2023 MDwise Medicare Inspire Flex (HMO-POS)

MDwise Medicare Inspire Flex (HMO-POS) H7746-003 is a 2023 Medicare Advantage Plan or Part-C by MDwise Medicare available to residents in Indiana. This plan includes extra prescription drug (Part-D) coverage. MDwise Medicare MDwise Medicare Inspire Flex (HMO-POS) has a monthly premium of $49.00 and has an in-network maximum out-of-pocket limit of $4,300 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $4,300 out-of-pocket. This can be an extremely nice safety net.

MDwise Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for MDwise Medicare Inspire Flex (HMO-POS) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from MDwise Medicare 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 MDwise Medicare except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Indiana.

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Benefits
Monthly Costs
Formulary and Drugs
Gap coverage
Premium Assistance
MOOP
Coverage Area

2023 MDwise Medicare Medicare Advantage Plan Overview

Name:	MDwise Medicare Inspire Flex (HMO-POS)
Plan ID:	H7746 003 0
Provider:	MDwise Medicare
Year:	2023
Type:	Local HMO
Combined Premium (C+D):	$49.00/mo
Part C Premium:	$0/mo
MOOP:	$4,300/yr
Part D (Drug) Premium:	$49.00/mo
Part D Supplemental Premium	$0/mo
Total Part D Premium:	$49.00/mo
Drug Deductible:	$0/yr
Tiers with No Deductible:	0
Gap Coverage:	Yes
Benchmark:	Not below the regional benchmark
Type of Medicare Health:	Enhanced Alternative
Drug Benefit Type:	Enhanced
Similar Plan:	H7746-001

What type of plan is MDwise Medicare Inspire Flex (HMO-POS)

MDwise Medicare Inspire Flex (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 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.

With a HMO-POS point-of-service you have the option to go out-of-network or see a specialist without a referral. But, you may pay more for out-of-network care you receive than from an in-network provider.

How much does MDwise Medicare Inspire Flex (HMO-POS) cost?

Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. MDwise Medicare charges a $49.00 consolidated premium. The Part C premium is $0 this charge covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. MDwise Medicare Inspire Flex (HMO-POS) has a monthly drug premium of $49.00 and a $0 drug deductible. This MDwise Medicare plan offers a $49.00 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. This Premium covers any enhanced plan benefits offered by MDwise Medicare above and beyond the standard PDP benefits. This can include extra coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $49.00. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

MDwise Medicare Gap Coverage

In 2023 once you and your plan provider have spent $4660 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 extra coverage. This MDwise Medicare plan does offer extra coverage through the gap.

Extra Help Premium Assistance

The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The MDwise Medicare Inspire Flex (HMO-POS) medicare insurance offers a $20.90 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $27.90 for 75% low-income subsidy $34.90 for 50% and $42.00 for 25%.

Full Assistance Premium:	$20.90
75% Assistance Premium:	$27.90
50% Assistance Premium:	$34.90
25% Assistance Premium:	$42.00

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. MDwise Medicare Inspire Flex (HMO-POS) by MDwise Medicare MOOP is $4,300. Once you spend $4,300 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.

Formulary and Drug Coverage

MDwise Medicare Inspire Flex (HMO-POS) 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.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$0
Tier 2	NA	$12
Tier 3	NA	$47
Tier 4	NA	$100
Tier 5	NA	33%
Tier 6	NA	$0

The complete MDwise Medicare Inspire Flex (HMO-POS) Formulary.
*Initial Coverage Phase and 30 day supply

2023 Summary of Benefits

The benefit information provided is a summary of what MDwise Medicare Inspire Flex (HMO-POS) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from MDwise Medicare 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

Contact lenses

In-Network Vision	$0 copay

Eyeglass frames

Vision	Not covered

Eyeglass lenses

Vision	Not covered

Eyeglasses (frames and lenses)

In-Network Vision	$0 copay

Other

Vision	Not covered

Routine eye exam

In-Network Vision	$0 copay

Upgrades

Vision	Not covered

In-Network Transportation	$0 copay
Out-of-Network Skilled Nursing Facility	30% per stay
In-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $196 per day for days 21 through 100

Occupational therapy visit

Out-of-Network Rehabilitation services	30% coinsurance
In-Network Rehabilitation services	$40 copay

Physical therapy and speech and language therapy visit

In-Network Rehabilitation services	$40 copay
Out-of-Network Rehabilitation services	30% coinsurance

Cleaning

In-Network Preventive dental	$0 copay

Dental x-ray(s)

In-Network Preventive dental	$0 copay

Fluoride treatment

In-Network Preventive dental	$0 copay

Oral exam

In-Network Preventive dental	$0 copay

Out-of-Network Preventive care	30% coinsurance
In-Network Preventive care	$0 copay
Out-of-Network Outpatient hospital coverage	30% coinsurance per visit
In-Network Outpatient hospital coverage	$275 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	Yes

Inpatient hospital - psychiatric

Out-of-Network Mental health services	30% per stay
In-Network Mental health services	$265 per day for days 1 through 7 $0 per day for days 8 through 90

Outpatient group therapy visit

In-Network Mental health services	$25 copay
Out-of-Network Mental health services	30% coinsurance

Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$25 copay
Out-of-Network Mental health services	30% coinsurance

Outpatient individual therapy visit

Out-of-Network Mental health services	30% coinsurance
In-Network Mental health services	$25 copay

Outpatient individual therapy visit with a psychiatrist

Out-of-Network Mental health services	30% coinsurance
In-Network Mental health services	$25 copay

Chemotherapy

In-Network Medicare Part B drugs	20% coinsurance
Out-of-Network Medicare Part B drugs	30% coinsurance

Other Part B drugs

In-Network Medicare Part B drugs	20% coinsurance
Out-of-Network Medicare Part B drugs	30% coinsurance

Diabetes supplies

In-Network Medical equipment/supplies	$0 copay
Out-of-Network Medical equipment/supplies	30% coinsurance per item

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

In-Network Medical equipment/supplies	20% coinsurance per item
Out-of-Network Medical equipment/supplies	30% coinsurance per item

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

In-Network Medical equipment/supplies	20% coinsurance per item
Out-of-Network Medical equipment/supplies	30% coinsurance per item

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$10,000 In and Out-of-network $4,300 In-network
In-Network Inpatient hospital coverage	$310 per day for days 1 through 7 $0 per day for days 8 through 90
Out-of-Network Inpatient hospital coverage	30% per stay

Fitting/evaluation

In-Network Hearing	$0 copay

Hearing aids

In-Network Hearing	$699-999 copay

Hearing exam

Out-of-Network Hearing	30% coinsurance
In-Network Hearing	$35 copay

Health plan deductible	$0
In-Network Ground ambulance	$220 copay

Foot exams and treatment

In-Network Foot care (podiatry services)	$25 copay
Out-of-Network Foot care (podiatry services)	30% coinsurance

Routine foot care

Foot care (podiatry services)	Not covered

Emergency

Emergency care/Urgent care	$95 copay per visit (always covered)

Urgent care

Emergency care/Urgent care	$50 copay per visit (always covered)

Primary

In-Network Doctor visits	$0 copay
Out-of-Network Doctor visits	30% coinsurance per visit

Specialist

Out-of-Network Doctor visits	30% coinsurance per visit
In-Network Doctor visits	$40 copay per visit

Diagnostic radiology services (e.g., MRI)

In-Network Diagnostic procedures/lab services/imaging	$150 copay
Out-of-Network Diagnostic procedures/lab services/imaging	30% coinsurance

Diagnostic tests and procedures

Out-of-Network Diagnostic procedures/lab services/imaging	30% coinsurance
In-Network Diagnostic procedures/lab services/imaging	$30 copay

Lab services

Out-of-Network Diagnostic procedures/lab services/imaging	30% coinsurance
In-Network Diagnostic procedures/lab services/imaging	$0 copay

Outpatient x-rays

In-Network Diagnostic procedures/lab services/imaging	$25 copay
Out-of-Network Diagnostic procedures/lab services/imaging	30% coinsurance

Diagnostic services

Comprehensive dental	Not covered

Endodontics

Comprehensive dental	Not covered

Extractions

In-Network Comprehensive dental	50% coinsurance

Non-routine services

Comprehensive dental	Not covered

Periodontics

In-Network Comprehensive dental	0-50% coinsurance

Prosthodontics, other oral/maxillofacial surgery, other services

In-Network Comprehensive dental	$0 copay

Restorative services

In-Network Comprehensive dental	50% coinsurance

In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	No

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 MDwise Medicare Inspire Flex (HMO-POS) requires you to live in that plan’s service area. The service area is listed below:

State:

Indiana Medicare

County:

Benton County MA Plans

Brown County MA Plans

Carroll County MA Plans

Cass County MA Plans

Clinton County MA Plans

Decatur County MA Plans

Fountain County MA Plans

Hamilton County MA Plans

Hancock County MA Plans

Hendricks County MA Plans

Henry County MA Plans

Howard County MA Plans

Jennings County MA Plans

Madison County MA Plans

Marion County MA Plans

Miami County MA Plans

Montgomery County MA Plans

Parke County MA Plans

Pike County MA Plans

Putnam County MA Plans

Randolph County MA Plans

Rush County MA Plans

Shelby County MA Plans

Tipton County MA Plans

Union County MA Plans

Warren County MA Plans

White County MA Plans

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How much does MDwise Medicare Inspire Flex (HMO-POS) cost?

MDwise Medicare charges a $49.00 consolidated monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage of Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is MDwise Medicare Inspire Flex (HMO-POS) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. MDwise Medicare Inspire Flex (HMO-POS) by MDwise Medicare MOOP is $4,300. Once you spend $4,300 you will pay nothing for Part A or Part B covered services.

What type of plan is MDwise Medicare Inspire Flex (HMO-POS)?

MDwise Medicare Inspire Flex (HMO-POS) is a Local HMO. With a health maintenance organization you will be required to receive most of your health care from an in-network provider. HMOs require that you select a primary care physician (PCP).

With a HMO-POS point-of-service you have the option to go out-of-network or see a specialist without a referral. But, you may pay more for out-of-network care you receive than from an in-network provider.

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.