Ozark Health Plan Plus and Dual Plus Review

Ozark Health Plan Plus and Ozark Health Plan Dual Plus are two Medicare Advantage HMO plans offered by Arcadian Health Plan.  Arcadian Health Plan offers Medicare coverage and Medicare Prescription drug coverage in several states.  The Ozark Health Plan is offered in Missouri, and is now backed by a company you may have heard of, Humana!  Let’s take a look at the current benefits:

Ozark Health Plan Plus (HMO)

  • Premium – $25/monthly
  • Maximum Out of Pocket – $5,950
  • Referral required for specialists
  • Hospital copay – $245/day Days 1-7
  • Doctors visits – $0 = Primary; $40 = Specialists
  • Outpatient Surgery – $375
  • Labs – $0
  • Diagnostic Procedures and Tests – $0
  • X-rays – 20%
  • Part D Deductible – $0
  • Part D Drugs – Tier 1 = $2; Tier 2 = $12; Tier 3 = $45; Tier 4 = $89; Tier 5 = 33%
  • Dental cleanings and x-rays covered
  • Routine hearing not covered
  • Eye exam and glasses covered up to $70

Ozark Health Plan Dual Plus (HMO-SNP)

  • Must have both Medicare and Medicaid
  • Premium – $0/monthly
  • Maximum Out of Pocket – $3,400
  • Referral required for specialists
  • All services offered at $0 copay depending on level of Medicaid assistance
  • Drugs will be $0 – $6.50 based on level of LIS
  • Dental cleanings and x-rays covered up to $1,000 for comprehensive dental benefits
  • Routine hearing exam = $10; hearing covered up to $1,200
  • Eye exam and glasses covered up to $150
  • Over the Counter benefit of $80/month
  • Transportation – $0 copay for up to 24 one way trips

Perhaps the biggest benefit that jumps out here is the Over the Counter benefit on the Dual Plus plan!  An amazing $80/month is absolutely huge, and would benefit people with Medicaid tremendously.  Since both of these plans are HMO’s you want to verify that your providers are in the plan’s network.  You will not be able to see providers out of network.  Also keep in mind that referrals will be required for some specialists and providers.  You may want to consult with an independent insurance agent to confirm which plan in your area is right for your specific needs.

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