Essential Plan

Available to residents of Washoe County and Carson City.

$0/mo

The Essential Plan offers residents of Washoe County and Carson City a wide variety of choices when it comes to providers, with $0 monthly premium.

Benefits Include:

Primary Care Visit	$0 per visit
Specialist Visit	$50 per visit
Routine Lab Services	$0 per visit
Urgently Needed Care	$30 per visit ($0 Teladoc)
Over-the-Counter Benefit	$25 Quarterly
Dental Coverage	Preventative Included

Co-payments listed are for preferred facilities.

How to enroll

All Northern Nevada Plans

Medical
Prescriptions
Documents

Doctors & Hospitals	Amount You Will Pay at Preferred Facilities
Maximum Out-of-Pocket	$3,400 per year
Primary Care Office Visit	$0 / $10 per visit
Specialist Office Visits	$50 per visit
Urgently Needed Care	$30 / $65 per visit ($0 Teladoc)
Routine Lab Services	$0 per visit
Diagnostic Tests (X-ray, CT, MRI)	$70 / $100 / $135 per visit
Emergency Room Care	$120 per visit
Ambulance Services	$250 per trip
Inpatient Hospital	Preferred Facility: $300 / 5 days per period; Non-Preferred Facility: $440 / 5 days per period
Outpatient Hospital Services	Preferred Facility: $275 per visit; Non-Preferred Facility: $440 per visit

Prescription Coverage	Amount You Will Pay for Preferred Medications
Coverage in the Gap	$2.50 (Tier 6)
Rx Deductible	No deductible
Preferred Generic (Tier 1)	$5 (30-day)
Non-Preferred Generic (Tier 2)	$12 (30-day)
Preferred Brand (Tier 3)	$41 (30-day)
Non-Preferred Brand (Tier 4)	$94 (30-day)
Specialty Drugs (Tier 5)	33% coinsurance
Select Drug (Tier 6)	$2.50 (30-day)
90-day Retail / 90-day Mail Order	2.5 times 30-day / 2 times 30-day

Evidence of Coverage Updated 09/30/21
Evidence of Coverage (Spanish) Updated 09/30/21
Summary of Benefits Updated 09/30/21
Annual Notice of Change Updated 09/30/21
Benefits at a Glance Updated 09/30/21
Benefits at a Glance (Spanish) Updated 09/30/21

Our Network
Essential Plan members can choose to see any community provider including priority access to Renown Health providers and facilities.

provider directories

Fitness Benefit
Members on the Essential Plan receive a year-long gym membership at one participating gym facility.

participating gyms

Over-the-Counter (OTC) Benefit
Essential Plan members receive a $25 quarterly over-the-counter to use toward qualifying over-the-counter medications, health supplies and more.

view the otc catalog - updated 01/01/22

Summary

The Essential Plan is the right option for you if your primary care physician is not a Renown provider. The Essential Plan includes the entire Senior Care Plus network of doctors and specialists, including priority access to Renown Health facilities.

The Essential Plan also includes the new Senior Savings Program on select Insulins for the low copay of $35 for a 30 day supply. Your select insulins will be covered all year at this copayment and will not increase in price.

Enjoy the added perks of a gym benefit, preventive dental, over-the-counter (OTC) allowance, vision, and hearing aid coverage. Personal Assistants, who can help schedule appointments and navigate the healthcare system are included when you select a Renown Primary Care Provider (PCP).

Above is a partial list of benefits and should not be construed as a complete list. Please refer to the Evidence of Coverage in the plan documents section above for a complete list of benefits.

Out-Of-Network Providers: If you use an out-of-network provider, your share of the costs for your covered services may be higher. Out-of-network providers are under no obligation to treat members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.

Enroll Today

Enroll online

Senior Care Plus
A Medicare Advantage organization from Hometown Health

Material ID: H2960_2023_SCPWebsite1_M (CMS Accepted)

Last updated: March 3 2022