New Hanover Health Advantage Platinum (HMO-POS)

Health Insurance Company: FirstMedicare Direct

Medicare Advantage Plan Details

FirstMedicare Direct
$55 /mo
monthly premium
New Hanover Health Advantage Platinum (HMO-POS)
Additional Coverage
Overall Star Rating (2024)
  • Rx
  • Dental
  • Vision
  • Hearing
4.5
out of 5 stars

General Plan Details

Medical Deductible
$0
Out-of-Pocket Maximum
$2900
Rx Drug Coverage
Yes
Rx Deductible
$0

Additional Benefits

Dental Coverage
Yes
Vision Coverage
Yes
Mental Health Coverage
Yes
Chiropractic Coverage
No
Optional Supplemental Benefits
No
Part B Give Back
No

Doctor & Hospital Coverage

Primary Doctor Office Visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist Office Visit
In-network: $0 copay
Out-of-network: $40 copay per visit
Periodic Exam Coverage
In-network: $0 copay
Out-of-network: $0 copay

Emergency Room

$135 copay per visit (always covered)

Ambulance Coverage

In-network: $265 copay
Out-of-network: $265 copay

Lab, X-Ray, Radiology Coverage

Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: In-network: $0-85 copay
Out-of-network: 40% coinsurance
Medicare-covered lab services: In-network: $0-50 copay
Out-of-network: 40% coinsurance
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): In-network: $0-275 copay
Out-of-network: 40% coinsurance
Medicare-covered x-ray services: In-network: $0-100 copay
Out-of-network: 30% coinsurance

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: In-network: $250 copay per visit
Out-of-network: $350 copay per visit

Hospitalization Coverage

Inpatient hospital-acute:
In-network: $275 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: $400 per day for days 1 through 6
$0 per day for days 7 through 90
Inpatient hospital psychiatric:
In-network: $160 per day for days 1 through 10
$0 per day for days 11 through 90
Out-of-network: $285 per day for days 1 through 10
$0 per day for days 11 through 90

Rehabilitation Coverage

Occupational therapy services:
In-network: $30 copay
Out-of-network: $45 copay
Physical therapy and speech and language therapy services:
In-network: $25 copay
Out-of-network: $40 copay

Urgent Care Coverage

$40 copay per visit (always covered)

Skilled Nursing Facility (SNF)

In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 41
$0 per day for days 42 through 100
Out-of-network: $0 per day for days 1 through 20
$203 per day for days 21 through 41
$0 per day for days 42 through 100

Mental Health Coverage

Medicare-covered individual sessions: In-network: $25 copay
Out-of-network: $40 copay
Medicare-covered group sessions: In-network: $25 copay
Out-of-network: $40 copay

Dental, Vision, Hearing Benefits

Dental Services

Oral exams: In-network: $0 copay
Out-of-network: $35 copay or 0-50% coinsurance
Prophylaxis (cleaning): In-network: $0 copay
Out-of-network: $35 copay or 0-50% coinsurance
Dental x-rays: In-network: $0 copay
Out-of-network: $35 copay or 0-50% coinsurance

Vision Benefits

Eye exams:
Routine eye exams: In-network: $0 copay
Out-of-network: No Data
Eyewear:
Contact Lenses: In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses: In-network: $0 copay
Out-of-network: $0 copay

Hearing Benefits

Hearing exams:
Routine hearing exams: In-network: $0 copay
Out-of-network: $40 copay
Hearing aids:
Hearing aids (all types): In-network: $0 copay
Out-of-network: No Data

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

$2.00 copay (30-day supply)
$6.00 copay (90-day supply)

Tier 2: Generic

$8.00 copay (30-day supply)
$24.00 copay (90-day supply)

Tier 3: Preferred Brand

$45.00 copay (30-day supply)
$135.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

50% coinsurance (30-day supply)
50% coinsurance (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

Rx Drug Coverage - Standard Mail Order Cost

Tier 1: Preferred Generic

$2.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$8.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 3: Preferred Brand

$45.00 copay (30-day supply)
$112.50 copay (90-day supply)

Tier 4: Non-Preferred Drug

50% coinsurance (30-day supply)
50% coinsurance (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

Plan Links

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Where This Plan is Available

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Additional Plan Info

Year:
2024
Plan ID:
H6306-014-0
Insurance Company Website:
FirstMedicare Direct

Health Insurance Companies Offering Plans

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  • Premera Blue Cross
  • SCAN Health Plan
  • Scott and White Health Plan now part of Baylor Scott & White Health
  • UnitedHealthcareⓇ
  • Wellcare