MetroPlus Platinum Plan (HMO)
Health Insurance Company: MetroPlus Health Plan
Medicare Advantage Plan Details
- Rx
- Hearing
General Plan Details
Additional Benefits
Doctor & Hospital Coverage
Emergency Room
$100 copay per visit (always covered)
Ambulance Coverage
$100 copay
Lab, X-Ray, Radiology Coverage
Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: 20% coinsurance
Medicare-covered lab services: 20% coinsurance
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): 20% coinsurance
Medicare-covered x-ray services: 20% coinsurance
Outpatient Surgery Coverage
Outpatient hospital:
Medicare-covered outpatient hospital services: 20% coinsurance per visit
Hospitalization Coverage
Inpatient hospital-acute:
$225 per day for days 1 through 8
$0 per day for days 9 through 90
Inpatient hospital psychiatric:
$195 per day for days 1 through 8
$0 per day for days 9 through 90
Rehabilitation Coverage
Occupational therapy services:
$25 copay
Physical therapy and speech and language therapy services:
$25 copay
Urgent Care Coverage
$0 copay
Skilled Nursing Facility (SNF)
In 2024 the amounts for each benefit period are:
$0 copay for days 1 through 20
$204 copay per day for days 21 through 100
Mental Health Coverage
Medicare-covered individual sessions: $40 copay
Medicare-covered group sessions: $40 copay
Dental, Vision, Hearing Benefits
Dental Services
Oral exams: Not covered
Prophylaxis (cleaning): Not covered
Dental x-rays: Not covered
Vision Benefits
Eye exams:
Routine eye exams: Not covered
Eyewear:
Contact Lenses: Not covered
Eyeglasses: Not covered
Hearing Benefits
Hearing exams:
Routine hearing exams: $20 copay
Hearing aids:
Hearing aids (all types): $0 copay
Plan Links
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