Integris Health Partners+ Choice (HMO) H4198-007 is a 2023 Medicare Advantage Plan or Part-C by Integris Health Partners+ (HMO) available to residents in Oklahoma. This plan does not provide extra prescription drug (Part-D) coverage. Integris Health Partners+ (HMO) Integris Health Partners+ Choice (HMO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,300 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $5,300 out-of-pocket. This can be an extremely nice safety net.

Integris Health Partners+ (HMO) works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Integris Health Partners+ Choice (HMO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Integris Health Partners+ (HMO) and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Integris Health Partners+ (HMO) except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Oklahoma.

2023 Integris Health Partners+ (HMO) Medicare Advantage Plan Overview

What type of plan is Integris Health Partners+ Choice (HMO)

Integris Health Partners+ Choice (HMO) 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 primary care physician 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 primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.

How much does Integris Health Partners+ Choice (HMO) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Integris Health Partners+ (HMO) charges a $0 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.

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Integris Health Partners+ Choice (HMO) by Integris Health Partners+ (HMO) MOOP is $5,300. Once you spend $5,300 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.

2023 Summary of Benefits

The benefit information provided is a summary of what Integris Health Partners+ Choice (HMO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Integris Health Partners+ (HMO) helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)	Covered

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Contact lenses

Vision	$0 copay

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Eyeglass frames

Vision	Not covered

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Eyeglass lenses

Vision	Not covered

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Eyeglasses (frames and lenses)

Vision	$0 copay

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Other

Vision	Not covered

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Routine eye exam

Vision	$0 copay

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Upgrades

Vision	Not covered

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Transportation	Not covered
Skilled Nursing Facility	$0 per day for days 1 through 20 $160 per day for days 21 through 100

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Occupational therapy visit

Rehabilitation services	$20 copay

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Physical therapy and speech and language therapy visit

Rehabilitation services	$20 copay

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Cleaning

Preventive dental	$0 copay

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Dental x-ray(s)

Preventive dental	$0 copay

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Fluoride treatment

Preventive dental	$0 copay

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Oral exam

Preventive dental	$0 copay

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Preventive care	$0 copay
Outpatient hospital coverage	$250 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

Mental health services	$245 per day for days 1 through 5 $0 per day for days 6 through 90

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Outpatient group therapy visit

Mental health services	$20 copay

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Outpatient group therapy visit with a psychiatrist

Mental health services	$20 copay

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Outpatient individual therapy visit

Mental health services	$20 copay

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Outpatient individual therapy visit with a psychiatrist

Mental health services	$20 copay

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Chemotherapy

Medicare Part B drugs	20% coinsurance

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Other Part B drugs

Medicare Part B drugs	20% coinsurance

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Diabetes supplies

Medical equipment/supplies	$0 copay

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Durable medical equipment (e.g., wheelchairs, oxygen)

Medical equipment/supplies	20% coinsurance per item

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Prosthetics (e.g., braces, artificial limbs)

Medical equipment/supplies	20% coinsurance per item

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$5,300 In-network
Inpatient hospital coverage	$245 per day for days 1 through 5 $0 per day for days 6 through 90

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Fitting/evaluation

Hearing	Not covered

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Hearing aids

Hearing	$0 copay

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Hearing exam

Hearing	$0 copay

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Health plan deductible	$0
Ground ambulance	$250 copay

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Foot exams and treatment

Foot care (podiatry services)	$35 copay

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Routine foot care

Foot care (podiatry services)	Not covered

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Emergency

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

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Urgent care

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

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Primary

Doctor visits	$0 copay

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Specialist

Doctor visits	$35 copay per visit

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Diagnostic radiology services (e.g., MRI)

Diagnostic procedures/lab services/imaging	$0-100 copay

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Diagnostic tests and procedures

Diagnostic procedures/lab services/imaging	$0-100 copay

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Lab services

Diagnostic procedures/lab services/imaging	$0 copay

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Outpatient x-rays

Diagnostic procedures/lab services/imaging	$0 copay

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Diagnostic services

Comprehensive dental	Not covered

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Endodontics

Comprehensive dental	$0 copay

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Extractions

Comprehensive dental	$0 copay

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Non-routine services

Comprehensive dental	Not covered

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Periodontics

Comprehensive dental	$0 copay

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Prosthodontics, other oral/maxillofacial surgery, other services

Comprehensive dental	$0 copay

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Restorative services

Comprehensive dental	$0 copay

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In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	Yes, contact plan for further details

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Integris Health Partners+ Choice (HMO) requires you to live in that plan’s service area. The service area is listed below:

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Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.