Medicare Advantage plan options and details
2022 Plans
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Part D coverage
Yes
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Part B premium reduction^
$35
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Out-of-network coverage
Yes
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In-home support services
10 hours/month
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Primary care
$0*/$50**
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Specialist
$35*/$50**
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Urgent care
$35 in- & out-of-network
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Emergency room
$120 in- & out-of-network
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Ambulance
$300 in- & out of network
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Hospital daily copay: 1-7 days
$325*/$500**
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Therapy: PT, OT & speech
$35*/$60**
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Outpatient surgery
$275*/20%
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Max out-of-pocket+
In-network: $2,500;
Combined in- & out-of-network: $5,000
-
Part D coverage
N/A
-
Part B premium reduction^
$50
-
Out-of-network coverage
Yes
-
In-home support services
10 hours/month
-
Primary care
$0*/$50**
-
Specialist
$35*/$50**
-
Urgent care
$35 in- & out-of-network
-
Emergency room
$120 in- & out-of-network
-
Ambulance
$300 in- & out of network
-
Hospital daily copay: 1-7 days
$325*/$500** daily
-
Therapy: PT, OT & speech
$35*/$60
-
Outpatient surgery
$275*/20%**
-
Max out-of-pocket+
In-network: $2,500; Combined in- & out-of-network: $5,000
*In-network; **Out-of network;
^ Benefit reduces your monthly Part B premium; + Payments for prescription drugs do not count toward annual maximum out-of-pocket limits.
2022 additional benefit overview
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Preventive & comprehensive dental
- No waiting period, deductibles or coinsurance
- Preventive and diagnostic services: $0 copay
-Gum disease maintenance and bridge/implants/dentures repairs: $45 copay
- Fillings, non-surgical gum disease treatment and extractions: $95 copay
- Root canals, bridges, implants, dentures, crowns, & surgical gum disease treatment: $595 copay
- $1,500 in dental services covered per year
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In-home and virtual support from Papa
Visits in your home or virtually for up to 10 hours per month
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Over-the-counter items
- $60 per quarter to spend on eligible over-the-counter products like bandages, pain relievers and much more
- In-store at participating retailers including Walgreens, CVS, Walmart and Dollar General stores
- Online at OTCNetwork.com
- Mail-order catalog
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Hearing
One $0 routine hearing exam and a $750 hearing aid allowance per year at in-network hearing aid providers
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Transportation
We partnered with Lyft to cover 24 one-way personal rides each year to medical appointments and to the pharmacy
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Post-discharge meals
14 meals from Mom’s Meals delivered to your door after you are discharged from the hospital or a skilled nursing facility
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Fitness
The Silver&Fit® program includes:
- Fitness center memberships
- Home fitness kit with a Fitbit, Garmin or other exercise equipment
- 8,000+ on-demand videos
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Nurse line
Nurses are available for free 24 hours a day, 365 days a year
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Living Healthy rewards
Earn up to $150 in rewards for completing healthy activities like receiving a flu shot, going to the dentist and getting an annual physical
See our additional benefits page for more information
2022 Part D prescription drug coverage overview
| SSM Integrity |
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No Part D deductible
|
| 1 month/30 days | 3 month/90 days |
Preferred retail and mail order
|
Tier 1: $0
Tier 2: $5
Tier 3: $40
Tier 4: $90
Tier 5: 33% cost sharing
| Tier 1: $0
Tier 2: $10
Tier 3: $100
Tier 4: $270
Tier 5:not applicable
|
Standard retail
|
Tier 1: $7
Tier 2: $12
Tier 3: $47
Tier 4: $100
Tier 5: 33% cost sharing
| Tier 1: $7
Tier 2: $24
Tier 3: $117.50
Tier 4: $300
Tier 5: not applicable
|
Coverage gap (donut hole)
|
25% coinsurance
|
Catastrophic coverage
|
Generic: 5% or $3.95
Brand: 5% or $9.85
|
Drug dispensing fees may apply
SSM Harmony (HMO-POS) MA only:
SSM Harmony does not offer Part D prescription drug coverage. This is an excellent choice if you already have prescription drug coverage through a State Prescription Drug Assistance Program, TRICARE for Life, the VA or an employer plan. You cannot have a Medicare Part D Prescription Drug plan if you enroll in the SSM Harmony plan.
Out-of-network services
Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. HMO-POS members: most providers are likely to accept you with the out-of-network coverage on your plan (SSM Integrity and SSM Harmony plans). HMO members (SSM Unity and SSM Companion plans): for a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service.
Call our Customer Care Center at 1-877-301-3326 (TTY:711) or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
