Sparrow Advantage (HMO-POS)
NO Deductibles
With Sparrow Advantage, there are no additional premiums to pay for prescription drug coverage or extras like dental and vision coverage. There are also no annoying deductibles to meet. Your coverage begins right away.
Complete Coverage With One Plan From One Company
Unlike Original Medicare, Sparrow Advantage bundles your medical, hospital and prescription drug coverage together in one comprehensive plan. The plan comes with valuable extra benefits that save you even more.
Additionally, our plans come with a number of valuable extra benefits that will save you time and money.
Important Travel Coverage
Whether you are making a trip out of the state or out of the country, we have you covered. If you ever get sick or injured when away from home, you can rest easy knowing you have emergency or urgent care coverage.
Important Financial Protection
Sparrow Advantage protects your savings and retirement by putting an annual limit on what you have to pay out of your own pocket for your covered medical expenses – important protection not offered by Original Medicare.
Valuable Extra Benefits That Save You Money
Every Sparrow Advantage plan comes with important extra benefits for no additional premium including dental, vision, transportation to and from doctor appointments, free memberships to health clubs through the popular SilverSneakers® program, and coverage on over-the-counter products such as non-prescription drugs and health-related items.
Benefits at a Glance:
We’ve Got You Covered From Head to Toe
The following table highlights just some of the many benefits available to you as a valued Sparrow Advantage member. For more details and a complete list of benefits, please review our Summary of Benefits or Evidence of Coverage which can be downloaded by clicking the links below.
Hospital & Medical Coverage
Your Sparrow Advantage plan provides comprehensive medical and hospital coverage with no annual deductible and low copayments.
| Sparrow Advantage (HMO-POS) | |
| Monthly Premium | $0 |
| Maximum Out-of-Pocket Limit (What’s this?)This means you will never pay more than $3,800 per year for covered medical expenses, even if you have an unexpected illness or injury. If you reach this limit, you will no longer have to pay any copays or co-insurance. | $3,800 Per Year |
| Annual Medical Deductible | $0 Per Year |
| Preventive Care/Screenings | $0 Copay |
| Primary Care Doctor Visits | $5 Copay |
| Specialty Care Doctor Visits | $30 Copay |
| Urgent Care | $60 Copay |
| Emergency Care | $90 Copay |
| Lab Services | $10 Copay |
| Home Health Care | 100% Coverage |
| Chiropractic Services | $20 Copay |
| Inpatient Hospital Care | $200 Copay Per Day for Days 1-7, $0 Per Day for Day 8 and beyond |
| Outpatient Surgery at Hospital | $150 Copay |
| Outpatient Surgery at Ambulatory Surgical Center | $100 Copay |
Part D Drug Coverage
This table shows the drug tiers associated with your plan, and the copayments or co-insurance that you will pay in each tier. A drug formulary provides a list of drugs that are covered by our plan.
| Sparrow Advantage (HMO-POS) | ||
| Preferred Pharmacies | Other Network Pharmacies | |
| Annual Part D Deductible | $0 Per Year | $0 Per Year |
| Tier 1 – Preferred Generics | $0 Copay | $5 Copay |
| Tier 2 – Generics | $0 Copay | $10 Copay |
| Tier 3 – Preferred Brands | $40 Copay | $45 Copay |
| Tier 4 – Non-Preferred Brands | $90 Copay | $95 Copay |
| Tier 5 – Specialty Drugs | 33% Co-insurance | 33% Co-insurance |
| Initial Coverage Limit | $4,020 Per Year | $4,020 Per Year |
Part D drug expenses are not covered under the maximum out-of-pocket limit.
Extra Benefits
Your Sparrow Advantage plan offers many valuable extras not offered by Original Medicare or Medicare supplement plans–at no additional cost to you.
| Sparrow Advantage (HMO-POS) | |
| Vision Care | $25 Copay for routine eye exam $0 Copay for a pair of eyeglass frames or contact lenses (2 six packs) |
| Preventive Dental Visits | $0 Copay |
| Over-the-Counter (OTC) Items | $55 per quarter up to 2 orders per quarter; no rollover |
| Hearing | $25 Copay for hearing exam $1,000 allowance for hearing aid coverage every 2 years (both ears combined) |
| Transportation Assistance | $0 Copay for 20 one-way trips to approved locations per year |
| SilverSneakers® Fitness Benefits (What’s this?)Sparrow Advantage wants to help you achieve and maintain long-lasting health and wellness. SilverSneaker® is a fun, energizing program that helps people with Medicare take greater control of their health by encouraging physical activity and offering social events…and it includes a fitness center membership to any participating location across the country at no extra cost to you! | Included at no additional cost |
| Travel Coverage | Emergency or urgent care coverage if you are making a trip out of state or country |
Extra benefit expenses are not covered under the maximum out-of-pocket limit.
