Bright Advantage Special Care plan in New York

Our Bright Advantage Special Care plan is built to give those who are dual eligible for Medicare and Medicaid a choice tailored for them. Enrolling in a Bright Advantage Special Care plan gives you access to extras like an OTC card, transportation, and comprehensive dental. Explore all the benefits below before enrolling.

Bright Advantage Special Care (HMO SNP)

Monthly Plan Premium

$0*

Plan Details

Monthly Plan Premium

$0

Annual Medical Deductible

$0

Annual Prescription Drug Deductible

$85

Primary Care Visit

$0 copay

Specialist Visit

$0 copay

Preventive Care

$0 copay

Annual Max Out-Of-Pocket

$0

Emergency Care

$0 copay

Urgent Care

$0 copay

Outpatient Surgery

$0 copay

Diagnostic Radiology Services

$0 copay

Lab Services

$0 copay

Outpatient X-rays

$0 copay

Hospitalization

$0 copay per Medicare covered stay

Outpatient Surgery (Ambulatory)

$0 copay

Prescription Drug Coverage Details

Annual Prescription Drug Deductible

$85

Costs For Initial Coverage Period

Costs will vary depending on your level of “Extra Help”. Check the Evidence of Coverage document below for complete details and to understand your prescription drug coverage.

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 and Enhanced Dental

Copay for X-rays

$0

Copay for oral exam

$0

Comprehensive Dental

Copay varies based on the services you receive

Hearing Services

Routine Hearing Exam & Hearing Aid Fitting/Evaluation

$0

Hearing Aid Allowance

$1,000 every three years

Preventive and Enhanced Vision Coverage

Routine Eye Exam

$0

Materials Allowance

$130 every two years

Included Extra Benefits

Fitness
Acupuncture
Transportation
Over-the-counter (OTC) drugs and supplies

Additional Plan Resources

Summary of Benefits

Evidence of Coverage (EOC)

LIS Premium Summary Chart

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!

Last Updated: Fri Nov 23 2018

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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.

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