 |
| Enrollment Options By clicking on the Online Enrollment link, you will be leaving the RMHP website | Enroll Enroll Online- Green Plan Green Plan+Rx | Enroll Enroll Online- Thrifty Plan Thrifty Plan+Rx | Enroll Enroll Online- Standard Plan Standard Plan+Rx | Enroll Enroll Online- Plus Plan Plus Plan+Rx |
| Monthly Plan Premium
Medical Only Prescription Drug Total | $8.00*
$40.10 $48.10* * plus you must continue to pay Medicare Part B premium | $34.00*
$40.20 $74.20* * plus you must continue to pay Medicare Part B premium | $42.90*
$56.20 $99.10* * plus you must continue to pay Medicare Part B premium | $156.80*
$89.40 $246.20* * plus you must continue to pay Medicare Part B premium |
| | $500 per calendar year (annual deductible). Applies to all services except Preventive Care, Primary Care Physician and Specialist Care office visits, lab services, and Emergency room services. | $500 per calendar year (annual deductible). Applies to all services except Preventive Care, Primary Care Physician and Specialist Care office visits, lab services, and Emergency room services. | $150 per calendar year (annual deductible). Applies to all services except Preventive Care, Primary Care Physician and Specialist Care office visits, lab services, and Emergency room services. | |
Medical Out of Pocket Maximum | $6,700 per calendar year. Amounts you pay for RMHP deductibles, copayments and coinsurance for Medicare-covered services count toward the maximum out-of-pocket amount. | | | |
Primary Care Physician
Office Visit Copayment | $15 per visit Deductible does not apply | $20 per visit Deductible does not apply | $20 per visit Deductible does not apply | |
Specialist Care Physician
Office Visit Copayment | $40 per visit Deductible does not apply | $50 per visit Deductible does not apply | $45 per visit Deductible does not apply | |
Inpatient Hospital Copayment | After the $500 annual deductible $250 copay per day up to 7 days per admission | After the $500 annual deductible $200 copay per day up to 5 days per admission | After the $150 annual deductible $600 per admission
| |
| | After the $500 annual deductible $400 per visit | After the $500 annual deductible $400 per visit | After the $150 annual deductible $350 per visit | |
| | $150 per trip Deductible does not apply | $200 per trip Deductible does not apply | $100 per trip Deductible does not apply | |
| | $65 per visit Worldwide Deductible does not apply | $50 per visit within the United States Deductible does not apply | $50 per visit
Worldwide Deductible does not apply | |
| | $40 per visit Worldwide Deductible does not apply | $50 per visit
within the United States Deductible does not apply | $45 per visit
Worldwide Deductible does not apply | |
| Additional Medicare Part D links | About RMHP Medicare Part D Part D Formulary | About RMHP Medicare Part D Part D Formulary | About RMHP Medicare Part D Part D Formulary | About RMHP Medicare Part D Part D Formulary |
Part D Prescription Drug Benefit | $125 Deductible- drugs on Tiers 3, 4 & 5 only
| | | |
$2 copay Tier 1
$13 copay Tier 2
$45 copay Tier 3
$87 copay Tier 4
30% coinsurance Tier 5
|
$3 copay Tier 1
$12 copay Tier 2
$45 copay Tier 3
$90 copay Tier 4
33% coinsurance Tier 5
|
$10 copay Tiers 1 & 2
$40 copay Tier 3
$60 copay Tier 4
33% coinsurance Tier 5
|
$8.50 copay Tiers 1 & 2
$38 copay Tier 3
$58 copay Tier 4
33% coinsurance Tier 5
|
After $2,930 in retail drug expenses, Member pays up to 86% of the price for generic drugs and 50% of the price (plus the dispensing fee) for the brand name drugs until the Member's out-of-pocket drug costs reach $4,700 | After $2,930 in retail drug expenses, Member pays up to 86% of the price for generic drugs and 50% of the price (plus the dispensing fee) for the brand name drugs until the Member's out-of-pocket drug costs reach $4,700 | After $2,930 in retail drug expenses, Member pays up to 86% of the price for generic drugs and 50% of the price (plus the dispensing fee) for the brand name drugs until the Member's out-of-pocket drug costs reach $4,700 | After $2,930 in retail drug expenses, Member pays either an $8.50 copayment (for a one month supply) or up to 86% of the price for generic drugs whichever is lower and 50% of the price (plus the dispensing fee) for brand name drugs until the Member's out-of-pocket drug costs reach $4,700 |
After the Member's out-of-pocket drug costs reach $4,700, they pay
$2.60 copay generic;
$6.50 copay for all other drugs; OR 5% (whichever is higher)
|
After the Member's out-of-pocket drug costs reach $4,700, they pay
$2.60 copay generic;
$6.50 copay for all other drugs; OR 5% (whichever is higher)
|
After the Member's out-of-pocket drug costs reach $4,700, they pay
$2.60 copay generic;
$6.50 copay for all other drugs; OR 5% (whichever is higher)
|
After the Member's out-of-pocket drug costs reach $4,700, they pay
$2.60 copay generic;
$6.50 copay for all other drugs; OR 5% (whichever is higher) |
| Mail Order Rx | 3 copays for 3 month supply | 2.5 copays for 3 month supply | 2.5 copays for 3 month supply | 2.5 copays for 3 month supply |
| Annual Routine Physical Exam | $0 Deductible does not apply | $0 Deductible does not apply | $0 Deductible does not apply | |
Preventive Screening Services | $0 Deductible does not apply | $0 Deductible does not apply | $0 Deductible does not apply | |
| | After the $500 annual deductible $0 days 1-20 $100 days 21-100 | After the $500 annual deductible $0 days 1-20 $100 days 21-100 | After the $150 annual deductible $0 days 1-20 $95 days 21-100 | $0 days 1-20 $95 days 21-100
|
Durable Medical Equipment | After the $500 annual deductible 20% coinsurance | After the $500 annual deductible 20% coinsurance | After the $150 annual deductible 20% coinsurance | |
 |
