A Guide to Clear Spring Health Medicare Advantage Plans

Clear Spring Health is a Medicare-authorized private insurer that provides Medicare Advantage (Part C) options in three states: Colorado, Georgia, and Illinois.

Medicare Advantage plans serve as an alternative to Original Medicare (Parts A and B) and are offered by Medicare-approved private carriers. They frequently bundle extra perks not included with Original Medicare, such as vision, dental, and hearing services.

Glossary of common Medicare terms

• Out-of-pocket cost: The sum you pay for care when Medicare does not cover the full expense or provide coverage. This encompasses premiums, deductibles, coinsurance, and copayments.
• Premium: The monthly fee you pay to maintain Medicare coverage.
• Deductible: The yearly amount you must pay out of your pocket before Medicare starts covering services and treatments.
• Coinsurance: The portion (percentage) of treatment costs you are responsible for paying. With Medicare Part B, this is commonly 20%.
• Copayment: A fixed dollar amount you pay when receiving certain services or treatments. With Medicare, this commonly applies to prescription drugs.

Types of Medicare Advantage plans from Clear Spring Health

Medicare Advantage plans come in several formats. Clear Spring Health provides:

• health maintenance organizations (HMO)
• preferred provider organizations (PPO)
• chronic condition special needs plans (C-SNP)

HMO

HMO plans generally require you to select a primary care physician (PCP) and obtain a referral to see specialists. You are also usually required to use providers within the plan’s network.

PPO

PPO plans typically do not require you to name a PCP or get referrals to see specialists. You can visit any provider who accepts Medicare, though seeing out-of-network providers may lead to higher costs.

C-SNP

Special needs plans (SNPs) are tailored for individuals with serious chronic conditions, particular healthcare needs, or those who are dually eligible for Medicaid. They provide targeted benefits and services to address those needs.

C-SNPs focus on beneficiaries with particular chronic illnesses, such as diabetes, dementia, and HIV.

Areas that Clear Spring Health covers

Not every insurer that offers Medicare Advantage plans serves every state.

Clear Spring Health provides plans in these states:

• Colorado
• Georgia
• Illinois

To view plans available where you live, enter your ZIP code on the Clear Spring Health site.

Medicare Advantage plan coverage with Clear Spring Health

Medicare Advantage plans must provide the same coverage that Original Medicare (Parts A and B) provides. Consequently, all Medicare Advantage plans cover:

• inpatient hospital care
• outpatient care and services
• physician visits
• preventive services
• durable medical equipment (DME)
• some home health services

Many Medicare Advantage offerings also include prescription drug coverage (Part D). These plans may additionally deliver extras that Original Medicare does not cover.

For instance, some Clear Spring Health plans offer:

• dental
• vision
• hearing
• $75 to $95 per month for over-the-counter (OTC) items
• $100 to $125 per month for groceries
• $75 per month for utility expenses

Available benefits differ by specific plan.

Costs of Medicare Advantage plans with Clear Spring Health

The table below provides sample costs for Clear Spring Health Medicare Advantage plans across different service areas.

You can compare and browse Medicare Advantage options available near you by entering your ZIP code on the Clear Spring Health portal.

Summary

Clear Spring Health is a private insurer offering Medicare Advantage plans in Colorado, Georgia, and Illinois.

Eligible individuals can select from HMO, PPO, and C-SNP options.

Medicare Advantage plans provide the same basic coverage as Original Medicare and may add extra services such as vision, dental, and hearing.