MDwise Medicare
Summary of Benefits D-SNP 2022

2022 Summary of Benefits

Summary of Benefits D-SNP (downloadable pdf)

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MDwise Medicare Inspire Duals (HMO D-SNP) H7746, Plan 004

This is a summary of drug and health services covered by McLaren Medicare for January 1, 2022 - December 31, 2022

This is a summary of drug and health services covered by MDwise Medicare for January 1, 2022 - December 31, 2022

The benefit information provided is a summary of what we cover and what you pay. It does not list every service that we cover or list every limitation or exclusion. To see a complete list of services we cover, please review the Evidence of Coverage on www.mdwise.org/medicare.

To join MDwise Medicare Inspire Duals you must be entitled to Medicare Part A, be enrolled in Medicare Part B, eligible for full Medicaid benefits, and live in our service area. Our service area includes the following counties in Indiana: Benton, Brown, Carroll, Cass, Clinton, Decatur, Fountain, Hamilton, Hancock, Hendricks, Henry, Howard, Jennings, Madison, Marion, Miami, Montgomery, Parke, Pike, Putnam, Randolph, Rush, Shelby, Tipton, Union, Warren, and White counties.

MDwise Medicare Inspire Duals

MDwise Medicare Inspire Duals has a network of doctors, hospitals, pharmacies, and other providers. If you use the providers that are not in our network, the plan may not pay for these services.

Out-of-network/noncontracted providers are under no obligation to treat members, except in emergency situations. Please call our member service number or review the Evidence of Coverage for more information, including the cost- sharing that applies to out-of- network services.

map of Indiana area coverage

Medicaid Benefits

Your covered services are paid for first by Medicare and then by Medicaid. The chart below shows you which benefits are covered by Medicare and which benefits are covered by Medicaid. If a benefit is not covered by Medicare, it may be covered by Medicaid depending on your type of Medicaid coverage.

If you want to know more about the coverage and costs of Original Medicare, look in your current “Medicare & You” handbook. View it online at http://www.medicare.gov or get a copy by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. This document is available in other formats such as Braille, large print or audio.

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For more information, please call us at the phone number below or visit us at www.mdwise.org/medicare.

Toll-free 1-833-358-2140, TTY users should call 711.

From October 1st to March 31st, you can call us 7 days a week from 8:00 a.m. to 8:00 p.m. Eastern Time. From April 1st to September 30th, you can call us Monday through Friday from 8:00 a.m. to 8:00 p.m. Eastern Time.

You can see our plan’s provider/pharmacy directory at our website at www.mdwise.org/medicare.

MDwise Medicare is a DSNP HMO plan with a Medicare contract and a contract with the State of Indiana Medicaid program. Enrollment in MDwise Medicare depends on contract renewal.

CMS Material ID: H7746_MDwiseWebsite
Updated: 10/7/2022 11:56:10 AM