral required) |
No |
$0 copay (authorization required) (referral required) |
Occupational therapy visit: | $40 copay (authorization required) (referral required) |
Physical therapy and speech and language therapy visit: | $40 copay (authorization required) (referral required) |
Contact plan for details (authorization required) (referral required) |
$0 copay (authorization required) |
Contact lenses: | $0 copay (limits may apply) (authorization required) |
Eyeglass frames: | $0 copay (limits may apply) (authorization required) |
Eyeglass lenses: | $0 copay (limits may apply) (authorization required) |
Eyeglasses (frames and lenses): | Not covered |
Other: | Not covered |
Routine eye exam: | $0 copay (limits may apply) |
Upgrades: | $0 copay (limits may apply) (authorization required) |
Covered (authorization required) (referral required) |
Ready to sign up for Bright Advantage Harmony Choice Plan (HMO C-SNP) ?
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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