Medicare & Long-Term Care Welcome to Healthfirst Signature (PPO)

Your Signature (PPO) plan has a $450 medical deductible and you have the option of going out of network to receive care from any doctor and hospital in the U.S. that accepts Medicare for medical care.

Your plan includes:

• $0 in-network copay/$50 out-of-network copay (after you pay your medical deductible) for a PCP visit
• $0–$40 in-network copay (after you pay your medical deductible)/$75 out-of-network copay (after you pay your medical deductible) for a specialist visit (no referral needed)
• $0 in-network copay/$50 out-of-network copay for a telehealth PCP visit
• $0 in-network copay (after you pay your medical deductible)/$75 out-of-network copay for a telehealth specialist visit
• $40 copay for urgent care in and out of network
• $115 copay for emergency care in and out of network

In addition to finding dental problems such as cavities early, dental exams can detect the first signs of diabetes, heart disease, and kidney disease. So it’s important to stay on top of your dental health.

Your plan includes:

• $0 in-network copays for all covered diagnostic and preventive services^*, including:
• dental checkups and cleanings twice a year
• oral exams
• fluoride treatment
• $0 in-network copays (after you pay your $750 deductible) for comprehensive services*, including:
  • cavity fillings, crowns, and dentures
  • oral surgery and root canals
• $1,500 annual maximum for both preventive and comprehensive dental services combined

Your Signature (PPO) plan includes Medicare Part D prescription drug coverage.

Your plan includes:

• $0 copay for Tier 1 (preferred generic) and Tier 6 (select care) drugs
• $4 copay for Tier 2 drugs, 19% coinsurance for Tier 3, 45% coinsurance for Tier 4, and 25% coinsurance for Tier 5 drugs
• $700 deductible for Tier 3 (preferred brand and non-preferred generic), Tier 4 (non-preferred), and Tier 5 (specialty) drugs
• Extra convenience with options for:
  • 90-day supplies
  • Home delivery
  • Pick up at large national chains or small local pharmacies

Mental health conditions can affect anyone at any time. If you’re suffering from anxiety, depression, the stress of aging, or any other mental health condition, reach out for help.

Your plan includes:

• $0 in-network copay/$50 out-of-network copay (after you pay your medical deductible) for outpatient:
  • individual and group therapy visits
  • substance abuse services
• $0 in-network copay/50% coinsurance out-of-network (after you pay your medical deductible) for outpatient opioid treatment services
• $461 copay per day for days 1–4 of in-network inpatient care (after you pay your medical deductible); $0 copay per day for days 5+. 30% coinsurance per out-of-network stay (after you pay your medical deductible)

If you are experiencing a medical emergency, please dial 911. If you’re in distress, call or text 988 for free, confidential support 24/7.

This traditional Chinese medicine practice may be beneficial for those suffering from a number of conditions.

Your plan includes:

• $0 in-network copay/$50 out-of-network copay (after you pay your medical deductible) for up to 20 visits a year for chronic lower back pain
• $0 in-network copay/$50 out-of-network copay for 12 additional visits for any condition, including lower back pain