Medical Services
PHP (HMO SNP) offers all the benefits that Original Medicare does through its network of HIV primary care doctors, specialists and hospitals.
For 2024 and 2025, PHP has no monthly Part D premium! You must continue to pay your Medicare Part B premium.
PHP has no cost sharing for most medical services and no Part B deductible for and 2024 and 2025. Original Medicare has a $240 Part B deductible for 2024.
Compare PHP’s 2024 and 2025 coverage and costs for these benefits with Original Medicare.
Benefits | Original Medicare | PHP | PHP |
Doctor Office Visits (includes visits to primary care and specialist providers) | 20% coinsurance (You pay 20% of the cost of the visit)
| $0 copay per visit to primary care provider (PCP) or specialist. | $0 copay per visit to primary care provider (PCP) or specialist. |
Emergency Care | 20% coinsurance for the doctor’s services. Specified copayment for outpatient hospital facility emergency services. Emergency services copay cannot exceed Part A inpatient hospital deductible for each service provided by the hospital. | You pay $25 copay per emergency room visit. Cost sharing for necessary emergency services furnished out-of-network is the same as for such services furnished in-network. Emergency care is only covered within the United States. | You pay $100 copay per emergency room visit. Cost sharing for necessary emergency services furnished out-of-network is the same as for such services furnished in-network. Emergency care is only covered within the United States. |
Urgently Needed Services | 20% coinsurance, or a set copay. | $0 copay | $0 copay |
Outpatient Services | 20% coinsurance for the doctor’s services. Specified copayment for outpatient hospital facility services. Copay cannot exceed Part A inpatient hospital deductible. 20% coinsurance for ambulatory surgical center facility services. | $0 copay for outpatient services. Some services require referral and authorization. | $0 copay for outpatient services. Some services require referral and authorization. |
Diagnostic Tests, X-Rays, Lab Services, and Radiology Services | 20% coinsurance for diagnostic tests and x-rays. $0 copay for Medicare-covered lab services.
| You pay nothing for the following services:
Referral required. The following services require authorization:
The following services do not require authorization:
| You pay nothing for the following services:
Referral required. |
Inpatient Hospital Care | In 2024, the amounts for each benefit period are:
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$0 copay per day for “lifetime reserve” days 91 through 150. |
Skilled Nursing Facility (SNF) | In 2024, the amounts for each benefit period are:
Three-day inpatient hospital stay required before going into SNF. |
No prior hospital stay is required. |
No prior hospital stay is required. |
You can also see the 2025 Summary of Benefits. This publication lists most of the plan’s benefits.
If you like PHP’s medical benefits, you’ll like its prescription drug benefit.
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