2022 Vibra Essential Advocate (PPO)

Vibra Essential Advocate (PPO) H9408-006 is a 2022 Medicare Advantage Plan or Part-C by Vibra Health Plan available to residents in Pennsylvania. This plan includes additional prescription drug (Part-D) coverage. The Vibra Essential Advocate (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $7,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,500 out-of-pocket. This can be a extremely nice safety net.

Vibra Essential Advocate (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.

Vibra Health Plan works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Vibra Essential Advocate (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Vibra 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 Vibra 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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Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

2022 Vibra Health Plan Medicare Advantage Plan Costs

Vibra Essential Advocate (PPO) Part-C Premium

Vibra Health Plan 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.

H9408-006 Part-D Deductible and Premium

Vibra Essential Advocate (PPO) has a monthly drug premium of $0.00 and a $0.00 drug deductible. This Vibra Health Plan 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 Vibra Health Plan 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.

Vibra Health Plan 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 Vibra Health Plan plan does not offer additional coverage through the gap.

H9408-006 Formulary or Drug Coverage

Vibra Essential Advocate (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 Vibra Essential Advocate (PPO) H9408-006 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$0	$15
Tier 2	$0	$20
Tier 3	$40	$47
Tier 4	$93	$100
Tier 5	33%	33%
Tier 6	$0	$7

*Initial Coverage Phase and 30 day supply

2021 Vibra Essential Advocate (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	50% coinsurance
Endodontics	50% coinsurance (Out-of-Network)
Extractions	50% coinsurance (Out-of-Network)
Extractions	50% coinsurance
Non-routine services	50% coinsurance
Non-routine services	50% coinsurance (Out-of-Network)
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	50% coinsurance
Restorative services	50% coinsurance
Restorative services	50% coinsurance (Out-of-Network)

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$275 copay
Diagnostic radiology services (e.g., MRI)	$275 copay (Out-of-Network)
Diagnostic tests and procedures	$25 copay
Diagnostic tests and procedures	$25 copay (Out-of-Network)
Lab services	$25 copay
Lab services	$25 copay (Out-of-Network)
Outpatient x-rays	$50 copay (Out-of-Network)
Outpatient x-rays	$50 copay

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Doctor Visits

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

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Emergency care/Urgent Care

Emergency	$90 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	$40 copay (Out-of-Network)
Foot exams and treatment	$40 copay
Routine foot care	Not covered

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Ground Ambulance

$250 copay
$250 copay (Out-of-Network)

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Hearing

Fitting/evaluation	50% coinsurance (Out-of-Network)
Fitting/evaluation	$0 copay
Hearing aids	$0 copay
Hearing aids	$0 copay (Out-of-Network)
Hearing exam	$40 copay (Out-of-Network)
Hearing exam	$40 copay

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Inpatient Hospital Coverage

$235 per day for days 1 through 8 $0 per day for days 9 through 90
$235 per day for days 1 through 8 $0 per day for days 9 through 90 (Out-of-Network)

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Medical Equipment/Supplies

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

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Medicare Part B Drugs

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

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Mental Health Services

Inpatient hospital - psychiatric	$225 per day for days 1 through 8 $0 per day for days 9 through 90 (Out-of-Network)
Inpatient hospital - psychiatric	$225 per day for days 1 through 8 $0 per day for days 9 through 90
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	$40 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient group therapy visit with a psychiatrist	$40 copay (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit	$40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay

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MOOP

$10,000 In and Out-of-network $6,700 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$350 copay per visit
$350 copay per visit (Out-of-Network)

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Preventive Care

20% coinsurance (Out-of-Network)
$0 copay

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Preventive Dental

Cleaning	Covered under office visit
Dental x-ray(s)	Covered under office visit
Fluoride treatment	Not covered
Office visit	50% coinsurance (Out-of-Network)
Office visit	$10.00
Oral exam	Covered under office visit

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Rehabilitation Services

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

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Skilled Nursing Facility

$0 per day for days 1 through 5 $0 per day for days 6 through 20 $184 per day for days 21 through 100 (Out-of-Network)
$0 per day for days 1 through 5 $0 per day for days 6 through 20 $184 per day for days 21 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	$0 copay
Eyeglass frames	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	Not covered
Other	Not covered
Routine eye exam	$20 copay
Routine eye exam	50% coinsurance (Out-of-Network)
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Vibra Essential Advocate (PPO) H9408

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Vibra Essential Advocate (PPO) Plans Performance

Health Plan Customer Service Rating for Vibra Essential Advocate (PPO)

Vibra Essential Advocate (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 Vibra Essential Advocate (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.