2022 PrimeTime Health Plan Basic - MA Only (HMO-POS)

PrimeTime Health Plan Basic - MA Only (HMO-POS) H3664-014 is a 2022 Medicare Advantage Plan or Part-C by PrimeTime Health Plan available to residents in Ohio. This plan does not provide additional prescription drug (Part-D) coverage. The PrimeTime Health Plan Basic - MA Only (HMO-POS) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $3,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,400 out-of-pocket. This can be a extremely nice safety net.

PrimeTime Health Plan Basic - MA Only (HMO-POS) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.

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

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

2022 PrimeTime Health Plan Medicare Advantage Plan Costs

2021 PrimeTime Health Plan Basic - MA Only (HMO-POS) 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
Diagnostic services	$0 copay (Out-of-Network)
Endodontics	$0 copay
Endodontics	$0 copay (Out-of-Network)
Extractions	$0 copay (Out-of-Network)
Extractions	$0 copay
Non-routine services	$0 copay (Out-of-Network)
Non-routine services	$0 copay
Periodontics	$0 copay (Out-of-Network)
Periodontics	$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Restorative services	$0 copay (Out-of-Network)
Restorative services	$0 copay

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$250 copay
Diagnostic tests and procedures	$100 copay
Lab services	$35 copay (Out-of-Network)
Lab services	$35 copay
Outpatient x-rays	$100 copay

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Doctor Visits

Primary	$0 copay
Specialist	$40 copay per visit

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Emergency care/Urgent Care

Emergency	$85 copay per visit (always covered)
Urgent care	$65 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$35 copay
Routine foot care	Not covered

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Ground Ambulance

$200 copay

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Hearing

Fitting/evaluation	Not covered
Hearing aids	$595-895 copay
Hearing exam	$0 copay

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Inpatient Hospital Coverage

$275 per day for days 1 through 6 $0 per day for days 7 through 90
Not Applicable (Out-of-Network)

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Medical Equipment/Supplies

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

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	Not Applicable (Out-of-Network)
Inpatient hospital - psychiatric	$175 per day for days 1 through 10 $0 per day for days 11 through 90
Outpatient group therapy visit	$35 copay
Outpatient group therapy visit with a psychiatrist	$35 copay
Outpatient individual therapy visit	$35 copay
Outpatient individual therapy visit with a psychiatrist	$35 copay

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MOOP

$3,400 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

25% coinsurance per visit

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Preventive Care

$0 copay

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Preventive Dental

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

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Rehabilitation Services

Occupational therapy visit	$35 copay
Physical therapy and speech and language therapy visit	$35 copay

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Skilled Nursing Facility

Not Applicable (Out-of-Network)
$20 per day for days 1 through 20 $150 per day for days 21 through 39 $0 per day for days 40 through 100

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Transportation

Not covered

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Vision

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

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for PrimeTime Health Plan Basic - MA Only (HMO-POS) H3664

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in PrimeTime Health Plan Basic - MA Only (HMO-POS) Plans Performance

Health Plan Customer Service Rating for PrimeTime Health Plan Basic - MA Only (HMO-POS)

PrimeTime Health Plan Basic - MA Only (HMO-POS) 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 PrimeTime Health Plan Basic - MA Only (HMO-POS)

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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.