Bright Advantage Plus plan details in Ohio
Selecting a Bright Advantage Plus plan in in Ohio gives our members more coverage through our unique Care Partner model with Mercy Health, lower copayments, and a lower out-of-pocket maximum. View the extra benefits included with this plan below, including dental coverage and an over-the-counter (OTC) card allowance.
Bright Advantage Plus (HMO)
Monthly Plan Premium
$32.90*
Your Selected Plan Add-ons
$0*
Total Monthly Premium
$32.9*
Plan Details
Monthly Plan Premium
$32.90
Annual Medical Deductible
$0
Annual Prescription Drug Deductible
$0
Primary Care Visit
$0 copay
Specialist Visit
$30 copay
Preventive Care
$0 copay
Annual Physical
$0 copay
Annual Max Out-Of-Pocket
$3,800
Emergency Care
$90 copay
Urgent Care
$35 copay
Outpatient Surgery (Ambulatory Surgery Center)
$185 copay
Diagnostic Radiology Services
20% copay
Lab Services
$10 copay
Outpatient X-rays
$10 copay
Hospitalization
$250/day for days 1-5
$0/day for days 6-90
$0/day for days 90+
Outpatient Surgery (Outpatient Hospital Facility)
$250 copay
Prescription Drug Coverage Details
Annual Prescription Drug Deductible
$0
Costs For Initial Coverage Period
Tier
Retail pricing (30-day supply)
Mail order pricing (90-day supply)
Tier 1: Preferred Generic
Retail pricing (30 or 90 day supply)
$0
Mail order pricing (90 day supply)
$0
Tier 2: Generic
Retail pricing (30 or 90 day supply)
$8
Mail order pricing (90 day supply)
$0
Tier 3: Preferred Brand
Retail pricing (30 or 90 day supply)
$42
Mail order pricing (90 day supply)
$126
Tier 4: Non-Preferred Drug
Retail pricing (30 or 90 day supply)
$95
Mail order pricing (90 day supply)
$285
Tier 5: Specialty Tier
Retail pricing (30 or 90 day supply)
33%
Mail order pricing (90 day supply)
33%
Coverage Gap
After your total yearly drug cost (including what our plan has paid and what you have paid) reaches $3,820, you will enter the coverage gap (also called the "donut hole"). This means that there's a temporary change in what you will pay for your drugs. Not everyone will enter the coverage gap. If you enter the coverage gap, you'll pay 25% of the plan's cost for covered brand name drugs and 37% of the plan's cost for covered generic drugs until your costs total $5,100, which is the end of 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 $5,100, you will pay the greater of:
- 5% of the cost, or
- a $3.40 copay for a generic drug or a drug that’s treated like a generic and a $8.50 copay for all other drugs
Bright Extra Benefits
Preventive Dental
Copay for X-rays
$0
Copay for oral exam
$0
Copay for cleaning
$0
Copay for fluoride treatment
$0
Want more coverage? Upgrade to enhanced dental coverage
• Copays vary depending on services you receive
$15/month
Hearing Services
Routine Hearing Exam & Hearing Aid Fitting/Evaluation
$0
Hearing Aid Allowance
$3,000 every three years
Preventive and Enhanced Vision Coverage
Routine Eye Exam
$0
Materials Allowance
$130 every two years
Included Extra Benefits
If you qualify for Extra Help, you may be eligible for discounted monthly premiums. Learn more about Bright Health plans with Extra Help
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Last Updated: Fri Nov 23 2018
Y0127_MA-WEB-3057_M
Bright Health plans are HMOs and PPOs with a Medicare contract. 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. Bright Health Insurance Company is a Colorado Life and Health company that issues indemnity products, including EPOs offered through Medicare Advantage. An EPO is an exclusive provider organization plan that may be written on an HMO license in some states and on a Life and Health license in some states, including Colorado. Enrollment in our plans depends on contract renewal.
This information is not a complete description of benefits. Call 844-667-5502 | 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.
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