Aspire Health Protect (HMO)
Medicare Advantage Health Plan Details
Health insurance company offering plan: Aspire Health
- Rx
General Plan Details
Additional Benefits
Doctor & Hospital Coverage
Out-of-network: $5 copay
Out-of-network: $45 copay
Out-of-network: $0 copay
Emergency Room
$115 copay
Ambulance Coverage
In-network: $325 copay
Out-of-network: $325 copay
Lab, X-Ray, Radiology Coverage
Diagnostic tests & procedures:
In-network: $20 copay
Out-of-network: $20 copay
Lab services:
In-network: $20 copay
Out-of-network: $20 copay
Diagnostic radiology services (e.g., CT, MRI, etc):
In-network: 15% coinsurance
Out-of-network: 15% coinsurance
Outpatient x-rays:
In-network: $20 copay
Out-of-network: $20 copay
Hospital Services
Inpatient hospital coverage:
Tier 1
$505 per day for days 1-2
$300 per day for days 3-4
$0 per day for days 5-90
$0 per stay
Outpatient hospital coverage:
In-network: $80 copay
Out-of-network: $80 copay
Rehabilitation Coverage
Occupational therapy services:
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Urgent Care Coverage
$115 copay
Skilled Nursing Facility (SNF)
Tier 1
$0 per day for days 1-20
$214 per day for days 21-100
Mental Health Coverage
Outpatient group therapy with a psychiatrist:
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy with a psychiatrist:
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient group therapy visits:
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy visit:
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Dental, Vision, Hearing Benefits
Rx Drug Coverage - Standard Retail Cost
Tier 1: Preferred Generic
$9.00 copay (30-day supply)
$27.00 copay (90-day supply)
Tier 2: Generic
$20.00 copay (30-day supply)
$60.00 copay (90-day supply)
Tier 3: Preferred Brand
$47.00 copay (30-day supply)
$141.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
25% coinsurance (30-day supply)
Tier 5: Specialty Tier
33% coinsurance (30-day supply)
Additional Added Benefits
Plan Links
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