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Wisconsin MedicareAdvantage Plans

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Medicare Advantage Plans in Washburn County, Wisconsin

Below are Medicare Advantage plans available to residents of Washburn county, Wisconsin. 5 carriers offer 26 plans throughout the county of Washburn. Residents may choose plans from carriers such as Medica Insurance Company, HealthPartners and UCare. This data has been made available by the Centers for Medicare & Medicaid Services (CMS) and is for informational purposes only. Some data may be inaccurate or incomplete. Please note that plans can vary by city, county, and state and all plans listed may not be available in all areas. To speak to an advisor and find the Medicare Advantage plan in Washburn county that is right for you complete the form at the top of the page.

Medicare Advantage Health Plans in the county of Washburn

Carrier Plan Title Plan Type
Medica Insurance Company Medica Prime Solution Basic with Part D Option 2 (Cost) (H2450-001) Cost Plan

    Premium and Other Important Information

    • Package: 1 - Medica Senior Dental:
    • $42.50 monthly premium in addition to your $122.60 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
    • $1 000 plan coverage limit every year for these benefits.
    • $3 000 out-of-pocket limit. All plan services included.
    • $122.6 monthly plan premium in addition to your monthly Medicare Part B premium.
    • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

    Doctor Office Visits

    • $0 copay for each primary care doctor visit for Medicare-covered benefits.
    • $0 to $20 copay for each in-area network urgent care Medicare-covered visit
    • $20 copay for each specialist visit for Medicare-covered benefits.
    Medica Insurance Company Medica Prime Solution Enhanced w/Part D Option 2 (Cost) (H2450-002) Cost Plan

      Premium and Other Important Information

      • Package: 1 - Medica Senior Dental:
      • Package: 2 - Wisconsin Rider:
      • $42.50 monthly premium in addition to your $172.60 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
      • $38 monthly premium in addition to your $172.60 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Skilled Nursing Facility (SNF) Home Health Services End-Stage Ren
      • $1 000 plan coverage limit every year for these benefits.
      • $30 000 plan coverage limit every year for these benefits.
      • $3 000 out-of-pocket limit. All plan services included.
      • $172.6 monthly plan premium in addition to your monthly Medicare Part B premium.
      • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

      Doctor Office Visits

      • $0 copay for each primary care doctor visit for Medicare-covered benefits.
      • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.
      • $0 copay for each specialist doctor visit for Medicare-covered benefits.
      Medica Insurance Company Medica Prime Solution Basic with Part D Option 3 (Cost) (H2450-005) Cost Plan

        Premium and Other Important Information

        • Package: 1 - Medica Senior Dental:
        • $42.50 monthly premium in addition to your $181.20 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
        • $1 000 plan coverage limit every year for these benefits.
        • $3 000 out-of-pocket limit. All plan services included.
        • $181.2 monthly plan premium in addition to your monthly Medicare Part B premium.
        • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

        Doctor Office Visits

        • $0 copay for each primary care doctor visit for Medicare-covered benefits.
        • $0 to $20 copay for each in-area network urgent care Medicare-covered visit
        • $20 copay for each specialist visit for Medicare-covered benefits.
        Medica Insurance Company Medica Prime Solution Enhanced w/Part D Option 3 (Cost) (H2450-006) Cost Plan

          Premium and Other Important Information

          • Package: 1 - Medica Senior Dental:
          • Package: 2 - Wisconsin Rider:
          • $42.50 monthly premium in addition to your $231.20 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
          • $38 monthly premium in addition to your $231.20 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Skilled Nursing Facility (SNF) Home Health Services End-Stage Ren
          • $1 000 plan coverage limit every year for these benefits.
          • $30 000 plan coverage limit every year for these benefits.
          • $3 000 out-of-pocket limit. All plan services included.
          • $231.2 monthly plan premium in addition to your monthly Medicare Part B premium.
          • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

          Doctor Office Visits

          • $0 copay for each primary care doctor visit for Medicare-covered benefits.
          • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.
          • $0 copay for each specialist doctor visit for Medicare-covered benefits.
          Medica Insurance Company Medica Prime Solution Thrift with Part D Option 1 (Cost) (H2450-007) Cost Plan

            Premium and Other Important Information

            • $6 700 out-of-pocket limit for Medicare-covered services.
            • $55.5 monthly plan premium in addition to your monthly Medicare Part B premium.
            • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

            Doctor Office Visits

            • 20% of the cost for each primary care doctor visit for Medicare-covered benefits.
            • 20% of the cost for each in-area network urgent care Medicare-covered visit
            • 20% of the cost for each specialist visit for Medicare-covered benefits.
            Medica Insurance Company Medica Prime Solution Basic with Part D Option 1 (Cost) (H2450-016) Cost Plan

              Premium and Other Important Information

              • Package: 1 - Medica Senior Dental:
              • $42.50 monthly premium in addition to your $105.50 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
              • $1 000 plan coverage limit every year for these benefits.
              • $3 000 out-of-pocket limit. All plan services included.
              • $105.5 monthly plan premium in addition to your monthly Medicare Part B premium.
              • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

              Doctor Office Visits

              • $0 copay for each primary care doctor visit for Medicare-covered benefits.
              • $0 to $20 copay for each in-area network urgent care Medicare-covered visit
              • $20 copay for each specialist visit for Medicare-covered benefits.
              Medica Insurance Company Medica Prime Solution Enhanced w/Part D Option 1 (Cost) (H2450-017) Cost Plan

                Premium and Other Important Information

                • Package: 1 - Medica Senior Dental:
                • Package: 2 - Wisconsin Rider:
                • $42.50 monthly premium in addition to your $155.50 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                • $38 monthly premium in addition to your $155.50 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Skilled Nursing Facility (SNF) Home Health Services End-Stage Ren
                • $1 000 plan coverage limit every year for these benefits.
                • $30 000 plan coverage limit every year for these benefits.
                • $3 000 out-of-pocket limit. All plan services included.
                • $155.5 monthly plan premium in addition to your monthly Medicare Part B premium.
                • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                Doctor Office Visits

                • $0 copay for each primary care doctor visit for Medicare-covered benefits.
                • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.
                • $0 copay for each specialist doctor visit for Medicare-covered benefits.
                Medica Insurance Company Medica Prime Solution Value with Part D Option 1 (Cost) (H2450-022) Cost Plan

                  Premium and Other Important Information

                  • Package: 1 - Medica Senior Dental:
                  • $42.50 monthly premium in addition to your $85.50 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                  • $1 000 plan coverage limit every year for these benefits.
                  • $3 350 out-of-pocket limit. All plan services included.
                  • $85.5 monthly plan premium in addition to your monthly Medicare Part B premium.
                  • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                  Doctor Office Visits

                  • $10 copay for each primary care doctor visit for Medicare-covered benefits.
                  • $10 to $30 copay for each in-area network urgent care Medicare-covered visit
                  • $30 copay for each specialist visit for Medicare-covered benefits.
                  Medica Insurance Company Medica Prime Solution Value with Part D Option 2 (Cost) (H2450-023) Cost Plan

                    Premium and Other Important Information

                    • Package: 1 - Medica Senior Dental:
                    • $42.50 monthly premium in addition to your $102.60 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                    • $1 000 plan coverage limit every year for these benefits.
                    • $3 350 out-of-pocket limit. All plan services included.
                    • $102.6 monthly plan premium in addition to your monthly Medicare Part B premium.
                    • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                    Doctor Office Visits

                    • $10 copay for each primary care doctor visit for Medicare-covered benefits.
                    • $10 to $30 copay for each in-area network urgent care Medicare-covered visit
                    • $30 copay for each specialist visit for Medicare-covered benefits.
                    Medica Insurance Company Medica Prime Solution Value with Part D Option 3 (Cost) (H2450-028) Cost Plan

                      Premium and Other Important Information

                      • Package: 1 - Medica Senior Dental:
                      • $42.50 monthly premium in addition to your $161.20 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                      • $1 000 plan coverage limit every year for these benefits.
                      • $3 350 out-of-pocket limit. All plan services included.
                      • $161.2 monthly plan premium in addition to your monthly Medicare Part B premium.
                      • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                      Doctor Office Visits

                      • $10 copay for each primary care doctor visit for Medicare-covered benefits.
                      • $10 to $30 copay for each in-area network urgent care Medicare-covered visit
                      • $30 copay for each specialist visit for Medicare-covered benefits.
                      HealthPartners HealthPartners Wisconsin Freedom Basic (Cost) (H2462-015) Cost Plan

                        Premium and Other Important Information

                        • $62.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                        • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i

                        Doctor Office Visits

                        • 20% of the cost for each primary care doctor visit for Medicare-covered benefits.
                        • 20% of the cost for each in-area network urgent care Medicare-covered visit
                        • 20% of the cost for each specialist visit for Medicare-covered benefits.
                        HealthPartners HealthPartners Wisconsin Freedom Ultimate (Cost) (H2462-016) Cost Plan

                          Premium and Other Important Information

                          • $3 000 out-of-pocket limit. All plan services included.
                          • $236.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                          • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i

                          Doctor Office Visits

                          • $0 copay for each primary care doctor visit for Medicare-covered benefits.
                          • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.
                          • $0 copay for each specialist doctor visit for Medicare-covered benefits.
                          HealthPartners HealthPartners Wisconsin Freedom Ultimate with Rx (Cost) (H2462-017) Cost Plan

                            Premium and Other Important Information

                            • $3 000 out-of-pocket limit. All plan services included.
                            • $258.5 monthly plan premium in addition to your monthly Medicare Part B premium.
                            • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                            Doctor Office Visits

                            • $0 copay for each primary care doctor visit for Medicare-covered benefits.
                            • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.
                            • $0 copay for each specialist doctor visit for Medicare-covered benefits.
                            UCare UCare for Seniors Value (HMO-POS) (H4270-001) HMO with POS Option

                              Premium and Other Important Information

                              • $3 400 out-of-pocket limit for Medicare-covered services.
                              • $61.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                              • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i

                              Doctor Office Visits

                              • $0 copay for each primary care doctor visit for Medicare-covered benefits.
                              • $25 copay for each in-area network urgent care Medicare-covered visit
                              • $30 copay for each specialist visit for Medicare-covered benefits.
                              UCare UCare for Seniors Classic (HMO-POS) (H4270-002) HMO with POS Option

                                Premium and Other Important Information

                                • Package: 1 - Comprehensive Dental:
                                • $21 monthly premium in addition to your $159 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Comprehensive Dental
                                • $1 000 plan coverage limit every year for these benefits.
                                • $3 400 out-of-pocket limit for Medicare-covered services.
                                • $159 monthly plan premium in addition to your monthly Medicare Part B premium.
                                • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                                Doctor Office Visits

                                • $0 copay for each primary care doctor visit for Medicare-covered benefits.
                                • $20 copay for each in-area network urgent care Medicare-covered visit
                                • $15 copay for each specialist visit for Medicare-covered benefits.
                                UCare UCare for Seniors Value Plus (HMO-POS) (H4270-003) HMO with POS Option

                                  Premium and Other Important Information

                                  • $3 400 out-of-pocket limit for Medicare-covered services.
                                  • $89 monthly plan premium in addition to your monthly Medicare Part B premium.
                                  • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                                  Doctor Office Visits

                                  • $0 copay for each primary care doctor visit for Medicare-covered benefits.
                                  • $25 copay for each in-area network urgent care Medicare-covered visit
                                  • $30 copay for each specialist visit for Medicare-covered benefits.
                                  UCare UCare for Seniors Standard D (HMO-POS) (H4270-004) HMO with POS Option

                                    Premium and Other Important Information

                                    • $3 400 out-of-pocket limit for Medicare-covered services.
                                    • $67 monthly plan premium in addition to your monthly Medicare Part B premium.
                                    • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                                    Doctor Office Visits

                                    • $0 copay for each primary care doctor visit for Medicare-covered benefits.
                                    • $25 copay for each in-area network urgent care Medicare-covered visit
                                    • $35 copay for each specialist visit for Medicare-covered benefits.
                                    Security Health Plan of Wisconsin Inc. Advocare Spirit (HMO-POS) (H5211-001) HMO with POS Option

                                      Premium and Other Important Information

                                      • $900 out-of-pocket limit. All plan services included.
                                      • $5 000 annual deductible. Contact the plan for services that apply.
                                      • $5 000 out-of-pocket limit. All plan services included.
                                      • $118.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                                      • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i

                                      Doctor Office Visits

                                      • $0 copay for each primary care doctor visit for Medicare-covered benefits.
                                      • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.
                                      • $20 copay for each specialist visit for Medicare-covered benefits.
                                      Security Health Plan of Wisconsin Inc. Advocare Essence Rx (HMO-POS) (H5211-002) HMO with POS Option

                                        Premium and Other Important Information

                                        • $3 400 out-of-pocket limit. All plan services included.
                                        • $5 000 annual deductible. Contact the plan for services that apply.
                                        • $5 000 out-of-pocket limit. All plan services included.
                                        • $39 monthly plan premium in addition to your monthly Medicare Part B premium.
                                        • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                                        Doctor Office Visits

                                        • $0 copay for each primary care doctor visit for Medicare-covered benefits.
                                        • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.
                                        • $20 copay for each specialist visit for Medicare-covered benefits.
                                        Security Health Plan of Wisconsin Inc. Advocare Essence (HMO-POS) (H5211-003) HMO with POS Option

                                          Premium and Other Important Information

                                          • $3 400 out-of-pocket limit. All plan services included.
                                          • $5 000 annual deductible. Contact the plan for services that apply.
                                          • $5 000 out-of-pocket limit. All plan services included.
                                          • $0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                                          • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i

                                          Doctor Office Visits

                                          • $0 copay for each primary care doctor visit for Medicare-covered benefits.
                                          • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.
                                          • $20 copay for each specialist visit for Medicare-covered benefits.
                                          Security Health Plan of Wisconsin Inc. Advocare Spirit Rx (HMO-POS) (H5211-004) HMO with POS Option

                                            Premium and Other Important Information

                                            • $900 out-of-pocket limit. All plan services included.
                                            • $5 000 annual deductible. Contact the plan for services that apply.
                                            • $5 000 out-of-pocket limit. All plan services included.
                                            • $167 monthly plan premium in addition to your monthly Medicare Part B premium.
                                            • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                                            Doctor Office Visits

                                            • $0 copay for each primary care doctor visit for Medicare-covered benefits.
                                            • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.
                                            • $20 copay for each specialist visit for Medicare-covered benefits.
                                            Security Health Plan of Wisconsin Inc. Advocare Vitality Rx (HMO-POS) (H5211-005) HMO with POS Option

                                              Premium and Other Important Information

                                              • In this plan you will have no cost sharing responsibility for Medicare-covered services and Non-Medicare Supplemental Services.
                                              • $5 000 annual deductible. Contact the plan for services that apply.
                                              • $5 000 out-of-pocket limit. All plan services included.
                                              • $254 monthly plan premium in addition to your monthly Medicare Part B premium.
                                              • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                                              Doctor Office Visits

                                              • $0 copay for each primary care doctor visit for Medicare-covered benefits.
                                              • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.
                                              • $0 copay for each specialist doctor visit for Medicare-covered benefits.
                                              Security Health Plan of Wisconsin Inc. Advocare Vitality (HMO-POS) (H5211-006) HMO with POS Option

                                                Premium and Other Important Information

                                                • In this plan you will have no cost sharing responsibility for Medicare-covered services and Non-Medicare Supplemental Services.
                                                • $5 000 annual deductible. Contact the plan for services that apply.
                                                • $5 000 out-of-pocket limit. All plan services included.
                                                • $192.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                                                • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i

                                                Doctor Office Visits

                                                • $0 copay for each primary care doctor visit for Medicare-covered benefits.
                                                • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.
                                                • $0 copay for each specialist doctor visit for Medicare-covered benefits.
                                                Humana Insurance Company HumanaChoice H5216-007 (PPO) (H5216-007) Local Preferred Provider Organization

                                                  Premium and Other Important Information

                                                  • Package: 1 - MyOption Vision:
                                                  • Package: 2 - MyOption Enhanced Dental:
                                                  • $15 monthly premium in addition to your $36 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Eye Exams Eye Wear
                                                  • $29 monthly premium in addition to your $36 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                                                  • $290 plan coverage limit every year for these benefits.
                                                  • $4 500 out-of-pocket limit for Medicare-covered services.
                                                  • $6 000 out-of-pocket limit for Medicare-covered services.
                                                  • $36 monthly plan premium in addition to your monthly Medicare Part B premium.
                                                  • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                                                  • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                                                  Doctor Office Visits

                                                  • $10 copay for each primary care doctor visit for Medicare-covered benefits.
                                                  • $35 copay for each in-area network urgent care Medicare-covered visit
                                                  • $35 copay for each specialist visit for Medicare-covered benefits.
                                                  • $40 copay for each primary care doctor visit
                                                  • $40 copay for each specialist visit
                                                  Humana Insurance Company Humana Gold Choice H8145-006 (PFFS) (H8145-006) Private Fee for Service

                                                    Premium and Other Important Information

                                                    • Package: 1 - MyOption Dental High PPO:
                                                    • Package: 2 - MyOption Dental Low PPO:
                                                    • Package: 3 - MyOption Vision:
                                                    • Package: 4 - MyOption Plus:
                                                    • $31 monthly premium in addition to your $61 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                                                    • $19 monthly premium in addition to your $61 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                                                    • $15 monthly premium in addition to your $61 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Eye Exams Eye Wear
                                                    • $30 monthly premium in addition to your $61 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental Eye Exams Eye Wear
                                                    • $1 500 plan coverage limit every year for these benefits.
                                                    • $1 000 plan coverage limit every year for these benefits.
                                                    • $290 plan coverage limit every year for these benefits.
                                                    • $6 000 out-of-pocket limit for Medicare-covered services.
                                                    • $61 monthly plan premium in addition to your monthly Medicare Part B premium.
                                                    • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                                                    • This plan does not allow providers to balance bill (charging more than your cost share amount).

                                                    Doctor Office Visits

                                                    • You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
                                                    • $15 copay for each primary care doctor visit for Medicare-covered benefits.
                                                    • $35 copay for each in-area network urgent care Medicare-covered visit
                                                    • $35 copay for each specialist visit for Medicare-covered benefits.
                                                    • $15 copay for each primary care doctor visit
                                                    • $35 copay for each specialist visit
                                                    Humana Insurance Company Humana Gold Choice H8145-121 (PFFS) (H8145-121) Private Fee for Service

                                                      Premium and Other Important Information

                                                      • Package: 1 - MyOption Dental High PPO:
                                                      • Package: 2 - MyOption Dental Low PPO:
                                                      • $31 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                                                      • $19 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                                                      • $1 500 plan coverage limit every year for these benefits.
                                                      • $1 000 plan coverage limit every year for these benefits.
                                                      • $5 000 out-of-pocket limit for Medicare-covered services.
                                                      • $0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                                                      • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i
                                                      • This plan does not allow providers to balance bill (charging more than your cost share amount).

                                                      Doctor Office Visits

                                                      • You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
                                                      • 15% of the cost for each primary care doctor visit for Medicare-covered benefits.
                                                      • 15% of the cost for each in-area network urgent care Medicare-covered visit
                                                      • 15% of the cost for each specialist visit for Medicare-covered benefits.
                                                      • 20% of the cost for each primary care doctor visit
                                                      • 20% of the cost for each specialist visit

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