You trust Aspirus for your care. Now you can trust Aspirus Health Plan for your Medicare coverage. We offer all the benefits you need without leaving the network you know.
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You want care for the whole you, from head to toe. Our Medicare Advantage plans help you get it, without breaking your budget.
Choose a $0 premium plan and pay a little more for care if you need it. Or choose our low premium plan and save on out-of-pocket costs when you need care.
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Formulary (list of covered drugs)
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Summary of benefits
*You must continue to pay your Part B premium
Primary: $0 copay
Specialist: $45 copay
In-network: $5,900
Out-of-network combined with in-network: $6,500
$0 copay for many services
$350 copay per day (days 1–5); then
100% covered
$395 copay
$90 copay
Includes routine dental with optional coverage available
$0 copay
30% of the cost of services
$50 semiannually
Includes basic health
club membership
Annual deductible:
Tier 1 & 2 = $0
Tiers 3–5 = $295
Copays based on drug tiers, as low as $3
$0 copay for routine eye exam
$45 copay for diagnostic eye exam
$100 eyewear/contacts allowance
Copays shown at preferred pharmacy rates^
$3 copay
$0 copay for routine hearing exam
$45 copay for diagnostic hearing exam
$699 per Advanced Hearing Aid
$999 per Premium Hearing Aid
^Aspirus Health Plan preferred pharmacies offer lower cost sharing.
*You must continue to pay your Part B premium
Primary: $0 copay
Specialist: $40 copay
In-network: $4,000
Out-of-network combined with in-network: $4,500
$0 copay for many services
$300 copay per stay; then 100% covered
$295 copay
$90 copay
Includes routine dental with optional coverage available
$0 copay
30% of the cost of services
$50 semiannually
Includes basic health
club membership
Annual deductible:
Tier 1 & 2 = $0
Tiers 3–5 = $295
Copays based on drug tiers, as low as $2
$0 copay for routine eye exam
$40 copay for diagnostic eye exam
$175 eyewear/contacts allowance
Copays shown at preferred pharmacy rates^
$2 copay
$0 copay for routine hearing exam
$40 copay for diagnostic hearing exam
$599 per Advanced Hearing Aid
$899 per Premium Hearing Aid
^Aspirus Health Plan preferred pharmacies offer lower cost sharing.
*You must continue to pay your Part B premium
Primary: $0 copay
Specialist: $40 copay
In-network: $4,000
Out-of-network combined with in-network: $4,500
$0 copay for many services
$300 copay stay; then 100% covered
$295 copay
$90 copay
Includes routine dental with optional coverage available
$0 copay
30% of the cost of services
$50 semiannually
Includes basic health club membership
Not covered
$0 copay for routine eye exam
$40 copay for diagnostic eye exam
$175 eyewear/contacts allowance
Not covered
$0 copay for routine hearing exam
$40 copay for diagnostic hearing exam
$599 per Advanced Hearing Aid
$899 per Premium Hearing Aid
Aspirus Health Plan, Inc. is a PPO plan with a Medicare contract. Enrollment in Aspirus Health Plan, Inc. depends on contract renewal.
H6874_50261_2121
10/2020
