Whether you’re new to Medicare or want to see what’s available, you’ll find Senior Preferred (HMO) offers Medicare Advantage plan options that cover everything Original Medicare covers and more. Senior Preferred 2020 plan options even include extra benefits such as an integrative wellness platform, over-the-counter benefit cards and post-hospital discharge meal delivery.

Beginning January 1, 2020, Senior Preferred will have one provider network, which means you can see any participating provider in the entire Senior Preferred network in Wisconsin, Iowa, Minnesota and Illinois. However, you will need to keep your eligibility in the county service area for the plan you have enrolled.

Do you have questions about Medicare or Senior Preferred? We have answers. Call Customer Service at (800) 394-5566; TTY 711 or (800) 877-8973.

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Print a Plan Comparison Guide


2020 Plans


 

ELITE 

VALUE D

ELITE D

 This plan does not include prescription drug coverage.This plan includes prescription drug coverage.This plan includes prescription drug coverage.
Monthly Premium$0$0$20.60
Annual Out-of-Pocket Maximum (does not include prescription drugs)$3,400$5,900$3,400
Office Visit (Personal physician/specialist)

Primary Care Provider: $0
Specialist: $45

Primary Care Provider: $0
Specialist: $50

Primary Care Provider: $0
Specialist: $45

Urgent Care (worldwide)ProHealth Urgent Care: $0
Participating Urgent Care: $30
Non-Participating Urgent Care: $60
ProHealth Urgent Care: $0
Participating Urgent Care: $30
Non-Participating Urgent Care: $60
ProHealth Urgent Care: $0
Participating Urgent Care: $30
Non-Participating Urgent Care: $60
Emergency (worldwide)$90 copay/visit$90 copay/visit$90 copay/visit
Lab and X-ray$3 - $6 copay$3 - $6 copay$3 - $6 copay
Inpatient Hospital CoverageDays 1 - 5: $250 copay 
Days 6 and beyond: $0
Days 1 - 4: $335 copay/day
Days 5 and beyond: $0
Days 1 - 5: $250 copay 
Days 6 and beyond: $0
Skilled nursing facility (an initial 3-day hospital stay required)Days 1-20: $0
Days 21-100: $130 copay/day
Days 1-20: $0
Days 21-100: $135 copay/day
Days 1-20: $0
Days 21-100: $130 copay/day
VisionInitial routine eye exam: $20
Eyewear: $100 for frames & lenses
Initial routine eye exam: $20
Eyewear: $100 for frames & lenses
Initial routine eye exam: $20
Eyewear: $100 for frames & lenses
HearingHearing exam: $15
Hearing aids: $699-$999 copay/aid
Limit: 1 per ear/year
Hearing exam: $15
Hearing aids: $699-$999 copay/aid
Limit: 1 per ear/year
Hearing exam: $15
Hearing aids: $699-$999 copay/aid
Limit: 1 per ear/year
Outpatient Surgery$0 - $250 copay$0 - $325 copay$0-$250 copay
Preventive ServicesCovered in fullCovered in fullCovered in full
Coverage Documents

2020 Summary of Benefits

2020 Evidence of Coverage

2020 Annual Notice of Changes

2020 Summary of Benefits

2020 Evidence of Coverage

2020 Annual Notice of Changes

2020 Summary of Benefits

2020 Evidence of Coverage

2020 Annual Notice of Changes



2019 Plans


 

ELITE D

ELITE

VALUE D

 This plan includes prescription drug coverage.This plan does not include prescription drug coverage.This plan includes prescription drug coverage.
Monthly Premium$20$0$0
Annual Out-of-Pocket Maximum (does not include prescription drugs)$3,400$3,400$5,900
Office Visit (Personal physician/specialist)Primary Care Provider: $0 copay/visit
Specialist: $45 copay/visit
Primary Care Provider: $0 copay/visit
Specialist: $45 copay/visit
Primary Care Provider: $0 copay/visit
Specialist: $50 copay/visit
Urgent Care (worldwide)In-Network: $30 copay/visit
Out-of-Network: $60 copay/visit
In-Network: $30 copay/visit
Out-of-Network: $60 copay/visit
In-Network: $30 copay/visit
Out-of-Network: $60 copay/visit
Emergency (worldwide)$75 copay/visit$75 copay/visit$75 copay/visit
Lab and X-ray$3 copay/test
$6 copay
$3 copay/test
$6 copay
$3 copay/test
$6 copay
Inpatient Hospital CoverageDays 1-5: $250 copay/day
Days 6 & beyond: $0
Days 1-5: $250 copay/day
Days 6 & beyond: $0
Days 1-4: $250 copay/day
Days 5 & beyond: $0
Skilled nursing facility (an initial 3-day hospital stay required)Days 1-20: $0
Days 21-100: $130 copay/day
Days 1-20: $0
Days 21-100: $130 copay/day
Days 1-20: $0
Days 21-100: $135 copay/day
VisionExam: $20
Eyewear: $100 for frames & lenses
Exam: $20
Eyewear: $100 for frames & lenses
Exam: $20
Eyewear: $100 for frames & lenses
HearingHearing exam: $15 copay
Hearing aids: $699-$999 copay/aid
Limit: 1 per ear/year
Hearing exam: $15 copay
Hearing aids: $699-$999 copay/aid
Limit: 1 per ear/year
Hearing exam: $15 copay
Hearing aids: $699-$999 copay/aid
Limit: 1 per ear/year
Outpatient SurgeryHospital: $0-$200 copay
Ambulatory Surgical Center: $100 copay
Hospital: $0-$200 copay
Ambulatory Surgical Center: $100 copay
Hospital: $0-$250 copay
Ambulatory Surgical Center: $150 copay
Preventive ServicesCovered in fullCovered in fullCovered in full
Part D Prescription Drug CoverageThis plan includes Part D coverage.This plan does not include prescription drug coverage.This plan includes Part D coverage.
Part D Prescription Drug CopaymentsLearn more hereNo Part D drug coverage.Learn more here
Coverage Documents

2019 Summary of Benefits

2019 Evidence of Coverage

2019 Annual Notice of Changes

2019 Summary of Benefits


2019 Evidence of Coverage

 

2019 Annual Notice of Changes

2019 Summary of Benefits

 

2019 Evidence of Coverage

 

2019 Annual Notice of Changes

 

*The CMS Quality Improvement Organzation has changed, for Illinois, Minnesota and Wisconsin please use:

Livanta BFCC-QIO Program
10820 Guilford Road, Suite 202
Annapolis Junction, MD 20701
888-524-9900
833-868-4059 (fax)
888-985-8775 TTY

For Iowa please use:

Livanta BFCC-QIO Program
10820 Guilford Road, Suite 202
Annapolis Junction, MD 20701
888-755-5580
833-868-4061 (fax)
888-985-9295 TTY

Out-of-network providers

In most cases, care you receive from an out-of-network provider (a provider who is not part of our plan’s network) will not be covered. These are three exceptions:

1. The plan covers emergency care or urgently needed care that you get from an out-of-network provider. For more information about this, and to see what emergency or urgently needed care means, see Section 3 in the Evidence of Coverage (links to the Evidence of Coverage documents can be found above).

2. If you need medical care that Medicare requires our plan to cover and the providers in our network cannot provide this care, you can get this care from an out-of-network provider. If your network provider suggests or recommends care out-of-network, a referral must be obtained in writing, and signed by the plan’s medical director prior to seeking care. In this situation, you will pay the same as you would pay if you got the care from a network provider.

3. Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area.

Using a pharmacy that is out of the network

If you cannot use a network pharmacy, here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:

  • Part D Vaccines administered in a clinic or hospital setting which are considered out-of-network.
  • Part D drugs which cannot be obtained from a network pharmacy in a timely manner, such as no network pharmacy available in a reasonable driving distance or that provides 24-hour, 7-day a week service.
  • Part D drugs which are not obtainable at a network pharmacy because they are only available from specialty pharmacies or typically shipped directly from the manufacturer.
  • Part D drugs dispensed while in an emergency department, provider-based clinic, or an outpatient setting and a network pharmacy is unavailable.
  • During any Federal disaster declaration or other public health emergency declaration in which you are evacuated or displaced.

Interpreter Services

Interpreter Services Information can be found here. We have interpreter services available to answer questions about our health and drug plan. To get an interpreter, call us at (800) 394‐5566. This is a free service.

Contact Information 

If you have questions or require language assistance, please contact Customer Service.

Disclaimers

Senior Preferred is an HMO plan with a Medicare contract. Enrollment in Senior Preferred depends on contract renewal. Medicare Advantage & Part D contracts are reviewed annually by The Centers for Medicare and Medicaid Services to determine renewal status of the plan. You must continue to pay your Medicare Part B premium. The benefit information provided herein is a brief summary, not a comprehensive description of benefits.  Members must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis. For more information contact the plan.

Senior Preferred does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

This web page was updated on October 28, 2019.