Our Plans
Because everyone has different needs, we have different Banner Medicare Advantage plan options. Our HMO and PPO plans each include comprehensive benefits, prescription drug coverage and access to 5,000+ providers to choose from. With both plans, you’ll get the same high-quality care and customer service. You decide which plan is right for your needs.
Call to speak with one of our licensed agents who can answer any questions you may have and even help you enroll. (833) 516-1007 (TTY 711). Or if you’re ready, you can enroll now.
Benefits At A Glance
Premiums and Benefits |
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| Prime HMO | Plus PPO | |
|---|---|---|
| Monthly Plan Premium | Prime HMO$0 | Plus PPO$25 |
| Annual Deductible | Prime HMO$0 | Plus PPO$0 |
| Annual Out-of-Pocket Maximum | Prime HMO$2,775 | Plus PPOIn-Network $4,500 In-Network and Out-of-Network Combined $9,000 |
| Inpatient Hospital: Acute (up to 90 days per benefit period) |
Prime HMODays 1-7: $195/day Days 8-90: $0/day | Plus PPOIn-Network Days 1-5: $275/day; Days 6-90: $0/day | Out-of-Network Days 1-90: 40% |
| Skilled Nursing Facility (SNF) (up to 100 days per benefit period) |
Prime HMODays 1-20: $0/day Days 21-100: $178/day | Plus PPOIn-Network Days 1-20: $0/day; Days 21-100: $178/day | Out-of-Network Days 1-100: $195/day |
| Outpatient Hospital: Surgery and Observation | Prime HMO$175 | Plus PPOIn-Network $250 | Out-of-Network 40% (Maricopa, Pinal, Yuma) In-Network $275 | Out-of-Network 40% (Pima, Santa Cruz) |
| Ambulance (one-way trip) | Prime HMO$265 (Maricopa, Pinal, Yuma) $250 (Pima, Santa Cruz) |
Plus PPOIn-Network and Out-of-Network $250 |
| Emergency Care | Prime HMO$90 | Plus PPOIn-Network and Out-of-Network $90 |
| Worldwide Emergency/Urgent Care | Prime HMO$90-up to $25,000/calendar year | Plus PPOIn-Network and Out-of-Network $90 Up to $25,000/calendar year |
| Urgently Needed Care | Prime HMO$30 | Plus PPOIn-Network and Out-of-Network $30 |
| Primary Care Physician (PCP) Visit | Prime HMO$0 | Plus PPOIn-Network $0 | Out-of-Network $35 |
| Preventative Care and Immunizations | Prime HMO$0 | Plus PPO$0 |
| Specialist Visit | Prime HMO$20 | Plus PPOIn-Network $30 | Out-of-Network $70 |
| Diagnostic Tests, Procedures and Lab Services | Prime HMO$10 | Plus PPOIn-Network $10 | Out-of-Network 40% |
| X-rays | Prime HMO$15 | Plus PPOIn-Network $20 | Out-of-Network $27 |
| Diagnostic Radiology (e.g., CT, MRI) | Prime HMO$125-$200 | Plus PPOIn-Network $125 | Out-of-Network 40% |
| Therapeutic Radiology | Prime HMO$60 | Plus PPOIn-Network $60 | Out-of-Network 40% |
| Home Health | Prime HMO$0 | Plus PPOIn-Network $0 | Out-of-Network 50% |
| Durable Medical Equipment (DME) | Prime HMO20% | Plus PPOIn-Network 20% | Out-of-Network 50% |
| Prosthetics and Orthotics | Prime HMO20% | Plus PPOIn-Network20% | Out-of-Network 50% |
| Renal Dialysis | Prime HMO20% | Plus PPOIn-Network 20% | Out-of-Network 40% |
Additional Benefits |
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| Prime HMO | Plus PPO | |
|---|---|---|
| Diabetic Supplies | Prime HMO$0 | Plus PPOIn-Network 0% | Out-of-Network 40% |
| Mental Health Services (individual and group sessions) |
Prime HMO$25 | Plus PPOIn-Network $30 | Out-of-Network $40 |
| Physical Therapy, Occupational Therapy and Speech Therapy | Prime HMO$25 | Plus PPOIn-Network $40 | Out-of-Network 40% (Maricopa | Pinal) In-Network $30 Out-of-Network 40% (Pima) |
| Routine Chiropractic | Prime HMO$35 (up to 6 visits per calendar year) | In-Network $35 | Out-of-Network 40% |
| Medicare-covered Chiropractic | Prime HMO$20 | In-Network $20 | Out-of-Network $70 |
| Medicare-covered Podiatry | Prime HMO$25 | In-Network $30 | Out-of-Network 40% |
| Medicare-covered Eye Exam | Prime HMO$0 | In-Network $0 | Out-of-Network 50% |
| Annual Routine Eye Exam | Prime HMO$0 | In-Network $0 | Out-of-Network 40% |
| Medicare-covered Eyewear (glasses or contacts after cataract surgery) |
Prime HMO20% | In-Network $0 | Out-of-Network 40% |
| Routine Eyewear |
Prime HMO$25 | $200 every 2 years (1 pair of contacts or glasses) |
$200 every 2 years In-Network $0 | Out-of-Network 40% (In- & Out-of-Network Combined) |
| Medicare-covered Hearing Exam | Prime HMO$0 | Plus PPOIn-Network $0 | Out-of-Network 40% |
| Annual Routine Hearing Exam | Prime HMO$0 | In-Network $0 | Out-of-Network 40% |
| Hearing Aid Fitting/Evaluation (every 2 years) |
Prime HMO$0 | In-Network $0 | Out-of-Network 40% (In- & Out-of-Network combined) |
| Hearing Aids | Prime HMO$0 | $1,000 every 2 years | In-Network $0 | Out-of-Network 40% $1,000 every 2 years |
| Preventive Dental | Prime HMO$0 | In-Network $0 | Out-of-Network 40% (up to 2 visits per year) |
| Over-the-Counter (OTC) Items | Prime HMO$50/quarter; unused amount rolls over | $50/quarter unused amount rolls over to next period |
| Fitness: Silver&Fit | Prime HMO$0 | In-Network $0 | Out-of-Network 40% |
| Meals |
Prime HMO$0 | 12 meals when ordered within 30 days of discharge |
In-Network $0 | Out-of-Network 40% (12 meals ordered within 30 days of inpatient discharge) |
Optional Supplemental Benefits - Comprehensive Dental |
||
| Prime HMO | Plus PPO | |
|---|---|---|
| Monthly Premium | Prime HMO$20.20 | Plus PPO$20.20 |
| Comprehensive Dental (non-routine service, diagnostic services, restorative services, endodontics) |
Prime HMO$1,000/calendar year | Plus PPO$1,000/calendar year |
Part D Prescription Drug Coverage |
||
| Prime HMO | Plus PPO | |
|---|---|---|
| Annual Part D Deductible | Prime HMO$0 | Plus PPO$0 |
| Retail: 31-day Supply | Prime HMOTier 1: $0 / Tier 2: $5 / Tier 3: $47 / Tier 4: $100 / Tier 5: 33% | Plus PPOTier 1: $0 / Tier 2: $5 / Tier 3: $47 / Tier 4: $100 / Tier 5: 33% |
| Mail Order: 90-day Supply | Prime HMOTier 1: $0 / Tier 2: $10 / Tier 3: $141 / Tier 4: $300 / Tier 5: Specialty drugs not available through mail order | Plus PPOTier 1: $0 / Tier 2: $10 / Tier 3: $141 / Tier 4: $300 / Tier 5: Specialty drugs not available through mail order |