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Longevity Health Plan (PPO I-SNP) By Longevity Health Plan



Longevity Health Plan (PPO I-SNP) H9942 001 0 is a 2023 Medicare Advantage Special Needs Plan plan by Longevity Health Plan. This plan from Longevity Health Plan works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Longevity Health Plan and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Longevity Health Plan (PPO I-SNP) H9942-001 is an Institutional SNP (I-SNP). An Institutional SNP is for beneficiaries who live in an institution such as a nursing home or require nursing care at home. If you live in an institution like a nursing home or hospital you can join any Medicare SNP you qualify for or switch plans at any time.







2023 Medicare Special Needs Plan Details

Plan Name:Longevity Health Plan (PPO I-SNP)
Plan ID:H9942 001 0
Special Needs Type:Institutional
Provider:Longevity Health Plan
Plan Year:2023
Plan Type:Local PPO
Monthly Premium C+D:$35.00
Part C Premium:$0
Part D (Drug) Premium:$35.00
Part D Supplemental Premium$0
Total Part D Premium:$35.00
Drug Deductible:$505.00
Tiers with No Deductible:0
Benchmark:below the regional benchmark
Type of Medicare Health Plan:Defined Standard Benefit
Drug Benefit Type:Basic
Gap Coverage:No
Similar Plan: H9942-001


The Longevity Health Plan (PPO I-SNP) H9942-001 is available to residents to Medicare eligible seniors in New Jersey. All Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Longevity Health Plan (PPO I-SNP) 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 Longevity Health Plan (PPO I-SNP) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Longevity Health Plan charges a $0 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.


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. Longevity Health Plan (PPO I-SNP) has a monthly drug premium of $35.00 and a $505.00 drug deductible. This Longevity Health Plan plan offers a $35.00 Part-D Basic Premium that is 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 Longevity 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 $35.00. 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.


Longevity Health Plan 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 additional coverage. This Longevity Health Plan plan does not offer additional 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 Longevity Health Plan (PPO I-SNP) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $8.70 for 75% low-income subsidy $17.50 for 50% and $26.20 for 25%.


Full Assistance Premium:$0
75% Assistance Premium:$8.70
50% Assistance Premium:$17.50
25% Assistance Premium:$26.20


H9942-001 Formulary and Drug Coverage

Longevity Health Plan (PPO I-SNP) 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 Special Needs 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 25%
The complete Longevity Health Plan (PPO I-SNP) H9942-001 Formulary
*Initial Coverage Phase and 30 day supply





2023 Summary of Benefits

The benefit information provided is a summary of what Longevity Health Plan (PPO I-SNP) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Longevity Health Plan 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 Vision30% coinsurance


Eyeglass frames


In-Network Vision$0 copay
Out-of-Network Vision30% coinsurance


Eyeglass lenses


In-Network Vision$0 copay
Out-of-Network Vision30% coinsurance


Eyeglasses (frames and lenses)


In-Network Vision$0 copay
Out-of-Network Vision30% coinsurance


Other


VisionNot covered


Routine eye exam


In-Network Vision$0 copay
Out-of-Network Vision30% coinsurance


Upgrades


In-Network Vision$0 copay
Out-of-Network Vision30% coinsurance



In-Network Transportation$0 copay
Out-of-Network Transportation30% coinsurance
Out-of-Network Skilled Nursing Facility30% per stay
30% per day for days 1 and beyond
In-Network Skilled Nursing Facility$0 copay


Occupational therapy visit


In-Network Rehabilitation services$0 copay
Out-of-Network Rehabilitation services30% coinsurance


Physical therapy and speech and language therapy visit


Out-of-Network Rehabilitation services30% coinsurance
In-Network Rehabilitation services$0 copay


Cleaning


Preventive dentalNot covered


Dental x-ray(s)


Preventive dentalNot covered


Fluoride treatment


Preventive dentalNot covered


Oral exam


Preventive dentalNot covered



In-Network Preventive care$0 copay
Out-of-Network Preventive care30% coinsurance
Out-of-Network Outpatient hospital coverage30% coinsurance per visit
In-Network Outpatient hospital coverage20% coinsurance per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo


Inpatient hospital - psychiatric


In-Network Mental health services$1,300 per stay
Out-of-Network Mental health services$1,300 per stay


Outpatient group therapy visit


In-Network Mental health services20% coinsurance
Out-of-Network Mental health services30% coinsurance


Outpatient group therapy visit with a psychiatrist


In-Network Mental health services20% coinsurance
Out-of-Network Mental health services30% coinsurance


Outpatient individual therapy visit


In-Network Mental health services20% coinsurance
Out-of-Network Mental health services30% coinsurance


Outpatient individual therapy visit with a psychiatrist


In-Network Mental health services20% coinsurance
Out-of-Network Mental health services30% coinsurance


Chemotherapy


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs30% coinsurance


Other Part B drugs


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs30% coinsurance


Diabetes supplies


Out-of-Network Medical equipment/supplies30% coinsurance per item
In-Network Medical equipment/supplies20% coinsurance per item


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


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies30% coinsurance per item


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


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies30% coinsurance per item



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$12,450 In and Out-of-network
$8,300 In-network
Out-of-Network Inpatient hospital coverage$1,300 per stay
In-Network Inpatient hospital coverage$1,300 per stay


Fitting/evaluation


In-Network Hearing$0 copay
Out-of-Network Hearing30% coinsurance


Hearing aids


In-Network Hearing$0 copay
Out-of-Network Hearing30% coinsurance


Hearing exam


Out-of-Network Hearing30% coinsurance
In-Network Hearing20% coinsurance



Health plan deductible$0
In-Network Ground ambulance20% coinsurance
Out-of-Network Ground ambulance20% coinsurance


Foot exams and treatment


Out-of-Network Foot care (podiatry services)30% coinsurance
In-Network Foot care (podiatry services)20% coinsurance


Routine foot care


In-Network Foot care (podiatry services)$0 copay
Out-of-Network Foot care (podiatry services)30% coinsurance


Emergency


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


Urgent care


Emergency care/Urgent care20% coinsurance per visit (always covered)


Primary


In-Network Doctor visits$0 copay
Out-of-Network Doctor visits30% coinsurance per visit


Specialist


In-Network Doctor visits0-20% coinsurance per visit
Out-of-Network Doctor visits30% coinsurance per visit


Diagnostic radiology services (e.g., MRI)


In-Network Diagnostic procedures/lab services/imaging20% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging30% coinsurance


Diagnostic tests and procedures


Out-of-Network Diagnostic procedures/lab services/imaging30% coinsurance
In-Network Diagnostic procedures/lab services/imaging20% coinsurance


Lab services


In-Network Diagnostic procedures/lab services/imaging$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging30% coinsurance


Outpatient x-rays


In-Network Diagnostic procedures/lab services/imaging20% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging30% coinsurance


Diagnostic services


Comprehensive dentalNot covered


Endodontics


Comprehensive dentalNot covered


Extractions


Comprehensive dentalNot covered


Non-routine services


Comprehensive dentalNot covered


Periodontics


Comprehensive dentalNot covered


Prosthodontics, other oral/maxillofacial surgery, other services


Comprehensive dentalNot covered


Restorative services


Comprehensive dentalNot covered



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 Special Need 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 Longevity Health Plan (PPO I-SNP) requires you to live in that plan’s service area. The service area is listed below:

State: Medicare New Jersey
County:SNP in Atlantic

SNP in Bergen

SNP in Burlington

SNP in Camden

SNP in Cape May

SNP in Essex

SNP in Gloucester

SNP in Hudson

SNP in Hunterdon

SNP in Mercer

SNP in Middlesex

SNP in Monmouth

SNP in Morris

SNP in Ocean

SNP in Passaic

SNP in Somerset

SNP in Union

SNP in Warren





Source: CMS.

Plans as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change. All contracts for 2023 have not been finalized. For 2023, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.

Includes 2023 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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