.

MDwise Medicare
View 2022 Plans

View 2022 Plans

MDwise Medicare Inspire (HMO)

MDwise Medicare Inspire Plus (HMO)

MDwise Medicare Inspire Flex (HMO-POS)

MDwise Medicare Inspire Duals (HMO DSNP)

2022 MDwise Medicare Enrollment Guide

MDwise Medicare Inspire (HMO) Plan

Plan Premiums and Other Costs

Monthly premium

$0

Maximum out of pocket limit

$5,200

Annual deductible

$300

Benefits and Costs

Primary care physician visit

$5 copay

Specialist visits

$40 copay

Preventive care

$0 copay

Inpatient hospital coverage

$295 per day for days 1 - 7
$0 per day for days 8 and after

Outpatient surgery - hospital

$275 copay

Outpatient surgery - ambulatory surgical center

$250 copay

Emergency care

$90 copay anywhere in the United States or its territories

Urgent care

$40 copay anywhere in the United States or its territories

Ambulance

$250 copay

Lab services

$0 copay

Diagnostic tests & procedures

$50 copay

Diagnostic radiology services (MRI, CT scan)

$200 copay

Standard x-rays

$25 copay

Over-the-counter allowance

$50/quarter with no rollover 

Preventive dental

$0 copay

Eyewear reimbursement

Up to $100 annually for glasses or contacts 

 Chiropractic services

$20 copay 

 Acupuncture services

 $25 copay

 Fitness membership reimbursement

Up to $100 annually 

Virtual care with McLarenNow

$0 copay 

Hearing aid reimbursement

Up to $750 annually

Part D Prescription Drug Coverage

Deductible Stage

$100 for Tiers 3 - 5

Initial Coverage Stage

Tier 1 (preferred generics)

$3.50

Tier 2 (generics)

$12.50

Tier 3 (preferred brand)

$47

Tier 4 (non-preferred brand)

$100

Tier 5 (specialty drugs)

31% of the cost

Tier 6 (select care drugs)

$0

Coverage Gap Stage

Once your total drug cost (what you pay plus what we pay) reaches $4,430, you will move into the Coverage Gap Stage where you will continue to pay your copay for drugs on Tier 1. For all other generics, you will pay 25% of the price. For brand name drugs, you will pay 25% of the price plus a portion of the dispensing fee.

Under this plan, during the Deductible Stage, Initial Coverage Stage, and Coverage Gap Stage, your out-of-pocket costs for Select Insulins will be $10 - $35. To find out which drugs are Select Insulins, please review the McLaren Medicare Formulary. Select Insulins are identified with “SI”.

Catastrophic Stage

Once your yearly out-of-pocket drug costs total $7,050, you will pay the greater of either a 5% coinsurance or $3.95 for generic drugs and $9.85 for all other drugs.

Enroll Here

MDwise Medicare Inspire Plus (HMO)

Plan Premiums and Other Costs

Monthly premium

$25

Maximum out of pocket limit

$4,300

Annual deductible

$0

Benefits and Costs

Primary care physician visit

$0 copay

Specialist visits

$40 copay

Preventive care

$0 copay

Inpatient hospital coverage

$290 per day for days 1 - 7
$0 per day for days 8 and after

Outpatient surgery - hospital

$275 copay

Outpatient surgery - ambulatory surgical center

$250 copay

Emergency care

$90 copay in or out of network

Urgent care

$40 copay in or out of network

Ambulance

$250 copay

Lab services

$0 copay

Diagnostic tests & procedures

$30 copay

Diagnostic radiology services (MRI, CT scan)

$150 copay

Standard x-rays

$25 copay

Over-the-counter allowance

$50/quarter with no rollover 

Preventive dental

$0 copay

Eyewear reimbursement

Up to $200 annually for glasses or contacts 

 Chiropractic services

$20 copay 

 Acupuncture services

 $25 copay

 Fitness membership reimbursement

Up to $200 annually 

Virtual care with McLarenNow

$0 copay 

Hearing aid reimbursement

Up to $1,500 annually

Worldwide emergency

or urgent care

$90 emergency copay

$40 urgent care copay

You may receive covered emergency and urgent care services anywhere in the world. If you are outside of the United States or its territories, your worldwide emergency and urgent care coverage is limited to $50,000

Meals after discharge

28 meals

(2 meals per day for 14 days) delivered directly to your home after each discharge from an inpatient acute or a skilled nursing facility stay. Annual limit of 5 discharges for a total of 140 meals per year.

Worldwide emergency

or urgent care

$90 emergency copay

$40 urgent care copay

You may receive covered emergency and urgent care services anywhere in the world. If you are outside of the United States or its territories, your worldwide emergency and urgent care coverage is limited to $50,000

Meals after discharge

28 meals

(2 meals per day for 14 days) delivered directly to your home after each discharge from an inpatient acute or a skilled nursing facility stay. Annual limit of 5 discharges for a total of 140 meals per year.

Part D Prescription Drug Coverage

Deductible Stage

There is no Part D deductible

Initial Coverage Stage

Tier 1 (preferred generics)

$3.50

Tier 2 (generics)

$12.50

Tier 3 (preferred brand)

$47

Tier 4 (non-preferred brand)

$100

Tier 5 (specialty drugs)

33% of the cost

Tier 6 (select care drugs)

$0

Coverage Gap Stage

Once your total drug cost (what you pay plus what we pay) reaches $4,430, you will move into the Coverage Gap Stage where you will continue to pay your copay for drugs on Tier 1. For all other generics, you will pay 25% of the price. For brand name drugs, you will pay 25% of the price plus a portion of the dispensing fee.

Under this plan, during the Deductible Stage, Initial Coverage Stage, and Coverage Gap Stage, your out-of-pocket costs for Select Insulins will be $10 - $35. To find out which drugs are Select Insulins, please review the McLaren Medicare Formulary. Select Insulins are identified with “SI”.

Catastrophic Stage

Once your yearly out-of-pocket drug costs total $7,050, you will pay the greater of either a 5% coinsurance or $3.95 for generic drugs and $9.85 for all other drugs.

Enroll Here

MDwise Medicare Inspire Flex (HMO-POS)

Plan Premiums and Other Costs

Monthly premium

$49

Maximum out of pocket limit

$4,300

Annual deductible

$100 in-network only

Benefits and Costs

 

In-Network

Point-of-Service

Primary care physician visit

$0 copay

30% coinsurance

Specialist visits

$40 copay

30% coinsurance

Preventive care

$0 copay

30% coinsurance

Inpatient hospital coverage

$310 per day for days 1 - 7
$0 per day for days 8 and after

30% coinsurance

Outpatient surgery - hospital

$275 copay

30% coinsurance

Outpatient surgery - ambulatory surgical center

$250 copay

30% coinsurance

Emergency care

$90 copay in or out of network

Urgent care

$40 copay in or out of network

Ambulance

$250 copay

Lab services

$0 copay

30% coinsurance

Diagnostic tests & procedures

$20 copay

30% coinsurance

Diagnostic radiology services (MRI, CT scan)

$150 copay

30% coinsurance

Standard x-rays

$25 copay

30% coinsurance

Over-the-counter allowance

$50/quarter with no rollover 

Preventive dental

$0 copay

Not covered

Eyewear reimbursement

Up to $200 annually for glasses or contacts 

 Chiropractic services

$20 copay 

30% coinsurance

 Acupuncture services

 $25 copay

Not covered

 Fitness membership reimbursement

Up to $200 annually 

Virtual care with McLarenNow

$0 copay 

Not covered

Hearing aid reimbursement

Up to $1,500 annually

Worldwide emergency

or urgent care

$90 emergency copay

$40 urgent care copay

You may receive covered emergency and urgent care services anywhere in the world. If you are outside of the United States or its territories, your worldwide emergency and urgent care coverage is limited to $50,000

Meals after discharge

28 meals

(2 meals per day for 14 days) delivered directly to your home after each discharge from an inpatient acute or a skilled nursing facility stay. Annual limit of 5 discharges for a total of 140 meals per year.

Part D Prescription Drug Coverage

Deductible Stage

There is no Part D deductible

Initial Coverage Stage

Tier 1 (preferred generics)

$3.50

Tier 2 (generics)

$12.50

Tier 3 (preferred brand)

$47

Tier 4 (non-preferred brand)

$100

Tier 5 (specialty drugs)

33% of the cost

Tier 6 (select care drugs)

$0

Coverage Gap Stage

Once your total drug cost (what you pay plus what we pay) reaches $4,430, you will move into the Coverage Gap Stage where you will continue to pay your copay for drugs on Tier 1. For all other generics, you will pay 25% of the price. For brand name drugs, you will pay 25% of the price plus a portion of the dispensing fee.

Under this plan, during the Deductible Stage, Initial Coverage Stage, and Coverage Gap Stage, your out-of-pocket costs for Select Insulins will be $10 - $35. To find out which drugs are Select Insulins, please review the McLaren Medicare Formulary. Select Insulins are identified with “SI”.

Catastrophic Stage

Once your yearly out-of-pocket drug costs total $7,050, you will pay the greater of either a 5% coinsurance or $3.95 for generic drugs and $9.85 for all other drugs.

Enroll Here

MDwise Medicare Inspire Duals (HMO DSNP)

Plan Premiums and Other Costs

Monthly premium

$0

Maximum out of pocket limit

$0

Annual deductible

$0

Benefits and Costs

Primary care physician visit

$0 copay

Specialist visits

$0 copay

Preventive care

$0 copay

Inpatient hospital coverage

$0 copay per stay

Outpatient surgery - hospital

$0 copay

Outpatient surgery - ambulatory surgical center

$0 copay

Emergency care

$0 copay

Urgent care

$0 copay

Ambulance

$0 copay

Lab services

$0 copay

Diagnostic tests & procedures

$0 copay

Diagnostic radiology services (MRI, CT scan)

$0 copay

Standard x-rays

$0 copay

Over-the-counter allowance

$40/quarter with no rollover 

Preventive dental

$0 copay

Eyewear reimbursement

Up to $100 annually for glasses or contacts 

 Chiropractic services

$0 copay 

 Acupuncture services

 $0 copay

 Fitness membership reimbursement

Up to $200 annually 

Virtual care with McLarenNow

$0 copay 

Hearing aid reimbursement

Up to $1,000 annually

Part D Prescription Drug Coverage

Deductible Stage

There is no Part D deductible

Initial Coverage Stage

Tier 1 (generic)

Either $0, $1.35 or $3.95 per prescription

Tier 1 (brand)

Either $0, $4 or $9.85 per prescription

Catastrophic Coverage Stage

Once your yearly out-of-pocket drug costs total $7,050 you will pay: $0 for Low Income Subsidy (LIS) Levels 1 – 3.

Enroll Here

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