MDwise Medicare
Summary of Benefits

2022 Summary of Benefits

Summary of Benefits (downloadable pdf)

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MDwise Medicare Inspire (HMO) H7746, Plan 001
MDwise Medicare Inspire Plus (HMO) H7746, Plan 002
MDwise Medicare Inspire Flex (HMO-POS) H7746, Plan 003

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 you must be entitled to Medicare Part A, be enrolled in Medicare Part B, 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 has a network of doctors, hospitals, pharmacies, and other providers. If you use 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.

Out-of-network/noncontracted providers are under no obligation to treat members, except in emergency situations. Please call oour 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 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 an HMO/HMO-POS plan with a Medicare contract. Enrollment in MDwise Medicare depends on contract renewal.

CMS Material ID: H7746_MDwiseWebsite
Updated: 10/1/2021 12:29:34 PM