Bright Health Medicare Advantage plan details in Cincinnati, Springfield, Toledo, and Youngstown
Selecting a Bright Advantage plan in Cincinnati, Springfield, Toledo, and Youngstown gives our members access to our unique Care Partner model with Mercy Health, with no referrals needed for in-network visits. Oh, and added benefits like dental, vision, and a free gym membership.
Bright Advantage Flex Plus (PPO)
Monthly Plan Premium
$49*
Your Selected Plan Add-ons
$0*
Total Monthly Premium
$49*
Please enter your zip to enroll
Plan Details
Monthly Premium
$49
Annual Out-Of-Pocket Maximum (not including Rx)
$3,800
Annual Medical Deductible
$0
Annual Prescription Drug (Rx) Deductible
$0
Coinsurance for Most OON Services
35%
Does Plan Have Out-of-Network (OON) Benefits?
Yes
Combined Annual Out-Of-Pocket Maximum (INN and OON Services)
$10,000
Primary Care Office Visits
$0 copay
Specialist Office Visits
$30 copay
Annual Routine Physical
$0 copay
Preventive Care
$0 copay
Inpatient Hospitalization
$250/day for days 1-5
$0/day for days 6+
Outpatient Surgery (ASC)
$185 copay
Outpatient Surgery (Outpatient Hospital Facility)
$250 copay
Emergency Room
$90 copay
Urgent Care
$35 copay
Ambulance (Ground)
$215 copay
Ambulance (Air)
$225 copay
Lab Services
$10 copay
Outpatient X-rays
$0 copay
Diagnostic Radiology Service (e.g., Ultrasound and other services)
$35 copay
Advanced Diagnostic Imaging (e.g., CT, MRI, and PET scans)
$200 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
Want more coverage? Upgrade to comprehensive dental benefits
Coinsurance varies depending on the services you receive
$18/month
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
$30 OTC credit every three months - (Up to $120 annual benefit) Learn More
Transportation
12 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.
Diabetes Care Rebate
Get up to $100 back for care related to your diabetes if you qualify
Prescription Drug Coverage Details
Pharmacy Network
Standard
Annual Prescription Drug (Rx) 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 copay
Mail order pricing (90 day supply)
$0 copay
Tier 2: Generic
Retail pricing (30 or 90 day supply)
$8 copay
Mail order pricing (90 day supply)
$16 copay
Tier 3: Preferred Brand
Retail pricing (30 or 90 day supply)
$47 copay
Mail order pricing (90 day supply)
$94 copay
Tier 4: Non-Preferred Drug
Retail pricing (30 or 90 day supply)
$100 copay
Mail order pricing (90 day supply)
$200 copay
Tier 5: Specialty Tier
Retail pricing (30 or 90 day supply)
33% coinsurance
Mail order pricing (90 day supply)
N/A
Tier 6: Select Care Drugs
Retail pricing (30 or 90 day supply)
$0 copay
Mail order pricing (90 day supply)
$0 copay
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.
*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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Disclaimer
† Savings with a Bright Health Medicare Advantage plan compared to Original Medicare or a Medicare Supplement plan.
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Last Updated: Tues Oct 1 2019
Y0127_Bright_Health
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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