Dignity Health Plan HMO Special Needs Plan with Prescription Drug for Institutional Residents (2022)

Dignity Health Plan (HMO-SNP) is a Medicare Advantage health plan designed specifically for
Medicare beneficiaries that reside in a long-term care facility. Dignity Health Plan is headquartered
in Southeast Louisiana and available in select Louisiana CMS-approved counties.

The Dignity Advantage

• Low Cost Premium
  $34.20 deductible for medical coverage
• Physical, Occupational and Speech Therapy
  No annual limit
• Skilled Nursing Care
  No prior hospital stay requirement
• All-In-One Plan
  Covers original Medicare benefits plus
  Medicare Part D prescription drugs
• Local Care Team
  Hands-on RNs and Nurse Practitioners to assist with quality care coordination

Summary of Important Costs
Monthly Premium	$34.20
Primary Care Visit	20% per visit
Specialist Visit	20% per visit
Inpatient Hospital Stays	$1,556 deductible for days 1 – 60 $352 copay per day for days 61 – 90 $704 copay per lifetime reserve day
Part D Prescription Drugs	Standard Benefit Coinsurance during the Initial Coverage Stage: 25%