Plan Comparison
You can choose from two different plans: The Premier Plan (HMO) or the Freedom Plan (HMO POS). They both give you comprehensive coverage, but there are differences the doctors you can see, and how much you’ll pay for services. The Premier Plan is an HMO, which means you can only see doctors that are in the plan’s network; if you see out-of-network doctors, you may be responsible for the entire cost. The Freedom Plan is an HMO POS, which means you can also see doctors that aren’t in the plan’s network, but it’ll usually cost you more out-of-pocket.
2022 Benefit Comparison
Here’s an overview of how the plans compare. For more in-depth information on how each plan works, visit Premier Plan Details and Freedom Plan Details.
|
OHP Premier Plan (HMO) |
OHP Freedom Plan (HMO POS) In-network |
|
|---|---|---|
| Maximum Out-of-Pocket Responsibility (does not include prescription drugs) |
$3,500 annually | $3,700 annually |
| Monthly Plan Premium | You pay $0 | You pay $0 |
| Monthly Part B Giveback | Up to $30 | N/A |
| Over-the-Counter (OTC) items | $75 / quarter | $75 / quarter |
| Primary Care Physician (PCP) visit | $0 copay | $0 copay |
| Specialist visit | $20 copay | $20 copay/visit |
| Inpatient Hospital |
$65 copayment each day for |
$65 per day for 1 through |
| Outpatient Hospital | $125 copay | $130 copay/visit |
2022 Medical Benefits
Use this chart to do a side-by-side comparison of cost and coverage on more services. Keep in mind, with the Premier Plan (HMO), you’re required to use in-network providers. With the Freedom Plan (HMO POS), cost and coverage vary between in- and out-of-network providers.
| Medical Benefits | OHP Premier Plan (HMO) |
OHP Freedom Plan (HMO POS) In-network |
OHP Freedom Plan (HMO POS) Out-of-network |
|---|---|---|---|
| Monthly Premium | You pay $0 | You pay $0 | You pay $0 |
| Part B Giveback | Up to $30/Month | N/A | N/A |
| Annual Medical Deductible | $0 | $0 copay | $0 |
| PCP Visit | $0 copay | $0 copay | 20% coinsurance |
| Specialist Visit | $20 copay | $20 copay/visit | 20% coinsurance/visit |
| Chiropractic Services | $10 copay | $20 copay/visit | 20% coinsurance |
| Preventive Services (flu shots, etc.) | $0 copay | $0 copay | 20% coinsurance |
| Urgent Care (local and world-wide) | $20 copay | $20 copay/visit | $20 copay/visit |
| Emergency Care (local and world-wide) | $90 copay | $90 copay/visit | $90 copay/visit |
| Ambulance (local and world-wide) | $235 copay ground; 20% coinsurance air |
$235 copay ground |
20% coinsurance for ground |
| Home Health | $0 copay for Medicare- covered services | $0 copay | 20% coinsurance/visit |
| Durable medical equipment (wheelchairs, oxygen, etc.) | 0% for DME from preferred provider, 20% from other providers. | 0% for DME from preferred provider, 20% from other providers | 20% coinsurance |
| Prosthetics (braces, artificial limbs, etc.) | 20% coinsurance | 20% coinsurance | 20% coinsurance |
|
Diabetes Supplies |
$0 copay |
$0 copay | 20% coinsurance |
| Dialysis | 20% coinsurance | 20% coinsurance | 20% coinsurance |
| Opioid Treatment Program Services | $0 copay | $0 copay | 20% coinsurance |
| In-network Out-of-Pocket Maximum | $3,500 annually | $3,700 annually |
2022 Supplemental Health & Wellness Benefits
Taking care of your health and well-being is about more than just doctor visits. With both plans, you also have access to things like a fitness benefits, meal delivery, and an allowance for over-the-counter items.
| Supplemental Health & Wellness Benefits | OHP Premier Plan (HMO) | OHP Freedom Plan (HMO POS) In-network | OHP Freedom Plan (HMO POS) Out-of-network |
|---|---|---|---|
| Over-the-Counter-Items-Allowance | You pay $0 copay for up to $75 per quarter of covered items | You pay $0 copay for up to $75 per quarter of covered items | No OON Coverage |
| Fitness Benefits (In-network) | $0 copay | $0 copay | No OON Coverage |
| Meal Delivery | $0 copay; 14 meals after inpatient discharge | $0 copay; 14 meals after inpatient discharge | No OON Coverage |
2022 Prescription Drug Benefits
Prescription Drug Benefits do not vary between plans.
| Stage 1: Annual Prescription Deductible |
Since you have no deductible for Part D drugs, this payment stage doesn't apply |
||
| Stage 2: Initial Coverage (After you pay your deductible, if applicable) | Retail | Mail Order | |
| 30-day supply | 90-day supply | 90-day supply | |
| Tier 1: Preferred Generic Drugs | $0 copay | $0 copay | $0 copay |
|
Tier 2: Generic Drugs1 |
$10 copay | $0 copay | $0 copay |
|
Tier 3: Preferred Brand Drugs |
$45 copay | $135 copay | $135 copay |
| Select Insulin Drugs2 | $35 copay | $105 copay | $105 copay |
|
Tier 4: Non-Preferred Brand Drugs |
$100 copay | $300 copay | $300 copay |
|
Tier 5: Specialty Tier Drugs |
33% coinsurance | N/A3 | N/A3 |
|
Stage 3: Coverage Gap Stage |
Tier 1 and Tier 2 Drugs are covered in the gap. For covered drugs on other tiers, after your total drug costs reach $4,430, you pay 25% coinsurance for generic drugs and 25% coinsurance for brand name drugs during the coverage gap. | ||
| Stage 4: Catastrophic Coverage | After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050, you pay the greater of: $3.95 for those generic or preferred multisource drugs with a retail price under $79 and 5% for those with a retail price greater than $79. For brand-name drugs, you would pay $9.85 for those drugs with a retail price under $197 and 5% for those with a retail price over $197. | ||
Other Limitations May Apply
1Tier includes enhanced drug coverage
2For 2022, this plan participated in the Insulin Senior Savings Program which offers lower, stable, and predictable out of pocket costs for covered insulin through the different Part D benefit coverage stages. You will pay a maximum of $35 for a 1-month supply of covered Senior Savings Program insulin during the deductible, initial coverage, and coverage gap or “donut hole” stages of your benefit. You will pay 5% of the cost of these covered insulin in the catastrophic stage. Your cost maybe less if you receive Extra Help from Medicare.
3 Limited to a 30-day supply.
Download and review a Complete Summary of Benefits
Visit our Resource Library to download a complete summary of benefits.