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2023 SelectHealth Medicare NoRx (PPO)

SelectHealth Medicare NoRx (PPO) H2246-020 is a 2023 Medicare Advantage Plan or Part-C by SelectHealth available to residents in Nevada. This plan does not provide extra prescription drug (Part-D) coverage. SelectHealth SelectHealth Medicare NoRx (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $6,700 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $6,700 out-of-pocket. This can be an extremely nice safety net.

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



2023 SelectHealth Medicare Advantage Plan Overview

Name:SelectHealth Medicare NoRx (PPO)
Plan ID:H2246 020 0
Provider:SelectHealth
Year:2023
Type:Local PPO *
Combined Premium (C+D):$0/mo
MOOP:$6,700/yr
Similar Plan: H2246-018




What type of plan is SelectHealth Medicare NoRx (PPO)

SelectHealth Medicare NoRx (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.

How much does SelectHealth Medicare NoRx (PPO) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. SelectHealth 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. SelectHealth Medicare NoRx (PPO) by SelectHealth MOOP is $6,700. Once you spend $6,700 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 SelectHealth Medicare NoRx (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from SelectHealth 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
Out-of-Network Vision$0 copay


Eyeglass frames


VisionNot covered


Eyeglass lenses


VisionNot covered


Eyeglasses (frames and lenses)


Out-of-Network Vision$0 copay
In-Network Vision$0 copay


Other


In-Network Vision$0 copay
Out-of-Network Vision$0 copay


Routine eye exam


Out-of-Network Vision$0 copay
In-Network Vision$0 copay


Upgrades


Out-of-Network Vision$0 copay
In-Network Vision$0 copay



Out-of-Network Transportation$0 copay
In-Network Transportation$0 copay
Out-of-Network Skilled Nursing Facility40% per day for days 1 through 100
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 services40% coinsurance
In-Network Rehabilitation services$20 copay


Physical therapy and speech and language therapy visit


In-Network Rehabilitation services$20 copay
Out-of-Network Rehabilitation services40% coinsurance


Cleaning


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental$0 copay


Dental x-ray(s)


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental$0 copay


Fluoride treatment


Preventive dentalNot covered


Oral exam


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental$0 copay



In-Network Preventive care$0 copay
Out-of-Network Preventive care40% coinsurance
In-Network Outpatient hospital coverage$40-375 copay or 20% coinsurance per visit
Out-of-Network Outpatient hospital coverage40% coinsurance per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo


Inpatient hospital - psychiatric


Out-of-Network Mental health services40% per day for days 1 through 90
In-Network Mental health services$395 per day for days 1 through 3
$0 per day for days 4 through 90


Outpatient group therapy visit


Out-of-Network Mental health services40% coinsurance
In-Network Mental health services$20 copay


Outpatient group therapy visit with a psychiatrist


In-Network Mental health services$20 copay
Out-of-Network Mental health services40% coinsurance


Outpatient individual therapy visit


Out-of-Network Mental health services40% coinsurance
In-Network Mental health services$25 copay


Outpatient individual therapy visit with a psychiatrist


In-Network Mental health services$25 copay
Out-of-Network Mental health services40% coinsurance


Chemotherapy


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs40% coinsurance


Other Part B drugs


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs40% coinsurance


Diabetes supplies


Out-of-Network Medical equipment/supplies40% coinsurance per item
In-Network Medical equipment/supplies$0 copay


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


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies40% coinsurance per item


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


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies40% coinsurance per item



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$10,000 In and Out-of-network
$6,700 In-network
Out-of-Network Inpatient hospital coverage40% per day for days 1 and beyond
In-Network Inpatient hospital coverage$395 per day for days 1 through 3
$0 per day for days 4 through 90


Fitting/evaluation


Out-of-Network Hearing40% coinsurance
In-Network Hearing$0 copay


Hearing aids


In-Network Hearing$399-699 copay
Out-of-Network Hearing$0 copay


Hearing exam


Out-of-Network Hearing40% coinsurance
In-Network Hearing$0 copay



Health plan deductible$0
In-Network Ground ambulance$250 copay
Out-of-Network Ground ambulance$250 copay


Foot exams and treatment


In-Network Foot care (podiatry services)$40 copay
Out-of-Network Foot care (podiatry services)40% coinsurance


Routine foot care


In-Network Foot care (podiatry services)$40 copay
Out-of-Network Foot care (podiatry services)40% coinsurance


Emergency


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


Urgent care


Emergency care/Urgent care$20-40 copay per visit (always covered)


Primary


In-Network Doctor visits$0 copay
Out-of-Network Doctor visits40% coinsurance per visit


Specialist


Out-of-Network Doctor visits40% coinsurance per visit
In-Network Doctor visits$40 copay per visit


Diagnostic radiology services (e.g., MRI)


Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance
In-Network Diagnostic procedures/lab services/imaging$75-150 copay


Diagnostic tests and procedures


Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance
In-Network Diagnostic procedures/lab services/imaging$0-50 copay or 0-20% coinsurance


Lab services


Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance
In-Network Diagnostic procedures/lab services/imaging$0 copay


Outpatient x-rays


In-Network Diagnostic procedures/lab services/imaging$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance


Diagnostic services


In-Network Comprehensive dental20% coinsurance
Out-of-Network Comprehensive dental20-50% coinsurance


Endodontics


Out-of-Network Comprehensive dental20-50% coinsurance
In-Network Comprehensive dental50% coinsurance


Extractions


In-Network Comprehensive dental50% coinsurance
Out-of-Network Comprehensive dental20-50% coinsurance


Non-routine services


In-Network Comprehensive dental20% coinsurance
Out-of-Network Comprehensive dental20-50% coinsurance


Periodontics


In-Network Comprehensive dental50% coinsurance
Out-of-Network Comprehensive dental20-50% coinsurance


Prosthodontics, other oral/maxillofacial surgery, other services


In-Network Comprehensive dental50% coinsurance
Out-of-Network Comprehensive dental20-50% coinsurance


Restorative services


In-Network Comprehensive dental20% coinsurance
Out-of-Network Comprehensive dental20-50% 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 SelectHealth Medicare NoRx (PPO) requires you to live in that plan’s service area. The service area is listed below:

State: Nevada Medicare
County:Clark County MA Plans

Nye County MA Plans



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How much does SelectHealth Medicare NoRx (PPO) cost?

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

How much is SelectHealth Medicare NoRx (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. SelectHealth Medicare NoRx (PPO) by SelectHealth MOOP is $6,700. Once you spend $6,700 you will pay nothing for Part A or Part B covered services.

What type of plan is SelectHealth Medicare NoRx (PPO)?

SelectHealth Medicare NoRx (PPO) is a Local PPO *. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.



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

Last updated on

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.

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MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.

Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.