Network PlatinumPlus (PPO) arrow Back to Available Plans
Medical coverage priced within your budget.
For an affordable premium of $46, our Network PlatinumPlus plan offers medical coverage and reasonable copayments for services.
- A good balance between having a monthly payment and paying for services when you use them
- You only pay $10 for doctor visits
- Plus, you pay $0 for your annual doctor visit and all preventive care (shots, tests and screenings)
Want to Add Drug Coverage?
Look at Network PlatinumPlus Pharmacy
Medical Coverage for PlatinumPlus
Here’s a quick glance at in-network benefits for medical coverage.
- See the 2014 Summary of Benefits for a list of benefits compared with our other plans and Original Medicare.
- See the 2014 Evidence of Coverage for all details about this plan.
|Premium||$46 per month|
|Out-of-Pocket Maximum||$2,800 per year combined (in and out-of-network) out-of-pocket limit|
|In-Network Hospital Stays||$75 per day for days 1-20; $0 per day for days 21 and beyond|
|Primary Care Office Visit||$10 per visit|
|Specialist Visit||$30 per visit|
|Emergency Room||$65 per visit|
|Urgent Care||$10 per visit|
|Outpatient Services||$100 per visit|
|Annual Welless Visit with Lab Tests||$0 copayment|
|Preventive Services||Plan covers all Medicare-covered preventive services at $0|
|Vision Services||$36 for one routine eye exam per year|
|Platinum Fitness||Up to $36 per month toward a full YMCA membership or other health club providers available in our network|