2022 Asuris Esteem (PPO)

Asuris Esteem (PPO) H5010-001 is a 2022 Medicare Advantage Plan or Part-C by Asuris Northwest Health available to residents in Washington. This plan does not provide additional prescription drug (Part-D) coverage. The Asuris Esteem (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,000 out-of-pocket. This can be a extremely nice safety net.

Asuris Esteem (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Asuris Northwest Health works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Asuris Esteem (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Asuris Northwest Health and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Asuris Northwest Health except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

2022 Asuris Northwest Health Medicare Advantage Plan Costs

2021 Asuris Esteem (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

---

Additional Benefits

No

---

Comprehensive Dental

Diagnostic services	$0 copay
Diagnostic services	50% coinsurance (Out-of-Network)
Endodontics	50% coinsurance
Endodontics	50% coinsurance (Out-of-Network)
Extractions	50% coinsurance (Out-of-Network)
Extractions	50% coinsurance
Non-routine services	50% coinsurance (Out-of-Network)
Non-routine services	$0 copay
Periodontics	50% coinsurance (Out-of-Network)
Periodontics	50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services	50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services	50% coinsurance (Out-of-Network)
Restorative services	50% coinsurance
Restorative services	50% coinsurance (Out-of-Network)

---

Deductible

$0

---

Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	20% coinsurance
Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$10 copay
Lab services	$0-10 copay
Lab services	30% coinsurance (Out-of-Network)
Outpatient x-rays	$10 copay
Outpatient x-rays	30% coinsurance (Out-of-Network)

---

Doctor Visits

Primary	$5 copay per visit
Primary	30% coinsurance per visit (Out-of-Network)
Specialist	30% coinsurance per visit (Out-of-Network)
Specialist	$40 copay per visit

---

Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$40 copay per visit (always covered)

---

Foot Care (podiatry services)

Foot exams and treatment	30% coinsurance (Out-of-Network)
Foot exams and treatment	$40 copay
Routine foot care	Not covered

---

Ground Ambulance

$275 copay
$275 copay (Out-of-Network)

---

Hearing

Fitting/evaluation	Not covered
Hearing aids	$699-999 copay
Hearing aids	$699-999 copay (Out-of-Network)
Hearing exam	$40 copay
Hearing exam	30% coinsurance (Out-of-Network)

---

Inpatient Hospital Coverage

$360 per day for days 1 through 4 $0 per day for days 5 through 90
30% per day for days 1 and beyond (Out-of-Network)

---

Medical Equipment/Supplies

Diabetes supplies	30% coinsurance per item (Out-of-Network)
Diabetes supplies	$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)	30% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

---

Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	30% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance
Other Part B drugs	30% coinsurance (Out-of-Network)

---

Mental Health Services

Inpatient hospital - psychiatric	$360 per day for days 1 through 4 $0 per day for days 5 through 90
Inpatient hospital - psychiatric	30% per day for days 1 through 190 (Out-of-Network)
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient group therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)

---

MOOP

$10,000 In and Out-of-network $5,000 In-network

---

Option

Yes, contact plan for further details

---

Optional supplemental benefits

No

---

Outpatient Hospital Coverage

$40-350 copay per visit
30% coinsurance per visit (Out-of-Network)

---

Preventive Care

30% coinsurance (Out-of-Network)
$0 copay

---

Preventive Dental

Cleaning	$0 copay
Cleaning	30% coinsurance (Out-of-Network)
Dental x-ray(s)	$0 copay
Dental x-ray(s)	30% coinsurance (Out-of-Network)
Fluoride treatment	$0 copay
Fluoride treatment	30% coinsurance (Out-of-Network)
Oral exam	30% coinsurance (Out-of-Network)
Oral exam	$0 copay

---

Rehabilitation Services

Occupational therapy visit	30% coinsurance (Out-of-Network)
Occupational therapy visit	$40 copay
Physical therapy and speech and language therapy visit	$40 copay
Physical therapy and speech and language therapy visit	30% coinsurance (Out-of-Network)

---

Skilled Nursing Facility

$0 per day for days 1 through 20 $160 per day for days 21 through 100
30% per day for days 1 through 100 (Out-of-Network)

---

Transportation

Not covered

---

Vision

Contact lenses	0-50% coinsurance (Out-of-Network)
Contact lenses	$0 copay
Eyeglass frames	$0 copay
Eyeglass frames	0-50% coinsurance (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglass lenses	0-50% coinsurance (Out-of-Network)
Eyeglasses (frames and lenses)	Not covered
Other	Not covered
Routine eye exam	30% coinsurance (Out-of-Network)
Routine eye exam	$0 copay
Upgrades	Not covered

---

Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Asuris Esteem (PPO) H5010

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Asuris Esteem (PPO) Plans Performance

Health Plan Customer Service Rating for Asuris Esteem (PPO)

Asuris Esteem (PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Asuris Esteem (PPO)

(Click county to compare all available Advantage plans)

Go to top

Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.