Plan Design Summary
As of January 1, 2010, SummaCare Secure will be offering three Medicare Advantage Prescription Drug plan designs: Silver Plus (HMOPOS), Gold Plus (HMOPOS) and Platinum (HMOPOS). Each plan offers different monthly premiums and out-of-pocket expenses. All of these plans include comprehensive prescription drug coverage.
The chart below compares common benefit categories and their level of coverage under the Silver Plus (HMOPOS), Gold Plus (HMOPOS) and Platinum (HMOPOS) plans. For a complete list, refer to the Summary of Benefits.
| Benefit | SummaCare Secure Silver Plus (HMOPOS) |
SummaCare Secure Gold Plus (HMOPOS) |
SummaCare Secure Platinum (HMOPOS) |
|---|---|---|---|
| Monthly Plan Premium | $0 |
$80 | $180 |
| Deductible | $0 | $0 | $0 |
| Each Doctor's Visit (Primary Care Physician) | $0 Copay | $0 Copay | $0 Copay |
| Each Doctor's Visit (Specialists) | $30 Copay | $25 Copay | $0 Copay |
| Inpatient Hospital Stays | Days 1-15: $195 copay/day Days 16-90: $0 copay/day $0 copay for additional days |
Days 1-15: $100 copay/day Days 16-90: $0 copay/day $0 copay for additional days |
Days 1-15: $100 copay/day Days 16-90: $0 copay/day $0 copay for additional days |
| Each Emergency Room Visit | $50 Copay (Waived if admitted to the hospital) |
$50 Copay (Waived if admitted to the hospital) |
$50 Copay (Waived if admitted to the hospital) |
| Ambulance Services | $150 | $100 | $0 |
| 30-Day Supply of a Generic Drug (Retail) | $3 Copay | $3 Copay | $3 Copay |
| 30-Day Supply of a Preferred Brand Name Drug (Retail) | $35 Copay | $30 Copay | $35 Copay |