Changing the way you
receive healthcare

  • 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  2022 and 2023, 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 2022 and 2023. Original Medicare has a $233 Part B deductible for 2022 and a $226 Part B deductible for 2023.

    Compare PHP’s 2022 and 2023 coverage and costs for these benefits with Original Medicare.

    Benefits

    Original Medicare

    PHP
    2022

    PHP
    2023

    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.

    $75 copay

    $75 copay

    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.

    $100 copay per outpatient hospital service, i.e., outpatient surgery and surgery services and diagnostic radiology services, tests and procedures done at a hospital facility.

    $0 copay for outpatient services.

    Diagnostic Tests, X-Rays, Lab Services, and Radiology Services

    20% coinsurance for diagnostic tests and x-rays.

    $0 copay for Medicare-covered lab services.

    $0 copay for diagnostic tests, x-rays, lab and radiology services.

    If diagnostic, lab or imaging services are done at a hospital facility, you will be subject to an outpatient hospital copay. See “Outpatient Services” above.

    $0 copay for diagnostic tests, x-rays, lab and radiology services.

     

    Inpatient Hospital Care

     In 2023, the amounts for each benefit period are:

    • $1,600 deductible
    • Days 1-60: $0 per day
    • Days 61-90: $400 per day
    • Days 91-150: $800 per lifetime reserve day
    • $100 copay per day for days 1 through 6.
    • $0 copay per day for days 7 through 90.
    • $0 copay per day for “lifetime reserve” days 91 through 150.
    • $100 copay per day for days 1 through     6.
    • $0 copay per day for days 7 through 90.
    • $0 copay per day for “lifetime reserve” days 91 through 150.

    Skilled Nursing Facility (SNF)

    In 2022, the amounts for each benefit period are:

    • Day 1-20: $0 per day
    • Days 21-100: $200 per day

    Three-day inpatient hospital stay required before going into SNF.

    • $0 copay per day for days 1 through 20.
    • $100 copay per day for days 21 through 100.

    No prior hospital stay is required.

    • $0 copay per day for days 1 through 20.
    • $100 copay per day for days 21 through 100.

    No prior hospital stay is required.

    You can also see the 2022 Summary of Benefits and the 2023 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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    You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.

     


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