Albany (change county)

WellSelect (PPO)

IN = In-Network; OUT = Out-of-Network

MVP is here to help. Call 1-800-324-3899

Monthly Plan Premium $0 with Part D
Part D Prescription Drug Coverage Tiers 1 and 2: No deductible.
Tiers 3-5: $325 deductible. You pay 100% of the cost of retail and mail order drugs until you spend $325.
Part D 30-Day Supply - Ask about $0 generics and mail order savings! Co-pays differ in the coverage gap. (LIS and EPIC may reduce your co-pays.)
Tier 1 - $0
Tier 2 - $12
Tier 3 - $47
Tier 4 - 25% co-insurance
Tier 5 - 27% co-insurance
Primary Doctor Visit IN - $0; OUT - $60
Specialist Visit IN - $50; OUT - $60
Urgently Needed Care Worldwide Coverage $60
Emergency Room Care Worldwide Coverage $90
Inpatient Hospital Stays Emergency admissions covered worldwide IN - $365/day for days 1-5; $0/day for days 6+; OUT - 40% co-insurance for non-emergency admissions
Ambulatory Surgical Center IN - $225; OUT - 40% co-insurance
Outpatient Hospital IN - $350; OUT - 40% co-insurance
X-ray IN - $60; OUT - $60
Lab IN - $0; OUT - 40% co-insurance
$100 WellBeing Rewards For health and wellness activities
TruHearing® Hearing Aid Benefit Hearing aids for $699 or $999 per ear
Eye Wear Allowance N/A
Dental Allowance for preventive services $240 per year
SilverSneakers® Fitness Program Gym membership and SilverSneakers classes
myVisitNow®–24/7 Online Doctor Visits $0
Out-of-Network Coverage for Non-Urgent and Non-Emergency Services $60 office visits; 40% co-insurance for most other services
Out-of-Pocket Protection That Includes Part B Drugs Does not include monthly premium, acupuncture and Part D costs IN ONLY - $6,700; IN and OUT - $10,000
Once met, MVP pays 100% of covered services
Candy Rivera Whitehead and Tom Branch

Have questions?
We can help you find the right plan for your needs.
Call 1-800-324-3899
Monday – Friday, 8 am – 6 pm Eastern Time (TTY: 1-800-622-1220) October 1 – March 31, Saturdays from 8 am – 12 pm.

Click here for the 2020 Summary of Benefits for WellSelect PPO with Part D (PPO) and Gold PPO with Part D (PPO).

Click here for the 2020 Annual Notice of Change for WellSelect with Part D (PPO).

Click here for the 2020 Evidence of Coverage for WellSelect with Part D (PPO).

See more details about WellSelect

View a side-by-side comparison of plans in your area

Click here for the 2020 Medicare Star Ratings.

Want to learn more?

Speak with an MVP Medicare Advisor:

1-800-324-3899 TTY: 1-800-662-1220

Monday – Friday, 8 am – 6 pm Eastern Time. October 1 – March 31, Saturdays, 8 am – 12 pm.

Or call the MVP Medicare Customer Care Center
Monday – Friday, 8 am – 8 pm 1-800-665-7924 (TTY: 1-800-662-1220).
From October 1 – March 31, call us every day from 8 am – 8 pm.

X
X
MVP Can Help