OSF MedAdvantage Deductible Plans FAQ

How the OSF MedAdvantage Plus and Select plans deductible works:

The deductible is included in the maximum out-of-pocket on both plans.

For most services, members will have to pay the full cost* until they meet their deductible. Certain services are excluded from the deductible like:

• Emergency Care
• Certain preventive services
• Perks like non-Medicare covered dental services, routine eye exams, routine hearing exams and hearing aids, and the fitness benefit

The deductible does not apply to prescription drug coverage.

For a full listing of services that are not subject to the deductible, see the Summary of Benefits (SOB) or Explanation of Coverage (EOC).

Members who use Tier 1 providers pay zero copay/co-insurance on all covered medical benefits once the $1,650.00 deductible is met on both plans.** Coverage for perks like routine hearing exams and hearing aids, dental services and the fitness benefit are subject to the coverage outlined in the SOB and EOC.

Example:

Joe is on the Plus plan. In January, he has a PCP visit, in February he goes to the ER and in March he has an outpatient surgery and a follow up specialist visit all with Tier 1 providers.

*Cost is equal to the Medicare allowable amount, not the billed amount

**Days 21 – 100 at a Skilled Nursing Facility still have a daily copay even after the deductible is met.