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Mary Washington Medicare Advantage Complete (HMO) is a Medicare Advantage (Part C) Plan by Mary Washington Medicare Advantage.
This page features plan details for 2023 Mary Washington Medicare Advantage Complete (HMO) H2825 – 001 – 0 available in Greater Fredericksburg Region.
IMPORTANT: This page features the 2023 version of this plan. See the 2024 version using the link below:
No 2024 version found. You can use the location links below to find 2024 plans in your area.Mary Washington Medicare Advantage Complete (HMO) is offered in the following locations.
Mary Washington Medicare Advantage Complete (HMO) offers the following coverage and cost-sharing.
| Insurer: | Mary Washington Medicare Advantage |
| Health Plan Deductible: | $0.00 |
| MOOP: | $3,400 In-network |
| Drugs Covered: | Yes |
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8am – 11pm EST. 7 days a week
Mary Washington Medicare Advantage Complete (HMO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $164.90 | $0.00 | $0.00 | $0.00 | $164.90 |
Mary Washington Medicare Advantage Complete (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $0.00 |
| Initial Coverage Limit: | $4,660.00 |
| Catastrophic Coverage Limit: | $7,400.00 |
| Drug Benefit Type: | Enhanced |
| Gap Coverage: | No |
| Formulary Link: | Formulary Link |
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs. The table below shows how the LIS impacts the Part D premium of this plan.
| Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $0.00 | $43.40 | $34.80 | $26.30 | $17.70 |
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Once you reach that amount, you will enter the next coverage phase.
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $4.00 copay | $0.00 copay | |
| 2 (Generic) | $0.00 copay | $12.00 copay | $0.00 copay | |
| 3 (Preferred Brand) | $39.00 copay | $44.00 copay | $39.00 copay | |
| 4 (Non-Preferred Drug) | $90.00 copay | $95.00 copay | $90.00 copay | |
| 5 (Specialty Tier) | 33% | 33% | 33% |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | ||||
| 2 (Generic) | ||||
| 3 (Preferred Brand) | ||||
| 4 (Non-Preferred Drug) | ||||
| 5 (Specialty Tier) |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $12.00 copay | $0.00 copay | |
| 2 (Generic) | $0.00 copay | $36.00 copay | $0.00 copay | |
| 3 (Preferred Brand) | $117.00 copay | $132.00 copay | $97.50 copay | |
| 4 (Non-Preferred Drug) | $270.00 copay | $285.00 copay | $225.00 copay | |
| 5 (Specialty Tier) |
After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
| Drug Type | Cost Share |
|---|---|
| Generic drugs | $4.15 copay or 5% (whichever costs more) |
| Brand-name drugs | $10.35 copay or 5% (whichever costs more) |
Mary Washington Medicare Advantage Complete (HMO) also provides the following benefits.
| In-Network: Yes, contact plan for further details |
| Diagnostic services: | Not covered (no limits) |
| Endodontics: | Not covered (no limits) |
| Extractions: | Not covered (no limits) |
| Non-routine services: | Not covered (no limits) |
| Periodontics: | Not covered (no limits) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | Not covered (no limits) |
| Restorative services: | Not covered (no limits) |
| Cleaning: | Covered under office visit (limits may apply) (authorization not required) (referral not required) |
| Dental x-ray(s): | Covered under office visit (limits may apply) (authorization not required) (referral not required) |
| Fluoride treatment: | Covered under office visit (limits may apply) (authorization not required) (referral not required) |
| Office visit: | $35.00 (authorization not required) (referral not required) |
| Oral exam: | Covered under office visit (limits may apply) (authorization not required) (referral not required) |
| Diagnostic radiology services (e.g., MRI): | 0-20% coinsurance (authorization required) (referral not required) |
| Diagnostic tests and procedures: | $0-50 copay (authorization required) (referral not required) |
| Lab services: | $5 copay (authorization required) (referral not required) |
| Outpatient x-rays: | $10 copay (authorization required) (referral not required) |
| Primary: | $0 copay |
| Specialist: | $40 copay per visit (authorization required) (referral required) |
| Emergency: | $125 copay per visit (always covered) |
| Urgent care: | $35 copay per visit (always covered) |
| Foot exams and treatment: | $40 copay (authorization not required) (referral required) |
| Routine foot care: | Not covered |
| In-Network: No |
| Fitting/evaluation: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Hearing aids: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Hearing exam: | $35 copay (authorization not required) (referral required) |
| $275 per day for days 1 through 6 $0 per day for days 7 through 90 (authorization required) (referral not required) |
| $275 copay per visit (authorization required) (referral not required) |
| $3,400 In-network |
| Diabetes supplies: | $0 copay (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 20% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | 20% coinsurance per item (authorization required) |
| Chemotherapy: | 20% coinsurance (authorization required) |
| Other Part B drugs: | 20% coinsurance (authorization required) |
| Inpatient hospital – psychiatric: | $318 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) (referral not required) |
| Outpatient group therapy visit: | $30 copay (authorization not required) (referral not required) |
| Outpatient group therapy visit with a psychiatrist: | $30 copay (authorization required) (referral not required) |
| Outpatient individual therapy visit: | $35 copay (authorization not required) (referral not required) |
| Outpatient individual therapy visit with a psychiatrist: | $35 copay (authorization required) (referral not required) |
| $0 copay (authorization not required) (referral not required) |
| Occupational therapy visit: | $35 copay (authorization not required) (referral required) |
| Physical therapy and speech and language therapy visit: | $35 copay (authorization not required) (referral required) |
| $0 per day for days 1 through 20 $164 per day for days 21 through 100 (authorization required) (referral not required) |
| $0 copay (limits may apply) (authorization not required) (referral not required) |
| Contact lenses: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass frames: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass lenses: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglasses (frames and lenses): | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Other: | Not covered (no limits) |
| Routine eye exam: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Upgrades: | $15-65 copay or 80-90% coinsurance (limits may apply) (authorization not required) (referral not required) |
| Covered (authorization not required) (referral not required) |
| Comprehensive dental: | Monthly Premium: | $27.00 |
| Comprehensive dental: | Deductible: | N/A |
Ready to sign up for Mary Washington Medicare Advantage Complete (HMO) ?
Get help from a licensed insurance agent.
8am – 11pm EST. 7 days a week
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint
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This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
All plan-related information on this site is from CMS.gov and Medicare.gov . We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period.
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
