Health Net Advantage plans are offered in three U.S. states. The plans may have benefits beyond the ones offered by original Medicare (Part A and Part B).
This article discusses Health Net, and where the company’s plans are available. It also looks at plan details and costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Health Net is a private company that offers Medicare Advantage plans in California, Oregon, and Washington. The company also offers other health plans for people who do not have Medicare, are on Medicaid, and for large and small businesses.
Many Advantage plans offer more benefits than original Medicare (parts A and B, including vision, dental, and hearing care. The plans may also tailor benefits to groups of people with a chronic illness.
Most Medicare Advantage plans are specific to a region or state. A person can search for Advantage plans in their area using the online tool on the Find a Medicare Plan website. The information generally includes plan contact information and details such as:
- premium
- deductible
- maximum out-of-pocket costs
- copays for doctors, tests, and emergency care
- cost for ambulance
- cost for mental health services
- coinsurance for durable medical equipment (DME)
- extra benefits offered and costs
Some plans offer online enrollment, while others may offer telephone services.
Health Net offers several types of Advantage plans, which vary among the three states.
To enroll in a Medicare Advantage plan a person must have original Medicare (parts A and B) and must live in the plan’s service area. Before enrollment in a plan, a person will be asked for their Medicare number and the date they started Medicare. The information is found on the Medicare card.
Taking San Diego as an example in California, Health Net offers seven Advantage plans including Health Net Sapphire Premier (HMO), Health Net Jade (HMO C-SNP), and Health Net Amber I (HMO D-SNP).
All plans offer prescription drug (Part D) coverage, and monthly premiums range from $0–$28.50.
HMO
The company’s Sapphire Premier (HMO) includes coverage for Medicare Part D prescription drugs. A person can choose their doctor from a network of healthcare providers in their area. It also includes benefits such as vision, dental, hearing, and chiropractic care. The plan has a monthly premium of $25.40, a zero deductible, and a maximum out-of-pocket cost of $3,450.
HMO C-SNP
The company’s Jade is a special needs (HMO C-SNP) plan for a person with certain medical conditions, including chronic heart failure, diabetes, or heart disorders. It also includes Medicare Part D, and benefits such as dental, vision, and hearing care. The plan has a zero monthly premium, a zero deductible, and a maximum out-of-pocket of $2,800.
HMO D-SNP
Health Net’s Amber I (HMO D-SNP) is a special needs plan for a person enrolled in original Medicare and who is also eligible for the California medical assistance program (Medi-Cal). It also includes Medicare Part D, and benefits such as dental, vision, and hearing care. The plan has a monthly premium ranging from zero to $27.80, a zero deductible, and maximum out-of-pocket of $5,250.
Taking Clackamas as an example in Oregon, Health Net offers 6 Advantage plans including Health Net Ruby (HMO), and Health Net Violet 3 (PPO).
All plans offer prescription drug (Part D) coverage, and monthly premiums for the plans range from $0–$121.
Health Net Ruby (HMO)
Through Health Net’s Ruby (HMO) a person can choose their primary healthcare provider and can get other benefits such as vision, hearing, and fitness. The plan has a zero monthly premium and deductible for 2021, and an out-of-pocket maximum of $6,600.
Health Net Violet 3 (PPO)
The company’s Violet 3 (PPO) includes fitness benefits and a limit on copays. For 2021, the monthly premium is zero, with a plan deductible of $200 and an out-of-pocket maximum of $7,550.
In Clark County, Washington, the company offers four Advantage (PPO) plans including Health Net Net Violet.
All plans offer prescription drug (Part D) coverage, and monthly premiums for the plans range from $0–$121.
Health Net Violet 2 (PPO)
The company’s Violet 2 (PPO) includes fitness benefits and a limit on copays. For 2021, the monthly premium is zero, with a plan deductible of $200 and an out-of-pocket maximum of $7,550.
Health Net Violet 1 (PPO)
Health Net’s Violet 1 (PPO) includes fitness benefits, a limit on copays, and a low out-of-pocket maximum. For 2021, the monthly premium is $121, with a plan deductible of $145 and an out-of-pocket maximum of $4,000.
Health Net Advantage plans include extra benefits, although the added coverage is different in the various areas in which Health Net offers Advantage plans. The extra benefits may include:
- over-the-counter drugs
- telehealth
- dental care
- reward systems
- online health and wellness programs
- discounts on acupuncture, chiropractic, and weight management programs
- fitness programs online or a local facility
What about Part D coverage?
Health Net Medicare Advantage plans include Medicare Part D prescription drug coverage, which may include:
- online formulary (list of drugs covered)
- mail-order pharmacy
- an in-network pharmacy option
- out-of-network pharmacies
- over-the-counter benefit
If a person’s medication is not in the plan’s list of drugs, they can ask for an exception, which would require a letter from the prescribing provider explaining why the drug is necessary. If the request is denied, a person can file an appeal.
The over-the-counter benefit gives people money to buy personal care and wellness products, such as toothpaste and vitamins. The products are purchased online and shipped to a person’s home.
The costs for prescription drug coverage are included in the plan’s premium. In some cases, the drug benefit has an added deductible.
Each plan has rules about a copayment or coinsurance for drug benefits. These costs are outlined in a person’s member benefits package.
Health Net Advantage are Medicare Advantage plans offered by a private company. Plans are available in Washington, Oregon, and California, with different plans offered in different areas of the three states.
The company offers HMO, PPO, and SNP plans, with costs based on the plan benefits, the person enrolling, and the location.