Network Health Premier (PPO) 2024 Benefit Details for Plan H5215-006-0 by Network Health Medicare Advantage Plans
Network Health Premier is a PPO Medicare Advantage plan, {with_without_pdp} Part D prescription drug benefits, available in 2024.
This health plan, from Network Health Medicare Advantage Plans, includes all Original Medicare benefits, and may offer extra services, but out-of-pocket costs are different.
This plan is rated 5.0 (Excellent) stars by CMS making it a top-rated plan.
Plan Basics | |
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Plan ID: | H5215 006 0 |
Plan Type: | Local PPO |
Plan Year: | 2024 |
Premium: | $95.00/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | $3,400/yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Not Included |
Rx Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | See List |
Insured By: | Network Health Medicare Advantage Plans |
Summary of Benefits |
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Health Plan Cost Sharing
This Network Health Medicare Advantage Plans Medicare Advantage plan has cost-sharing. These are costs you must pay out-of-pocket when you use approved health services.
NOTE: Most preventive services are covered 100% by the plan as a Part B benefit.
The following table summarizes the most common out-of-pocket costs you will incur if you join this plan unless you go out-of-network:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $10 Copay |
Specialist: | $20 Copay Authorization Required |
Wellness programs (e.g., fitness, nursing hotline): | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $20 Copay Authorization Required |
Routine foot care: | Not Covered |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $20 Copay Authorization Required |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | $110 Copay |
Urgent care: | $20 Copay |
Ground ambulance: | $0 |
Inpatient hospital coverage: | $75.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient hospital coverage: | $0 |
Skilled Nursing Facility: | |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $0 |
Outpatient group therapy visit with a psychiatrist: | $0 |
Inpatient hospital - psychiatric: | |
Outpatient group therapy visit: | $0 |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $20 Copay Authorization Required |
Occupational therapy visit: | $20 Copay Authorization Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 |
Durable medical equipment (e.g., wheelchairs, oxygen): | $0 |
Prosthetics (e.g., braces, artificial limbs): | $0 |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $0 |
Lab services: | $0 |
Outpatient x-rays: | $0 |
Diagnostic tests and procedures: | $0 |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Network Health Premier Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits Network Health Medicare Advantage Plans includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | Covered Limits may apply |
Vision | Maximum vision benefit: | Non Specified |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | $10 Copay |
Contact lenses (In-Network) | Not Covered |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
2024 CMS Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories based on a 5-star rating system. Here are the most recent CMS ratings for Network Health Premier.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
This is one of the rare 5-star PPO plans available in 2024 in the areas served (see list below). Network Health Premier does an excellent job keeping its members healthy through its preventive care program with proactive screenings, tests, and vaccines. This plan is good at managing its member's chronic (long-term) health conditions.
Overall, members say their experience with this Network Health Medicare Advantage Plans PPO plan is excellent. When it comes to complaints and changes in performance, this plan gets the highest marks. If you're concerned about how this health plan will treat you when you call for assistance, don't be. Members say it's good.
Network Health Premier offers some vision and hearing benefits, but not dental.
With an added premium of $95.00 dollars per month, prospective members are advised to carefully weigh the value of the plan's additional benefits. While not the lowest, Network Health Premier's maximum out-of-pocket (MOOP) limit ($3,400/yr) won't cost you more than Original Medicare for a 5-day stay in the hospital. This health plan does not have an annual deductible, making health care a little easier to budget.
Plan Availability
Network Health Premier (H5215-006-0) is available in the following locations (click to open):
Additional Medicare Advantage Plan Options
The Medicare Advantage program offers a myriad of options, including these plans:
- H5215-008-0: Network Health Select (PPO)
- H5215-010-0: Network Health Anywhere (PPO)
- H5215-011-0: Network Health Choice (PPO)
- H5215-009-0: Network Health Go (PPO)
- H5215-012-0: Network Health Zero (PPO)
Contact Network Health Medicare Advantage Plans
Plan Website: | https://networkhealth.com/ |
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Formulary Information: | https://networkhealth.com/find-a-pharmacy.html |
Pharmacy Information: | Network Health Medicare Advantage Plans Pharmacy Page |
Prospective Members: | (800)983-7587 |
TTY Users: | (800)947-3529 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- Network Health Medicare Advantage Plans, https://networkhealth.com/, Last Accessed February 20, 2024
- Medicare.gov, "Medicare Advantage Plans cover all Medicare services", Last Accessed February 20, 2024
- Medicare.gov, "How Original Medicare Works", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You", Last Accessed February 19, 2024
- Medicare.gov, "What Medicare Covers", Last Accessed February 7, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
About This H5215-006-0 Plan Detail Page
The data on this Network Health Premier plan detail page is derived from the 2024 Landscape Source Files, Plan Benefit Package, and Medicare Part C and Part D Performance Data published by CMS.
The author interprets these files, and their associated data dictionary, with great care, making every attempt to communicate the data submitted by Network Health Medicare Advantage Plans to CMS as clearly and accurately as possible. Given the complexity of the data, the author recommends that all potential enrollees request an official Summary of Benefits from Network Health Medicare Advantage Plans, at (800)983-7587, prior to enrollment.