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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
days 1 to 10 for Medicare-covered
hospital care.

$65 per day for 1 through
7 days

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 air 

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.