Bright Health Medicare Advantage plan details in New York, NY

Selecting a Bright Advantage plan in New York, NY gives our members access to our unique Care Partner model with Mount Sinai, with no referrals needed for in-network visits. Oh, and added benefits like dental, vision, and a free gym membership.

Bright Advantage Special Care (HMO D-SNP)

Monthly Plan Premium

$0*

Please enter your zip to enroll

Plan Details

Monthly Premium

$0

Annual Out-Of-Pocket Maximum (not including Rx)

$0

Annual Medical Deductible

$0

Annual Prescription Drug (Rx) Deductible

$0 or $89 depending on level of Extra Help

Does Plan Have Out-of-Network (OON) Benefits?

No

Primary Care Office Visits

$0 copay

Specialist Office Visits

$0 copay

Annual Routine Physical

$0 copay

Preventive Care

$0 copay

Inpatient Hospitalization

$0

Outpatient Surgery (ASC)

$0 copay

Outpatient Surgery (Outpatient Hospital Facility)

$0 copay

Emergency Room

$0 copay

Urgent Care

$0 copay

Ambulance (Ground)

$0 copay

Ambulance (Air)

$0 copay

Lab Services

$0 copay

Outpatient X-rays

$0 copay

Diagnostic Radiology Service (e.g., Ultrasound and other services)

$0 copay

Advanced Diagnostic Imaging (e.g., CT, MRI, and PET scans)

$0 copay

Bright Extra Benefits

Hearing Services

Routine Hearing Exam

$0 copay

Hearing Aid Allowance

$750 hearing aid allowance every year

Dental Services

Annual Dental Benefit Maximum

$1,500 annual benefit maximum

X-rays

$0 copay

Oral Exams

$0 copay

Cleaning (prophylaxis)

$0 copay

Fluoride Treatment

$0 copay

Vision Services

Routine Eye Exam

$0 copay

Materials Allowance

$130 vision materials allowance every two years

Included Extra Benefits

Over-The-Counter (OTC) Debit Card

$150 OTC credit every month - (Up to $1,800 annual benefit)

Transportation

24 one-way trips to plan-approved locations every year

Fitness/Gym Membership

Bright Health Silver & Fit program includes an annual fitness center membership or home fitness kits at no copay/cost share to the member.

Telehealth

Covered

Prescription Drug Coverage Details

Pharmacy Network

Standard

Annual Prescription Drug (Rx) Deductible

$0 or $89 depending on level of Extra Help

Costs For Initial Coverage Period

Generic (including brand drugs treated as generic): $0, $1.30, $3.60 copay, or 15% coinsurance

All other drugs: $0, $3.90, $8.95 copay, or 15% coinsurance

Coverage Gap

After your total drug costs (including what our plan has paid and what you have paid) reach $4,020, you will pay no more than 25% coinsurance for generic drugs or 25% coinsurance for brand name drugs, for any drug tier during the coverage gap.

Catastrophic Coverage

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $6,350, you pay the greater of:

  • 5% coinsurance, or
  • $3.60 copay for generic (including brand drugs treated as generic) and a $8.95 copay for all other drugs.

If you get full “Extra Help” you may pay as little as a $0 copay for your prescription drugs during this stage.

Additional Plan Resources

Annual Notice of Changes (ANOC)

Evidence of Coverage (EOC)

Enrollment Form

Summary of Benefits

*If you qualify for Extra Help, you may be eligible for discounted monthly premiums. Learn more about Bright Health plans with Extra Help

Still have questions?
We'd love to hear from you!

Disclaimer

† Savings with a Bright Health Medicare Advantage plan compared to Original Medicare or a Medicare Supplement plan.

Last Updated: Tues Oct 1 2019

Y0127_Bright_Health

Bright Health’s New York D-SNP plan is an HMO with a Medicare contract and a Coordination of Benefits Agreement with New York State Department of Health. Our plans are issued through Bright Health Insurance Company or one of its affiliates. Enrollment in our plans depends on contract renewal.

This information is not a complete description of benefits. Call 844-667-5503 | TTY:711 for more information.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

You must continue to pay your Medicare Part B premium.

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

Medicare beneficiaries may also enroll in Bright Health Medicare Advantage plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov 

Bright Health Medicare Advantage plans are plans with a network of doctors, hospitals, pharmacies, and other providers. Out-of-network/noncontracted providers are under no obligation to treat Bright Health members, except in emergency situations.

Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. You must generally use network pharmacies to fill your prescriptions for covered Part D drugs.

Other providers are available in our network. Most network providers participate through our Care Partner.

Bright Advantage Special Care (HMO SNP) has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) through 2021 based on a review of Bright Advantage Special Care (HMO SNP) Model of Care.

Español | 中文 | Tiếng Việt | 한국어 | Tagalog | Русский | العربية | Kreyòl Ayisyen | Français | Português | Polski | 日本語 | Italiano | Deutsch | فارسی | אידיש | বাংলা | Diné Bizaad | اُردُو