Medicare Plan Benefits

 

Western Health Advantage MyCare Select (HMO)

Medicare Advantage Plan Highlights
Medicare Advantage Plan Effective 01.01.22
Monthly Plan Premium  $314.94 per member per month1 
You must continue to pay your Medicare Part B premium
Deductible $0 – There is no yearly deductible for medical services
Out-of-Pocket Responsibility Your yearly limit(s) for this plan – $1,500 
Covered Benefits What You Pay
Inpatient Hospital Coverage2,3  $0 copay 
Doctor’s office visits: Primary care physician and Specialist2,3 $0 copay
Preventive care $0 copay
Urgently needed services $0 copay
Lab services and X-ray $0 copay
Value-Added Services What You Pay
Routine chiropractic and acupuncture $15 copay; up to 20 combined visits annually
Over-the-counter credits  $100 per quarter
Fitness program $0 copay
Eyewear allowance up to $200 every two years
1Individual subscriber premium only 2Services may require prior authorization 3Services may require a referral from your doctor

 

 
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Need more information?

If you need help finding a doctor or have questions about covered services, call Western Health Advantage at 888.WHA.PERS (888.942.7377 toll-free; 711 TTY. Available seven days a week, 7 a.m. to 8 p.m. Translation services and assistance are available. Hard copies of WHA MyCare Select (HM0) plan documents are available by filling out the online request form or calling WHA at the number above.

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