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Three Plans that Fit Your Needs

Samaritan Health Plans is the only locally-managed Medicare provider serving Benton, Lincoln and Linn counties. We’re proud to offer a range of benefits designed to keep you healthy.

Choose between our Conventional Plan (medical-only) and our Premier and Premier Plus plans (prescription drugs included). All Samaritan Advantage plans offer:

  • $0 deductibles
  • $3,750 out-of-pocket maximum
  • Coverage for acupuncture, chiropractic, skilled nursing facility services, worldwide emergency care, eyewear and more

New Benefit Options

icon of a tooth$1,000 for Dental Services (Premier Plan Plus only)
Use for filling, extractions, crowns etc. Orthodontia Excluded. 

icon of a dumbellSamFit Membership (Conventional Plan and Premier Plan Plus only)
Enjoy the area’s premier 24/7 fitness center at no cost. 

icon of pill bottle$0 Copay for Tier 6 Drugs (Premier and Premier Plan Plus only)
Tier 6 includes select diabetic prescription drugs.

Overview of Plan Benefits

  Conventional Plan (HMO) Premier Plan (HMO) Premier Plan Plus (HMO)
Doctor Office Visits $5 per primary care visit
$20 per specialist visit
$15 per primary care visit
$35 per specialist visit
$15 per primary care visit
$35 per specialist visit
Hospitalization $200 per day for days 1–5
$0 after day 5
$1,750 out-of-pocket maximum
$300 per day for days 1–6
$0 after day 6
$1,750 out-of-pocket maximum
$300 per day for days 1–6
$0 after day 6
$1,750 out-of-pocket maximum
Outpatient Hospital Services $150 per outpatient hospital services and observation services
$100 per ambulatory surgical services
$200 per outpatient surgery 15% of the cost of outpatient surgery
Urgent Care — Nationwide $25  $35 $35
Dental $20 preventive visits N/A $25 preventive visits
$1,000 annual allowance for comprehensive care
SamFit 24/7 Fitness Center $0 membership N/A $0 membership
Part D Prescription Drug Benefits N/A Yes Yes
Tier 1: Preferred Generic N/A Up to $3 / one month Up to $3 / one month
Tier 2: Generic N/A Up to $9 / one month Up to $9 / one month
Tier 3: Preferred Brand N/A Up to $47 / one month Up to $47 / one month
Tier 4: Non-Preferred Drug N/A 48% 50%
Tier 5: Specialty Tier N/A 33% 33%
Tier 6: Select Care Drugs N/A $0 $0
Additional RX Gap Coverage N/A Generic - 37%
Brand - 25%
Tier 1: $3 or 37%, whichever is lower
Tier 2: $9 or 37%, whichever is lower
Tier 6: $0
Brand - 25%
Vision $20 for routine eye exam, 1 per year
$20 per Medicare-covered visit
$0 for routine eye exam, 1 per year
$35 per Medicare-covered visit
$35 for routine eye exam, 1 per year
$35 per Medicare-covered visit
Hearing Aid N/A N/A $500 per calendar year for hearing aids (all types)
both ears combined
Premium $70 / month $100 / month $129 / month
Additional Information More Conventional Plan details More Premier Plan details More Premier Plan Plus details

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H3811_MA4001-2019A, Page updated 10/1/2018