Mary Washington Medicare Advantage (HMO) Plans in Your Area

Mary Washington Medicare Advantage Complete (HMO)Mary Washington Medicare Advantage Rewards (HMO)
Medical & Hospital
Monthly Premium$0$0
Part B Premium Reduction
What's this?
$0$50 Per Month
Maximum Out-of-Pocket Limit$3,400 Per Year$5,600 Per Year
Annual Deductible$0$0
Preventative Care/Screenings$0 Copay$0 Copay
Primary Care Physician Visits$0 Copay$5 Copay
Specialist Doctor Visits$40 Copay$45 Copay
Urgent Care$35 Copay$35 Copay
Emergency Care$120 Copay$90 Copay
Lab Services$5 Copay$5 Copay
Home Healthcare100% Coverage100% Coverage
Chiropractic Care$20 Copay$20 Copay
Inpatient Hospital$275 Per Day for Days 1-6,
$0 Per Day for Day 7 and Beyond
$315 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond
Outpatient Surgery at Hospital$275 Copay$300 Copay
Outpatient Surgery at Ambulatory Surgery Center$250 Copay$275 Copay
Part D Prescription Drug Coverage
Annual Deductible
  • Preferred Pharmacies - $0
  • Other Network Pharmacies - $0
  • Preferred Pharmacies - $0
  • Other Network Pharmacies - $0
Tier 1
Preferred Generics
  • Preferred Pharmacies - $0 Copay
  • Other Network Pharmacies - $4 Copay
  • Preferred Pharmacies - $2 Copay
  • Other Network Pharmacies - $12 Copay
Tier 2
Non-Preferred Generics
  • Preferred Pharmacies - $0 Copay
  • Other Network Pharmacies - $12 Copay
  • Preferred Pharmacies - $7 Copay
  • Other Network Pharmacies - $17 Copay
Tier 3
Preferred Brand Names
  • Preferred Pharmacies - $39 Copay
  • Other Network Pharmacies - $44 Copay
  • Preferred Pharmacies - $42 Copay
  • Other Network Pharmacies - $47 Copay
Tier 4
Non-Preferred Brand Names
  • Preferred Pharmacies - $90 Copay
  • Other Network Pharmacies - $95 Copay
  • Preferred Pharmacies - $95 Copay
  • Other Network Pharmacies - $100 Copay
Tier 5
Specialty Drugs
  • Preferred Pharmacies - 33% Co-insurance
  • Other Network Pharmacies - 33% Co-insurance
  • Preferred Pharmacies - 33% Co-insurance
  • Other Network Pharmacies - 33% Co-insurance
Mail Order
90 Day Supply
  • Preferred Pharmacies
    • Tier 1: $0
    • Tier 2: $0
    • Tier 3: $117
    • Tier 4: $270
  • Other Network Pharmacies
    • Tier 1: $0
    • Tier 2: $0
    • Tier 3: $117
    • Tier 4: $270
  • Preferred Pharmacies
    • Tier 1: $6
    • Tier 2: $21
    • Tier 3: $126
    • Tier 4: $285
  • Other Network Pharmacies
    • Tier 1: $6
    • Tier 2: $21
    • Tier 3: $126
    • Tier 4: $285
Initial Coverage Limits
  • Preferred Pharmacies - $4,130 Per Year
  • Other Network Pharmacies - $4,130 Per Year
  • Preferred Pharmacies - $4,130 Per Year
  • Other Network Pharmacies - $4,130 Per Year
Extra Benefits
Vision Care
  • $35 Copay for routine eye exam
  • $0 Copay for a pair of eyeglass frames
  • $35 Copay for routine eye exam
  • $0 Copay for a pair of eyeglass frames
Preventive Dental Care$35 Copay$35 Copay
Over-the-Counter (OTC) Items
  • $50 Per Quarter
  • Up to 2 orders per quarter; no rollover
Not Covered
Hearing
  • $35 Copay for routine or Medicare-covered hearing exam
    Hearing aid coverage for both ears has a maximum benefit of $1,000 every 2 years
  • $35 Copay for routine or Medicare-covered hearing exam
    No hearing aid coverage
Transportation Assistance$0 Copay for 20 one-way trips to approved locations per yearNot covered
Fitness MembershipSilverSneakers® included at no costSilverSneakers® included at no cost
Travel BenefitsEmergency or urgent care coverage if you are making a trip out of state or countryEmergency or urgent care coverage if you are making a trip out of state or country
Mary Washington Medicare Advantage
Complete (HMO)
Mary Washington Medicare Advantage
Rewards (HMO)
Medical & Hospital
Monthly Premium
$0$0
Part B Premium Reduction
What's this?
$0$50 Per Month
Maximum Out-of-Pocket Limit
$3,400 Per Year$5,600 Per Year
Annual Deductible
$0$0
Preventive Care/Screenings
$0 Copay$0 Copay
Primary Care Physician Visits
$0 Copay$5 Copay
Specialist Doctor Visits
$30 Copay$45 Copay
Urgent Care
$35 Copay$35 Copay
Emergency Care
$120 Copay$90 Copay
Lab Services
$5 Copay$5 Copay
Home Healthcare
100% Coverage100% Coverage
Chiropractic Care
$20 Copay$20 Copay
Inpatient Hospital Care
$275 Per Day for Days 1-6, $0 Per Day for Day 7 and Beyond$315 Per Day for Days 1-7, $0 Per Day for Day 8 and Beyond
Outpatient Surgery at Hospital
$275 Copay$300 Copay
Outpatient Surgery at Ambulatory Surgery Center
$250 Copay$275 Copay
Part D Prescription Drug Coverage
Annual Deductible
  • Preferred Pharmacies - $0
  • Other Network Pharmacies - $0
  • Preferred Pharmacies - $0
  • Other Network Pharmacies - $0
Tier 1
Preferred Generics
  • Preferred Pharmacies - $0 Copay
  • Other Network Pharmacies - $4 Copay
  • Preferred Pharmacies - $2 Copay
  • Other Network Pharmacies - $12 Copay
Tier 2
Non-Preferred Generics
  • Preferred Pharmacies - $0 Copay
  • Other Network Pharmacies - $12 Copay
  • Preferred Pharmacies - $7 Copay
  • Other Network Pharmacies - $17 Copay
Tier 3
Preferred Brand Names
  • Preferred Pharmacies - $39 Copay
  • Other Network Pharmacies - $44 Copay
  • Preferred Pharmacies - $42 Copay
  • Other Network Pharmacies - $47 Copay
Tier 4
Non-Preferred Brand Names
  • Preferred Pharmacies - $90 Copay
  • Other Network Pharmacies - $95 Copay
  • Preferred Pharmacies - $95 Copay
  • Other Network Pharmacies - $100 Copay
Tier 5
Specialty Drugs
  • Preferred Pharmacies - 33% Co-insurance
  • Other Network Pharmacies - 33% Co-insurance
Mail Order
90 Day Supply
  • Preferred Pharmacies
    • Tier 1: $0
    • Tier 2: $0
    • Tier 3: $117
    • Tier 4: $270
  • Other Network Pharmacies
    • Tier 1: $0
    • Tier 2: $0
    • Tier 3: $117
    • Tier 4: $270
  • Preferred Pharmacies
    • Tier 1: $6
    • Tier 2: $21
    • Tier 3: $126
    • Tier 4: $285
  • Other Network Pharmacies
    • Tier 1: $6
    • Tier 2: $21
    • Tier 3: $126
    • Tier 4: $285
Initial Coverage Limits
  • Preferred Pharmacies - $4,130 Per Year
  • Other Network Pharmacies - $4,130 Per Year
  • Preferred Pharmacies - $4,130 Per Year
  • Other Network Pharmacies - $4,130 Per Year
Extra Benefits
Vision Care
  • $35 Copay for routine eye exam
  • $0 Copay for a pair of eyeglass frames or contact lenses (2 six packs)
  • $35 Copay for routine eye exam
  • $0 Copay for a pair of eyeglass frames or contact lenses (2 six packs)
Preventive Dental Care
$35 Copay$35 Copay
Over-the-Counter (OTC) Items
  • $50 Per Quarter
  • Up to 2 orders per quarter; no rollovers
Not Covered
Hearing
  • $35 Copay for routine or Medicare-covered hearing exam
    Hearing aid coverage for both ears has a maximum benefit of $1,000 every 2 years
  • $35 Copay for routine or Medicare-covered hearing exam
    No hearing aid coverage
Transportation Assistance
$0 Copay for 20 one-way trips to approved locations per yearNot Covered
Fitness Membership
SilverSneakers® included at no costSilverSneakers® included at no cost
Travel Benefits
Emergency or urgent care coverage if you are making a trip out of state or countryEmergency or urgent care coverage if you are making a trip out of state or country

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