McLaren Medicare
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McLaren Medicare Inspire (HMO)

McLaren Medicare Inspire Plus (HMO)

McLaren Medicare Inspire Flex (HMO-POS)

McLaren Medicare Inspire Duals (HMO DSNP)

McLaren Medicare Inspire (HMO)

Plan Premiums and Other Costs

Monthly Premium $0
Maximum Out of Pocket Limit $5,200
Annual Deductible $300
Benefits & Costs

Benefits and Costs

Primary Care Physician Visit $5 copay
Specialist Visits $40 copay
Preventive Care $0 copay
Inpatient Hospital Coverage $250 per day for days 1 - 7
$0 per day for days 8 and after
Outpatient Surgery - Hospital $200 copay
Outpatient Surgery - Ambulatory Surgical Center $150
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 $20 copay
Diagnostic Radiology Services (MRI, CT scan) $200 copay
Standard X-rays $25 copay
OTC
Meals After Discharge
Preventive Dental
Comprehensive Dental
Vision
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 Coverage 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.
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McLaren Medicare Inspire Plus (HMO)

Plan Premiums and Other Costs

Monthly premium $25
Maximum out of pocket limit $3,800
Annual deductible $0

Benefits and Costs

Primary care physician visit $0 copay
Specialist visits $25 copay
Preventive care $0 copay
Inpatient hospital coverage $200 per day for days 1 - 7
$0 per day for days 8 and after
Outpatient surgery - hospital $200 copay
Outpatient surgery - ambulatory surgical center $150 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 $20 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
Transportation $0 copay for up to 20 one-way non-emergency trips per year to plan approved health-related locations>
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 Coverage 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

McLaren Medicare Inspire Flex (HMO-POS)

Plan Premiums and Other Costs

Plan Premiums and Other Costs
Monthly premium $49
Maximum out of pocket limit $3,800
Annual deductible $100 in-network only

Benefits and Costs

In-Network Point-of-Service
Primary care physician visit $0 copay 30% coinsurance
Specialist visits $25 copay 30% coinsurance
Preventive care $0 copay 30% coinsurance
Inpatient hospital coverage $200 per day for days 1 - 7
$0 per day for days 8 and after
30% coinsurance
Outpatient surgery - hospital $200 copay 30% coinsurance
Outpatient surgery - ambulatory surgical center $150 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 Coverage 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

McLaren 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
$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 $45/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.
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