Your Benefit Options
The Health Options Program offers hospital, medical/surgical, and prescription drug benefits for Medicare-eligible and non-Medicare-eligible individuals.
If You Are Medicare-Eligible
The HOP Medical Plan
If you keep Original Medicare, you can supplement it by enrolling in the HOP Medical Plan. This Plan covers many of the deductibles, coinsurance and other expenses that you are required to pay under Original Medicare. In addition:
- You have the freedom to use virtually any health care provider (doctor or hospital) you want.
- You pay nothing for covered hospital and medical expenses, except for $10 per physician visit.
- You’re covered anywhere in the United States and abroad when you are traveling.
- You can add prescription drug coverage by enrolling in HOP’s Basic or Enhanced Medicare Rx Option.
The Basic and Enhanced Medicare Rx Options
The Basic and Enhanced Medicare Rx Options are Medicare prescription drug (Part D) plans designed specifically for HOP Medical Plan participants and their eligible dependents. You can choose either Option with or without enrolling in the HOP Medical Plan.
- The Basic Medicare Rx Option provides the standard level of prescription drug coverage required by Medicare.
- The Enhanced Medicare Rx Option covers certain medications that are not covered under the Basic Medicare Rx Option or any of the other prescription drug programs offered by commercial carriers. Unlike many other plans (including the Basic Medicare Rx Option), it also provides coverage in the Medicare coverage gap. Premiums for the Enhanced Medicare Rx Option are higher than those for the Basic Medicare Rx Option because the plan provides greater coverage.
Medicare Advantage Plans
You also have an option to choose a Medicare Advantage plan (known as a Medicare Part C plan) instead of Original Medicare and the HOP Medical Plan. Medicare Advantage plans provide benefits designed especially for the Health Options Program and include both medical and prescription drug coverage. Therefore, if you choose this option, you cannot enroll in any other Medicare prescription drug plan. Also, you must use a provider in the Medicare Advantage plan's network to receive the maximum benefit.
|If You Are Medicare-Eligible, |
you can choose to enroll in:
|If you are not eligible for Medicare, |
you can choose to enroll in:
If You are NOT Medicare-Eligible
The HOP Pre-65 Medical Plan
The HOP Pre-65 Medical Plan covers hospital, surgical, and medical services and offers an option for prescription drug coverage:
- Except for a free physical exam each year that requires no deductible, you must meet a $1,500 annual deductible before the Plan pays benefits.
- Once you meet the deductible, you pay 25% of the cost for network providers and 40% of the cost for out-of-network providers.
- If your annual out-of-pocket spending reaches $5,500 in a calendar year, the Plan will pay 100% of your covered medical expenses for the rest of the year, up to a $250,000 annual maximum benefit.
- The Plan also includes a fitness benefit through the SilverSneakers® Fitness Program.
You can elect to enroll in the HOP Pre-65 Medical Plan with or without prescription drug coverage, but you cannot enroll for prescription drug coverage only. If you choose prescription drug coverage, you must meet a $350 annual deductible (separate from the medical deductible). Once you meet the deductible, you pay 50% of the cost for most generic and brand-name drugs that you purchase either at a local network pharmacy or by mail.
- Click here for an overview of the benefits for pre-65 participants, and the type of coverage available.
The Pre-65 Managed Care Plans
You have an option to enroll in a Pre-65 Managed Care Plan instead of the HOP Pre-65 Medical Plan. The Pre-65 Managed Care Plans provide benefits designed especially for the Health Options Program and include both medical and prescription drug coverage. You must use a provider in the MCO's network to receive the maximum benefit. See the regional Managed Care Plan guides for descriptions of the Managed Care Plans available where you live, the benefits they provide and their rates.