2022 Bright Advantage Health Dollars Plan (PPO)

Bright Advantage Health Dollars Plan (PPO) H3281-001 is a 2022 Medicare Advantage Plan or Part-C by Bright Health available to residents in Florida. This plan includes additional prescription drug (Part-D) coverage. The Bright Advantage Health Dollars Plan (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $4,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,400 out-of-pocket. This can be a extremely nice safety net.

Bright Advantage Health Dollars Plan (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.

Bright Health works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Bright Advantage Health Dollars Plan (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Bright 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 Bright Health except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Bright Health Medicare Advantage Plan Costs

Bright Advantage Health Dollars Plan (PPO) Part-C Premium

Bright Health charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H3281-001 Part-D Deductible and Premium

Bright Advantage Health Dollars Plan (PPO) has a monthly drug premium of $0.00 and a $0.00 drug deductible. This Bright Health plan offers a $0.00 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Bright Health above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Bright Health Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Bright Health plan does offer additional coverage through the gap.

H3281-001 Formulary or Drug Coverage

Bright Advantage Health Dollars Plan (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 Bright Advantage Health Dollars Plan (PPO) H3281-001 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$0
Tier 2	NA	$0
Tier 3	NA	$47
Tier 4	NA	$100
Tier 5	NA	33%
Tier 6	NA	$0

*Initial Coverage Phase and 30 day supply

2021 Bright Advantage Health Dollars Plan (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	$0 copay or 30% coinsurance (Out-of-Network)
Diagnostic services	$0 copay
Endodontics	$0 copay or 30% coinsurance (Out-of-Network)
Endodontics	$0 copay
Extractions	$0 copay
Extractions	$0 copay or 30% coinsurance (Out-of-Network)
Non-routine services	$0 copay
Non-routine services	$0 copay or 30% coinsurance (Out-of-Network)
Periodontics	$0 copay
Periodontics	$0 copay or 30% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay or 30% coinsurance (Out-of-Network)
Restorative services	$0 copay
Restorative services	$0 copay or 30% coinsurance (Out-of-Network)

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$25-125 copay
Diagnostic radiology services (e.g., MRI)	40% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0-125 copay
Diagnostic tests and procedures	40% coinsurance (Out-of-Network)
Lab services	40% coinsurance (Out-of-Network)
Lab services	$0 copay
Outpatient x-rays	$0 copay
Outpatient x-rays	40% coinsurance (Out-of-Network)

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Doctor Visits

Primary	$0 copay
Primary	$0 copay (Out-of-Network)
Specialist	$25 copay per visit
Specialist	$25 copay per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$35 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	40% coinsurance (Out-of-Network)
Foot exams and treatment	$35 copay
Routine foot care	Not covered

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Ground Ambulance

$200 copay
$200 copay (Out-of-Network)

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Hearing

Fitting/evaluation	$0 copay
Fitting/evaluation	$0 copay or 40% coinsurance (Out-of-Network)
Hearing aids	$0 copay
Hearing aids	$0 copay or 40% coinsurance (Out-of-Network)
Hearing exam	$0 copay
Hearing exam	40% coinsurance (Out-of-Network)

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Inpatient Hospital Coverage

$225 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 and beyond
35% per day for days 1 through 90 (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	$0 copay
Diabetes supplies	40% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	40% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	40% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	40% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance
Other Part B drugs	40% coinsurance (Out-of-Network)

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Mental Health Services

Inpatient hospital - psychiatric	$225 per day for days 1 through 5 $0 per day for days 6 through 90
Inpatient hospital - psychiatric	35% per day for days 1 through 90 (Out-of-Network)
Outpatient group therapy visit	40% coinsurance (Out-of-Network)
Outpatient group therapy visit	$30 copay
Outpatient group therapy visit with a psychiatrist	$30 copay
Outpatient group therapy visit with a psychiatrist	40% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit	40% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	40% coinsurance (Out-of-Network)

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MOOP

$10,000 In and Out-of-network $5,800 In-network

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Option

No

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Optional supplemental benefits

Yes

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Outpatient Hospital Coverage

40% coinsurance per visit (Out-of-Network)
$250 copay per visit

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Package #1

Deductible
Monthly Premium	$19.00

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Preventive Care

$0 copay
40% coinsurance (Out-of-Network)

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Preventive Dental

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

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Rehabilitation Services

Occupational therapy visit	$25 copay
Occupational therapy visit	40% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$25 copay
Physical therapy and speech and language therapy visit	40% coinsurance (Out-of-Network)

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Skilled Nursing Facility

$0 per day for days 1 through 20 $178 per day for days 21 through 100
40% per day for days 1 through 100 (Out-of-Network)

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Transportation

$0 copay
$0 copay (Out-of-Network)

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Vision

Contact lenses	$0-60 copay or 40% coinsurance (Out-of-Network)
Contact lenses	$0-60 copay
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	$25 copay
Eyeglasses (frames and lenses)	$0-60 copay or 40% coinsurance (Out-of-Network)
Other	Not covered
Routine eye exam	$0-60 copay or 40% coinsurance (Out-of-Network)
Routine eye exam	$0 copay
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

Ready to Enroll?

Click Here

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

Coverage Area for Bright Advantage Health Dollars Plan (PPO)

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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.