This plan generally replaces your Medicare coverage. You agree to let Health Net manage your Medicare benefits. It is an HMO (health maintenance organization) with a custom network of providers.
How the plan works
- You choose a primary care physician (PCP) who coordinates your care and refers you to specialists within your designated medical group.
- You pay a small copayment for prescription drugs and some services.
- The plan covers the cost of services only if your PCP authorizes them.
- HMOs provide coverage for services outside of your medical group only in cases of emergency.
- Health Net provides behavioral health services.
- The Centers for Medicare and Medicaid Services must approve the service area for each Medicare plan. If your home zip code is outside of the Health Net Seniority Plus service area, you will not be eligible to enroll. Eligible zip codes can change throughout the year. Please contact the Retirement Administration Service Center, Health Net or Medicare.gov if you have a question about the eligibility of a particular zip code.
Best fit for you if:
- You want lower out-of-pocket costs
- You like having one doctor manage your care
- You are comfortable with out-of-network coverage only in emergencies
Typical out-of-pocket costs
Office visit/urgent care visit: $20 (preventive care has no charge)
Emergency room: $65
Hospital stay: $250
Prescription drugs: $5, generic; $25, brand name; $40, non-formulary
Health Net began mailing 2017 ID cards on Dec. 27, 2016. You may also print a copy of your ID card from the Health Net website or call 800-539-4072 to request your ID number.