Zing Open Access MI (HMO-POS) H4624-007 is a 2023 Medicare Advantage Plan or Part-C by Zing Health available to residents in Michigan. This plan includes extra prescription drug (Part-D) coverage. Zing Health Zing Open Access MI (HMO-POS) has a monthly premium of $25.00 and has an in-network maximum out-of-pocket limit of $4,500 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $4,500 out-of-pocket. This can be an extremely nice safety net.

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

2023 Zing Health Medicare Advantage Plan Overview

What type of plan is Zing Open Access MI (HMO-POS)

Zing Open Access MI (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 Zing Open Access MI (HMO-POS) cost?

Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Zing Health charges a $25.00 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. Zing Open Access MI (HMO-POS) has a monthly drug premium of $16.80 and a $0 drug deductible. This Zing Health plan offers a $16.80 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 $8.20. This Premium covers any enhanced plan benefits offered by Zing Health 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 $25.00. 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.

Zing Health 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 Zing Health 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 Zing Open Access MI (HMO-POS) medicare insurance offers a $8.20 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $12.40 for 75% low-income subsidy $16.60 for 50% and $20.80 for 25%.

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Zing Open Access MI (HMO-POS) by Zing Health MOOP is $4,500. Once you spend $4,500 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

Zing Open Access MI (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	$5
Tier 3	NA	$47
Tier 4	NA	$100
Tier 5	NA	33%

The complete Zing Open Access MI (HMO-POS) Formulary.
*Initial Coverage Phase and 30 day supply

2023 Summary of Benefits

The benefit information provided is a summary of what Zing Open Access MI (HMO-POS) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Zing Health 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

In-Network Vision	$0 copay

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Eyeglass frames

In-Network Vision	$0 copay

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Eyeglass lenses

In-Network Vision	$0 copay

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Eyeglasses (frames and lenses)

In-Network Vision	$0 copay

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Other

Vision	Not covered

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Routine eye exam

In-Network Vision	$0 copay

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Upgrades

Vision	Not covered

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

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Occupational therapy visit

In-Network Rehabilitation services	$20 copay
Out-of-Network Rehabilitation services	$20 copay

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Physical therapy and speech and language therapy visit

In-Network Rehabilitation services	$20 copay
Out-of-Network Rehabilitation services	$20 copay

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Cleaning

Preventive dental	Covered under office visit

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Dental x-ray(s)

Preventive dental	Covered under office visit

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Fluoride treatment

Preventive dental	Covered under office visit

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Office visit

In-Network Preventive dental	$0.00

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Oral exam

Preventive dental	Covered under office visit

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

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Inpatient hospital - psychiatric

In-Network Mental health services	$300 per day for days 1 through 6 $0 per day for days 7 through 90
Out-of-Network Mental health services	$300 per day for days 1 through 6 $0 per day for days 7 through 90

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Outpatient group therapy visit

In-Network Mental health services	$35 copay
Out-of-Network Mental health services	$35 copay

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Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$35 copay
Out-of-Network Mental health services	$35 copay

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Outpatient individual therapy visit

In-Network Mental health services	$35 copay
Out-of-Network Mental health services	$35 copay

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Outpatient individual therapy visit with a psychiatrist

Out-of-Network Mental health services	$35 copay
In-Network Mental health services	$35 copay

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Chemotherapy

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

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Other Part B drugs

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

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Diabetes supplies

Out-of-Network Medical equipment/supplies	0-20% coinsurance per item
In-Network Medical equipment/supplies	0-20% coinsurance per item

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

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

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

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

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$4,500 In and Out-of-network $4,500 In-network
Out-of-Network Inpatient hospital coverage	$300 per day for days 1 through 6 $0 per day for days 7 through 90
In-Network Inpatient hospital coverage	$300 per day for days 1 through 6 $0 per day for days 7 through 90

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Fitting/evaluation

In-Network Hearing	$0 copay

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Hearing aids - inner ear

In-Network Hearing	$0 copay

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Hearing aids - outer ear

In-Network Hearing	$0 copay

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Hearing aids - over the ear

In-Network Hearing	$0 copay

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Hearing exam

In-Network Hearing	$35 copay
Out-of-Network Hearing	$35 copay

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Health plan deductible	$0
In-Network Ground ambulance	$200 copay

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Foot exams and treatment

Out-of-Network Foot care (podiatry services)	$35 copay
In-Network Foot care (podiatry services)	$35 copay

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Routine foot care

In-Network Foot care (podiatry services)	$20 copay

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Emergency

Emergency care/Urgent care	$110 copay per visit (always covered)

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Urgent care

Emergency care/Urgent care	$10 copay per visit (always covered)

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Primary

In-Network Doctor visits	$0 copay

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Specialist

Out-of-Network Doctor visits	$35 copay per visit
In-Network Doctor visits	$35 copay per visit

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Diagnostic radiology services (e.g., MRI)

Out-of-Network Diagnostic procedures/lab services/imaging	$50-150 copay
In-Network Diagnostic procedures/lab services/imaging	$50-150 copay

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Diagnostic tests and procedures

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

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Lab services

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

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Outpatient x-rays

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

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Diagnostic services

In-Network Comprehensive dental	$0 copay

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Endodontics

In-Network Comprehensive dental	$0 copay

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Extractions

In-Network Comprehensive dental	$0 copay

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Non-routine services

In-Network Comprehensive dental	$0 copay

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Periodontics

In-Network Comprehensive dental	$0 copay

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Prosthodontics, other oral/maxillofacial surgery, other services

In-Network Comprehensive dental	$0 copay

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Restorative services

In-Network Comprehensive dental	$0 copay

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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 Zing Open Access MI (HMO-POS) 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.