2022 CDPHP Flex (PPO)

CDPHP Flex (PPO) H5042-012 is a 2022 Medicare Advantage Plan or Part-C by CDPHP Medicare Advantage available to residents in New York. This plan does not provide additional prescription drug (Part-D) coverage. The CDPHP Flex (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,500 out-of-pocket. This can be a extremely nice safety net.

CDPHP Flex (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.

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

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2022 CDPHP Medicare Advantage Medicare Advantage Plan Costs

2021 CDPHP Flex (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	Not covered
Endodontics	Not covered
Extractions	Not covered
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	Not covered

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$135 copay
Diagnostic tests and procedures	$0-40 copay
Diagnostic tests and procedures	30% coinsurance (Out-of-Network)
Lab services	30% coinsurance (Out-of-Network)
Lab services	$0-40 copay
Outpatient x-rays	$40 copay
Outpatient x-rays	$40 copay (Out-of-Network)

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Doctor Visits

Primary	$40 copay per visit (Out-of-Network)
Primary	$0 copay
Specialist	$40 copay per visit
Specialist	30% coinsurance per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$60 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$40 copay
Foot exams and treatment	$60 copay (Out-of-Network)
Routine foot care	Not covered

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Ground Ambulance

$255 copay
$255 copay (Out-of-Network)

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Hearing

Fitting/evaluation	$0 copay
Fitting/evaluation	$0-45 copay (Out-of-Network)
Hearing aids	$599-899 copay
Hearing aids	$599-899 copay (Out-of-Network)
Hearing exam	$45 copay
Hearing exam	$0-45 copay (Out-of-Network)

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Inpatient Hospital Coverage

30% per stay (Out-of-Network)
$310 per day for days 1 through 6 $0 per day for days 7 through 90

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Medical Equipment/Supplies

Diabetes supplies	30% coinsurance per item (Out-of-Network)
Diabetes supplies	0-20% coinsurance per item
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

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Medicare Part B Drugs

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

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Mental Health Services

Inpatient hospital - psychiatric	30% per stay (Out-of-Network)
Inpatient hospital - psychiatric	$300 per day for days 1 through 5 $0 per day for days 6 through 90
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	$60 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$60 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit	$60 copay (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	$60 copay (Out-of-Network)

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MOOP

$10,000 In and Out-of-network $5,500 In-network $10,000 Out-of-network

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Option

Yes, contact plan for further details

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

30% coinsurance per visit (Out-of-Network)
$325 copay per visit

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Preventive Care

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

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Preventive Dental

Cleaning	Covered under office visit
Dental x-ray(s)	$20-30 copay (Out-of-Network)
Dental x-ray(s)	$20-30 copay
Fluoride treatment	Not covered
Office visit	$20-30 copay (Out-of-Network)
Office visit	$20.00
Oral exam	Covered under office visit

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Rehabilitation Services

Occupational therapy visit	$60 copay (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	$60 copay (Out-of-Network)

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Skilled Nursing Facility

$0 per day for days 1 through 20 $145 per day for days 21 through 100
30% per stay (Out-of-Network)

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Transportation

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

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Vision

Contact lenses	$0 copay (Out-of-Network)
Contact lenses	$0 copay
Eyeglass frames	$0 copay (Out-of-Network)
Eyeglass frames	$0 copay
Eyeglass lenses	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	30% coinsurance (Out-of-Network)
Routine eye exam	$20 copay
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for CDPHP Flex (PPO) H5042

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in CDPHP Flex (PPO) Plans Performance

Health Plan Customer Service Rating for CDPHP Flex (PPO)

CDPHP Flex (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 CDPHP Flex (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.