Medicare Advantage plan options and details

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Enroll now with a Medicare expert

Order an enrollment kit or contact one of our Medicare experts: 

Phone:  833-942-2158 (TTY:711) 

Email us: [email protected] 

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2023 plans

Premier benefits

See 2023 additional benefits

Cost-sharing at a glance

SSM Integrity (HMO-POS)

$
0
Monthly Premium
  • Max out-of-pocket
    In-network: $2,500
    Out-of-network: $5,000
  • Hospital daily copay: 1-7 days
    In-network: $325
    Out-of-network: $500
  • Primary care
    In-network: $0
    Out-of-network: $50
  • Specialist
    In-network: $35
    Out-of-network: $50
  • Emergency room
    $100 in- & out-of-network
  • Urgent care
    $35 in- & out-of-network
  • Ambulance
    $300 in- & out-of-network
  • Therapy: PT, OT & speech
    In-network: $35
    Out-of-network: $60
  • Outpatient surgery
    In-network: $300
    Out-of-network: 40%

SSM FlexSpend (HMO-POS)

$
0
Monthly Premium
  • Max out-of-pocket
    In-network: $2,750
    Out-of-network: $5,000
  • Hospital daily copay: 1-7 days
    In-network: $325
    Out-of-network: $500
  • Primary care
    In-network: $0
    Out-of-network: $50
  • Specialist
    In-network:$35
    Out-of-network: $50
  • Emergency room
    $100 in- & out-of-network
  • Urgent care
    $35 in- & out-of-network
  • Ambulance
    $300 in- and out-of-network
  • Therapy: PT, OT & speech
    In-network: $35
    Out-of-network: $60
  • Outpatient surgery
    In-network: $300
    Out-of-network: 40%

SSM Harmony (HMO-POS MA-only)

$
0
Monthly Premium
  • Max out-of-pocket
    In-network: $3,250
    Out-of-network: $10,000
  • Hospital daily copay: 1-7 days
    In-network: $325
    Out-of-network: $750
  • Primary care
    In-network: $0
    Out-of-network: $75
  • Specialist
    In-network: $35
    Out-of-network: $75
  • Emergency room
    $125 in- & out-of-network
  • Urgent care
    $35 in- & out-of-network
  • Ambulance
    $300 in & out-of-network
  • Therapy: PT, OT & speech
    In-network: $40
    Out-of-network: $75
  • Outpatient surgery
    In-network: $300
    Out-of-network: 40%

Additional savings

SSM Integrity (HMO-POS)

$
35
Monthly Part B premium reduction
  • FlexSpend benefit
    Not included
  • Eyeglasses
    Not included
  • Dental
    $1000 of dental services per year
    • Preventive and diagnostic services: $0 copay
    • Comprehensive services: 50% coinsurance
  • Hearing aids
    $750 in-network only

SSM FlexSpend (HMO-POS)

$
0
Monthly Part B premium reduction
  • FlexSpend benefit
    $500 yearly
  • Eyeglasses
    FlexSpend benefit
  • Dental
    $1000 of dental services per year
    • Preventive and diagnostic services: $0 copay
    • Comprehensive services: 50% coinsurance
    + FlexSpend Benefit
  • Hearing aids
    $750 In-Network Only
    + FlexSpend Benefit

SSM Harmony (HMO-POS) MA-only

$
45
Monthly Part B premium reduction
  • FlexSpend benefit^
    $500 yearly
  • Eyeglasses
    FlexSpend benefit
  • Dental
    $1000 of dental services per year
    • Preventive and diagnostic services: $0 copay
    • Comprehensive services: 50% coinsurance
    + FlexSpend benefit
  • Hearing aids
    $750 in-network only
    + FlexSpend benefit

FlexSpend benefit: Prepaid allowance on your WellFirst Wallet Card to be used toward additional dental services, vision services, eyewear, hearing services and hearing aids. Your FlexSpend benefit can be spent at any free-standing dental, vision or hearing facility. You are not restricted to in-network providers.

See our additional benefits page for more information. 

2023 Part D benefit overview

SSM Integrity and SSM FlexSpend only

No Part D deductible
You pay: 
Drug dispensing fees may apply
  1 month/30 day 3 month/100 day
  Preferred retail & mail order Standard retail Mail order Preferred retail Standard retail
Tier 1 $2 $7 $0 $2 $7
Tier 2 $8 $13 $0 $16 $26
Tier 3 $42 $47 $117.50 $117.50 $130
Tier 4 $95 $100 $285 $285 $300
Tier 5 33% 33% NA NA NA
You pay: 
25% coinsurance
You pay: 
Generic: 5% or $4.15
Brand: 5% or $!0.35

Out-of-network services 

Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. Most providers are likely to accept you with the out-of-network coverage on your plan. 

Call our Customer Care Center at 1-877-301-3326 (TTY:711) or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

View our Medicare disclaimer.
H8019_wellfirsthealth.com
Updated: 10/1/22