Mary Washington Medicare Advantage Complete (HMO)

NO Deductibles

With Mary Washington Medicare Advantage, there are no additional premiums to pay for prescription drug coverage or extras like preventive dental and vision coverage. There are also no annoying deductibles to meet. Your coverage begins right away.

Complete Coverage With One Plan From One Company

Unlike Original Medicare plans, Mary Washington Medicare Advantage bundles your medical, hospital and prescription drug coverage together in one comprehensive plan.

Additionally, our plans come with a number of valuable extra benefits that will save you time and money.

$0 Copays on Generic Prescriptions

Save even more money on your prescription drugs when you fill your prescription at preferred pharmacies. Mary Washington Medicare Advantage Complete members can get generic prescriptions for $0 copays and reduced copays on brand-name medications at any participating preferred pharmacy.

Important Travel Coverage

Whether you are making a trip out of the state or out of the country, we have you covered. If you ever get sick or injured when away from home, you can rest easy knowing you have emergency or urgent care coverage.

Important Financial Protection

Mary Washington Medicare Advantage protects your savings and retirement by putting an annual limit on what you have to pay out of your own pocket for your covered medical expenses—important protection not offered by Original Medicare plans.

Valuable Extra Benefits That Save You Money

Mary Washington Medicare Advantage Complete comes with important extra benefits for no additional premium such as preventive dental, vision, hearing, transportation to and from doctor appointments, free memberships to health clubs through the popular SilverSneakers® program, and coverage on over-the-counter products such as non-prescription drugs and health-related items.


Benefits at a Glance:
We’ve Got You Covered From Head to Toe

The following table highlights just some of the many benefits available to you as a valued Mary Washington Medicare Advantage member. For more details and a complete list of benefits, please review our Summary of Benefits or Evidence of Coverage which can be downloaded by clicking the links below.

Hospital & Medical Coverage

Your Mary Washington Medicare Advantage plan provides comprehensive medical and hospital coverage with no annual deductible and low copayments.

 Mary Washington Medicare Advantage Complete (HMO)
Monthly Premium$0
Maximum Out-of-Pocket Limit (What’s this?)This means you will never pay more than $3,400 per year for covered medical expenses, even if you have an unexpected illness or injury. If you reach this limit, you will no longer have to pay any copays or co-insurance.$3,400 Per Year
Annual Medical Deductible$0 Per Year
Preventive Care/Screenings$0 Copay
Primary Care Doctor Visits$0 Copay
Specialty Care Doctor Visits$40 Copay
Urgent Care$35 Copay
Emergency Care$120 Copay
Lab Services$5 Copay
Home Healthcare100% Coverage
Chiropractic Services$20 Copay
Inpatient Hospital Care$275 Copay Per Day for Days 1-6,
$0 Per Day for Day 7 and beyond
Outpatient Surgery at Hospital$275 Copay
Outpatient Surgery at Ambulatory Surgical Center$250 Copay

Part D Drug Coverage

This table shows the drug tiers associated with your plan, and the copayments or co-insurance that you will pay in each tier. A drug formulary provides a list of drugs that are covered by our plan.

 Mary Washington Medicare Advantage Complete (HMO) 
 Preferred
Pharmacies
Other Network
Pharmacies
Annual Part D Deductible$0 Per Year$0 Per Year
Tier 1 – Preferred Generics$0 Copay$4 Copay
Tier 2 – Generics$0 Copay$12 Copay
Tier 3 – Preferred Brands$39 Copay$44 Copay
Tier 4 – Non-Preferred Brands$90 Copay$95 Copay
Tier 5 – Specialty Drugs33% Co-insurance33% Co-insurance
Initial Coverage Limit$4,130 Per Year$4,130 Per Year

Part D drug expenses are not covered under the maximum out-of-pocket limit. 


Extra Benefits

Your Mary Washington Medicare Advantage plan offers many valuable extras not offered by Original Medicare or Medicare supplement plans–at no additional cost to you.

 Mary Washington Medicare Advantage Complete (HMO)
Vision Care$35 Copay for routine eye exam
$0 Copay for a pair of eyeglass frames or contact lenses (2 six packs)
Preventive Dental Visits$35 Copay
Over-the-Counter (OTC) Items$50 per quarter up to 2 orders per quarter; no rollover
Hearing$35 Copay for hearing exam
$1,000 allowance for up to 2 hearing aids every 2 years (both ears combined)
Transportation Assistance$0 Copay for 20 one-way trips to approved locations per year
SilverSneakers® Fitness Benefits (What’s this?)Mary Washington Medicare Advantage Complete wants to help you achieve and maintain long-lasting health and wellness. SilverSneakers® is a fun, energizing program that helps people with Medicare take greater control of their health by encouraging physical activity and offering social events…and it includes a fitness center membership to any participating location across the country at no extra cost to you!Included at no additional cost
Travel CoverageEmergency or urgent care coverage if you are making a trip out of state or country

Extra benefit expenses are not covered under the maximum out-of-pocket limit.


Important Plan Documents

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