PHP, Florida

Robert Heglar
AHF Provider

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 2018 and 2019, PHP has no monthly premium for Part D prescription drug coverage; however, you must continue to pay your Medicare Part B premium.  PHP has no cost sharing for most medical services and no Part B deductible.  Original Medicare has a $185 Part B deductible for 2019.

Compare PHP’s 2018 and 2019 coverage and costs for these benefits with Original Medicare.

Benefits Original Medicare PHP 2018 PHP 2019

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. $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. $0 copay for diagnostic tests, x-rays, lab and radiology services.
Inpatient Hospital Care In 2019, the amounts for each benefit period are:

  • $1,364 deductible
  • Days 1-60:  $0 per day
  • Days 61-90: $341 per day
  • Days 91-150: $682 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 2019, the amounts for each benefit period are:

  • Day 1-20:  $0 per day
  • Days 21-100:  $170.50 per day

3 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.

 

This information is not a complete description of benefits.  Call (888) 456-4715 (TTY 711) for more information.  You can also see the 2018 Summary of Benefits and the 2019 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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