2011 Medicare Advantage Plan Benefit Details for the HumanaChoice R5826-008 (Regional PPO) - R5826-008-0
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| 2011 Medicare Advantage Plan Details | |||||
|---|---|---|---|---|---|
| Medicare Plan Name: | HumanaChoice R5826-008 (Regional PPO) | ||||
| Location: | Boyd, Kentucky Click to see other locations | ||||
| Plan ID: | R5826 - 008 - 0 Click to see other plans | ||||
| Member Services: | 1-800-457-4708 TTY users 711 | ||||
| — This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
| Medicare Contact Information: | Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance |
||||
Email a copy of the HumanaChoice R5826-008 (Regional PPO) benefit details
 | |||||
| — Medicare Plan Features — | |||||
| Monthly Premium: | $71.00 (see Plan Premium Details below) | ||||
| Annual Deductible: | $0 | ||||
| Health Plan Type: | Regional PPO | ||||
| Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $5,500 | ||||
| Additional Gap Coverage? | Few Generics, Few Brands | ||||
| Total Number of Formulary Drugs: | 3,997 drugs | Browse the HumanaChoice R5826-008 (Regional PPO) Formulary | |||
| This plan has 4 drug tiers. See cost-sharing highlights below. | |||||
| Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
| • Preferred Pharmacy Cost-Sharing during initial coverage phase: | $6.00 | $39.00 | $80.00 | 33% | |
| • Number of Drugs per Tier: | 1512 | 858 | 1331 | 296 | |
| Plan's Pharmacy Search: | http://www.humana.com/Medicare/medicare_prescription_drugs | ||||
| Number of Members enrolled in this plan in (R5826 - 008): | 16,604 members | ||||
| — Plan Premium Details — | |||||
| Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
| Monthly Part D Premium with LIS: | $0.00 | $0.00 | $0.00 | $0.00 | |
| — Plan Health Benefits — | |||||
| ** Cost ** | |||||
| Premium and Other Important Information | |||||
| $71 monthly plan premium in addition to your monthly Medicare Part B premium. | |||||
| Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B and Part D premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. | |||||
| This plan covers all Medicare-covered preventive services with zero cost sharing. | |||||
| $5 500 out-of-pocket limit. | |||||
| This limit includes only Medicare-covered services. | |||||
| $8 000 out-of-pocket limit. | |||||
| In-Network: This limit includes only Medicare-covered services. | |||||
| Out-Of-Network: This limit includes only Medicare-covered services. | |||||
| ** Doctor and Hospital Choice ** | |||||
| Doctor and Hospital Choice | |||||
| No referral required for network doctors specialists and hospitals. | |||||
| You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits. | |||||
| Plan covers you when you travel in the U.S. | |||||
| ** Extra Benefits ** | |||||
| Prescription Drugs | |||||
| 0% to 20% of the cost for Part B-covered drugs (not including Part B-covered chemotherapy drugs). | |||||
| 20% of the cost for Part B-covered chemotherapy drugs. | |||||
| 0% to 20% of the cost for Part B drugs out-of-network. | |||||
| This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at http://www.humana.com/members/tools/prescription_tools/medicare_drug_list.asp on the web. | |||||
Different out-of-pocket costs may apply for people who
| |||||
| The plan offers national in-network prescription coverage (i.e. this would include 50 states and DC). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel). | |||||
| Total yearly drug costs are the total drug costs paid by both you and the plan. | |||||
| The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition. | |||||
| Some drugs have quantity limits. | |||||
| Your provider must get prior authorization from HumanaChoice R5826-008 (Regional PPO) for certain drugs. | |||||
| You must go to certain pharmacies for a very limited number of drugs due to special handling provider coordination or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan's website formulary printed materials as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov. | |||||
| If the actual cost of a drug is less than the normal cost-sharing amount for that drug you will pay the actual cost not the higher cost-sharing amount. | |||||
| If you request a formulary exception for a drug and HumanaChoice R5826-008 (Regional PPO) approves the exception you will pay Tier 3: Non-Preferred Brand Drugs cost sharing for that drug. | |||||
| $0 deductible. | |||||
| You pay the following until total yearly drug costs reach $2 840: | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information. | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information. | |||||
| Call plan for details concerning additional Gap Coverage. | |||||
| You pay the following: | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information. | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information. | |||||
| After your total yearly drug costs reach $2 840 you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 93% of the plan's costs for generic drugs until your yearly out-of-pocket drug costs reach $4 550. | |||||
| Please contact the plan for a complete list of drugs covered through the gap. | |||||
After your yearly out-of-pocket drug costs reach $ 4 550 you pay the greater of:
| |||||
| Plan drugs may be covered in special circumstances for instance illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from HumanaChoice R5826-008 (Regional PPO). | |||||
| You will be reimbursed up to the full cost of the drug minus the following for drugs purchased out-of-network until total yearly drug costs reach $2 840: | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount. | |||||
| You will be reimbursed for these drugs purchased out-of-network up to the full cost of the drug minus the following: | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount. | |||||
After your yearly out-of-pocket drug costs reach $ 4 550 you will be reimbursed for drugs purchased out-of-network up to the full cost of the drug minus your cost share which is the greater of:
| |||||
| You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount. | |||||
| Physical Exams | |||||
| $0 copay for routine exams. | |||||
| Limited to 1 exam(s) every year. | |||||
| $0 copay for the required Medicare-covered initial preventive physical exam and annual wellness visits. | |||||
| 20% of the cost for routine exams. | |||||
| Vision Services | |||||
| Authorization rules may apply. | |||||
| In general routine eye exams and eye wear not covered. However this plan covers some vision benefits for an extra cost (see 'Optional Benefits'). | |||||
$0 copay for
| |||||
| 20% of the cost for eye exams. | |||||
| $0 copay for eye wear. | |||||
| Dental Services | |||||
| Authorization rules may apply. | |||||
| $35 copay for Medicare-covered dental benefits. | |||||
| 50% of the cost for preventive dental benefits. | |||||
| 50% of the cost for comprehensive dental benefits. | |||||
| 20% of the cost for comprehensive dental benefits. | |||||
| Contact the plan for availability of additional in-network and out-of-network comprehensive dental benefits. | |||||
| ** Important Information ** | |||||
| Premium and Other Important Information | |||||
| $71 monthly plan premium in addition to your monthly Medicare Part B premium. | |||||
| Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B and Part D premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. | |||||
| This plan covers all Medicare-covered preventive services with zero cost sharing. | |||||
| $5 500 out-of-pocket limit. | |||||
| This limit includes only Medicare-covered services. | |||||
| $8 000 out-of-pocket limit. | |||||
| In-Network: This limit includes only Medicare-covered services. | |||||
| Out-Of-Network: This limit includes only Medicare-covered services. | |||||
| Doctor and Hospital Choice | |||||
| No referral required for network doctors specialists and hospitals. | |||||
| You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits. | |||||
| Plan covers you when you travel in the U.S. | |||||
| ** Inpatient Care ** | |||||
| Inpatient Hospital Care (Acute) | |||||
| No limit to the number of days covered by the plan each benefit period. | |||||
| For Medicare-covered hospital stays: | |||||
| Days 1 - 7: $225 copay per day | |||||
| Days 8 - 90: $0 copay per day | |||||
| $0 copay for each additional hospital day. | |||||
| Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital. | |||||
| 20% of the cost for each hospital stay. | |||||
| Inpatient Mental Health Care | |||||
| You get up to 190 days in a Psychiatric Hospital in a lifetime. | |||||
| For Medicare-covered hospital stays: | |||||
| Days 1 - 7: $225 copay per day | |||||
| Days 8 - 90: $0 copay per day | |||||
| Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital. | |||||
| 20% of the cost for each hospital stay. | |||||
| Skilled Nursing Facility (SNF) | |||||
| Authorization rules may apply. | |||||
| Plan covers up to 100 days each benefit period | |||||
| No prior hospital stay is required. | |||||
| For SNF stays: | |||||
| Days 1 - 8: $0 copay per day | |||||
| Days 9 - 100: $50 copay per day | |||||
| 20% of the cost for each SNF stay. | |||||
| Home Health Care | |||||
| Authorization rules may apply. | |||||
| $0 copay for each Medicare-covered home health visit. | |||||
| 20% for home health visits. | |||||
| Hospice | |||||
| You must get care from a Medicare-certified hospice. | |||||
| ** Outpatient Care ** | |||||
| Doctor Office Visits | |||||
| See 'Welcome to Medicare; and Annual Wellness Visit' for more information. | |||||
| Authorization rules may apply. | |||||
| $15 copay for each primary care doctor visit for Medicare-covered benefits. | |||||
| $35 copay for each in-area network urgent care Medicare-covered visit. | |||||
| $35 copay for each specialist visit for Medicare-covered benefits. | |||||
| 20% for each primary care doctor visit. | |||||
| 20% for each specialist visit. | |||||
| Chiropractic Services | |||||
| Authorization rules may apply. | |||||
| $15 copay for each Medicare-covered visit. | |||||
| Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers. | |||||
| 20% of the cost for chiropractic benefits. | |||||
| Podiatry Services | |||||
| Authorization rules may apply. | |||||
| $35 copay for each Medicare-covered visit. | |||||
| Medicare-covered podiatry benefits are for medically-necessary foot care. | |||||
| 20% of the cost for podiatry benefits. | |||||
| Outpatient Mental Health Care | |||||
| Authorization rules may apply. | |||||
| $35 copay for each Medicare-covered individual or group therapy visit. | |||||
| 20% of the cost for Mental Health benefits. | |||||
| 20% of the cost for Mental Health benefits with a psychiatrist. | |||||
| Outpatient Substance Abuse Care | |||||
| Authorization rules may apply. | |||||
| $150 copay for Medicare-covered individual or group visits. | |||||
| 20% of the cost for outpatient substance abuse benefits. | |||||
| Outpatient Hospital Services | |||||
| Authorization rules may apply. | |||||
| $150 copay for each Medicare-covered ambulatory surgical center visit. | |||||
| $50 to $200 copay [or 20% of the cost] for each Medicare-covered outpatient hospital facility visit. | |||||
| 20% of the cost for ambulatory surgical center benefits. | |||||
| 20% of the cost for outpatient hospital facility benefits. | |||||
| Emergency Care | |||||
| $50 copay for Medicare-covered emergency room visits. | |||||
| Worldwide coverage. | |||||
| If you are admitted to the hospital within 24-hour(s) for the same condition you pay $0 for the emergency room visit | |||||
| Outpatient Rehabilitation Services | |||||
| Authorization rules may apply. | |||||
| $35 to $150 copay for Medicare-covered Occupational Therapy visits. | |||||
| $35 to $150 copay for Medicare-covered Physical and/or Speech and Language Therapy visits. | |||||
| $35 to $150 copay for Medicare-covered Cardiac Rehab services. | |||||
| 20% of the cost for Occupational Therapy benefits. | |||||
| 20% of the cost for Physical and/or Speech and Language Therapy visits. | |||||
| 20% of the cost for Cardiac Rehab services. | |||||
| ** Outpatient Medical Services and Supplies ** | |||||
| Durable Medical Equipment | |||||
| Authorization rules may apply. | |||||
| 20% of the cost for Medicare-covered items. | |||||
| 20% of the cost for durable medical equipment. | |||||
| Prosthetic Devices | |||||
| Authorization rules may apply. | |||||
| 20% of the cost for Medicare-covered items. | |||||
| 20% of the cost for prosthetic devices. | |||||
| Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies | |||||
| Authorization rules may apply. | |||||
| $0 copay for Diabetes self-monitoring training. | |||||
| $0 copay for Nutrition Therapy for Diabetes. | |||||
| $0 to $10 copay [or 20% of the cost] for Diabetes supplies. | |||||
| 20% of the cost for Diabetes self-monitoring training. | |||||
| 20% of the cost for Nutrition Therapy for Diabetes. | |||||
| 20% of the cost for Diabetes supplies. | |||||
| ** Preventive Services ** | |||||
| Bone Mass Measurement | |||||
| $0 copay for Medicare-covered bone mass measurement. | |||||
| 20% of the cost for Medicare-covered bone mass measurement. | |||||
| Colorectal Screening Exams | |||||
| $0 copay for Medicare-covered colorectal screenings. | |||||
| 20% of the cost for colorectal screenings. | |||||
| Immunizations | |||||
| $0 copay for Flu and Pneumonia vaccines. | |||||
| No referral needed for Flu and pneumonia vaccines. | |||||
| $0 copay for Hepatitis B vaccine. | |||||
| $0 copay for immunizations. | |||||
| Pap Smears and Pelvic Exams | |||||
| Authorization rules may apply. | |||||
| $0 copay for Medicare-covered pap smears and pelvic exams | |||||
| 20% of the cost for pap smears and pelvic exams. | |||||
| Prostate Cancer Screening Exams | |||||
| Authorization rules may apply. | |||||
| $0 copay for Medicare-covered prostate cancer screening. | |||||
| 20% of the cost for prostate cancer screening. | |||||
| ** Additional Benefits ** | |||||
| Dialysis | |||||
| Authorization rules may apply. | |||||
| 0% to 20% of the cost for renal dialysis | |||||
| $0 copay for Nutrition Therapy for End-Stage Renal Disease. | |||||
| 0% to 20% of the cost for renal dialysis. | |||||
| 20% of the cost for Nutrition Therapy for End-Stage Renal Disease. | |||||
| Prescription Drugs | |||||
| 0% to 20% of the cost for Part B-covered drugs (not including Part B-covered chemotherapy drugs). | |||||
| 20% of the cost for Part B-covered chemotherapy drugs. | |||||
| 0% to 20% of the cost for Part B drugs out-of-network. | |||||
| This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at http://www.humana.com/members/tools/prescription_tools/medicare_drug_list.asp on the web. | |||||
Different out-of-pocket costs may apply for people who
| |||||
| The plan offers national in-network prescription coverage (i.e. this would include 50 states and DC). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel). | |||||
| Total yearly drug costs are the total drug costs paid by both you and the plan. | |||||
| The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition. | |||||
| Some drugs have quantity limits. | |||||
| Your provider must get prior authorization from HumanaChoice R5826-008 (Regional PPO) for certain drugs. | |||||
| You must go to certain pharmacies for a very limited number of drugs due to special handling provider coordination or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan's website formulary printed materials as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov. | |||||
| If the actual cost of a drug is less than the normal cost-sharing amount for that drug you will pay the actual cost not the higher cost-sharing amount. | |||||
| If you request a formulary exception for a drug and HumanaChoice R5826-008 (Regional PPO) approves the exception you will pay Tier 3: Non-Preferred Brand Drugs cost sharing for that drug. | |||||
| $0 deductible. | |||||
| You pay the following until total yearly drug costs reach $2 840: | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information. | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information. | |||||
| Call plan for details concerning additional Gap Coverage. | |||||
| You pay the following: | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information. | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| Not all drugs on this tier are available at this extended day supply. Please contact the plan for more information. | |||||
| After your total yearly drug costs reach $2 840 you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 93% of the plan's costs for generic drugs until your yearly out-of-pocket drug costs reach $4 550. | |||||
| Please contact the plan for a complete list of drugs covered through the gap. | |||||
After your yearly out-of-pocket drug costs reach $ 4 550 you pay the greater of:
| |||||
| Plan drugs may be covered in special circumstances for instance illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from HumanaChoice R5826-008 (Regional PPO). | |||||
| You will be reimbursed up to the full cost of the drug minus the following for drugs purchased out-of-network until total yearly drug costs reach $2 840: | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount. | |||||
| You will be reimbursed for these drugs purchased out-of-network up to the full cost of the drug minus the following: | |||||
| Tier 1: Preferred Generic Drugs | |||||
| Tier 2: Non-Preferred Generic and Preferred Brand Drugs | |||||
| Tier 3: Non-Preferred Brand Drugs | |||||
| Tier 4: Specialty Tier Drugs | |||||
| You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount. | |||||
After your yearly out-of-pocket drug costs reach $ 4 550 you will be reimbursed for drugs purchased out-of-network up to the full cost of the drug minus your cost share which is the greater of:
| |||||
| You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount. | |||||
| Dental Services | |||||
| Authorization rules may apply. | |||||
| $35 copay for Medicare-covered dental benefits. | |||||
| 50% of the cost for preventive dental benefits. | |||||
| 50% of the cost for comprehensive dental benefits. | |||||
| 20% of the cost for comprehensive dental benefits. | |||||
| Contact the plan for availability of additional in-network and out-of-network comprehensive dental benefits. | |||||
| Hearing Services | |||||
| Authorization rules may apply. | |||||
| In general routine hearing exams and hearing aids not covered. | |||||
| 20% of the cost for hearing exams. | |||||
| Vision Services | |||||
| Authorization rules may apply. | |||||
| In general routine eye exams and eye wear not covered. However this plan covers some vision benefits for an extra cost (see 'Optional Benefits'). | |||||
$0 copay for
| |||||
| 20% of the cost for eye exams. | |||||
| $0 copay for eye wear. | |||||
| Physical Exams | |||||
| $0 copay for routine exams. | |||||
| Limited to 1 exam(s) every year. | |||||
| $0 copay for the required Medicare-covered initial preventive physical exam and annual wellness visits. | |||||
| 20% of the cost for routine exams. | |||||
| Health/Wellness Education | |||||
| The plan covers the following health/wellness education benefits: | |||||
| $0 copay for each Medicare-covered smoking cessation counseling session. | |||||
| $0 copay for each Medicare-covered HIV screening. | |||||
| HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection including anyone who asks for the test. Medicare covers this test once every 12 months or up to three times during a pregnancy. | |||||
| 20% of the cost for Health and Wellness services. | |||||
| Transportation | |||||
| This plan does not cover routine transportation. | |||||
| Acupuncture | |||||
| This plan does not cover Acupuncture. | |||||
| ** Cost ** | |||||
| Premium and Other Important Information | |||||
| Package: 1 - MyOption Vision: | |||||
$14 monthly premium in addition to your $71 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits:
| |||||
| ** Extra Benefits ** | |||||
| Vision Services | |||||
| $290 plan coverage limit for eye wear every year. | |||||
| $0 copay for | |||||
| ** Important Information ** | |||||
| Premium and Other Important Information | |||||
| Package: 1 - MyOption Vision: | |||||
$14 monthly premium in addition to your $71 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits:
| |||||
| ** Additional Benefits ** | |||||
| Vision Services | |||||
| $290 plan coverage limit for eye wear every year. | |||||
| $0 copay for | |||||
| ** Cost ** | |||||
| Premium and Other Important Information | |||||
| Package: 2 - MyOption Enhanced Dental PPO: | |||||
$22 monthly premium in addition to your $71 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits:
| |||||
| ** Extra Benefits ** | |||||
| Dental Services | |||||
| 50% of the cost for preventive dental services. | |||||
| 50% to 75% of the cost for comprehensive dental services. | |||||
| $1 500 plan coverage limit for comprehensive dental benefits every year. This limit applies to both in-network and out-of-network benefits. | |||||
| Contact the plan for availability of additional in-network and out-of-network comprehensive dental benefits. | |||||
| ** Important Information ** | |||||
| Premium and Other Important Information | |||||
| Package: 2 - MyOption Enhanced Dental PPO: | |||||
$22 monthly premium in addition to your $71 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits:
| |||||
| ** Additional Benefits ** | |||||
| Dental Services | |||||
| 50% of the cost for preventive dental services. | |||||
| 50% to 75% of the cost for comprehensive dental services. | |||||
| $1 500 plan coverage limit for comprehensive dental benefits every year. This limit applies to both in-network and out-of-network benefits. | |||||
| Contact the plan for availability of additional in-network and out-of-network comprehensive dental benefits. | |||||
| ** Cost ** | |||||
| Premium and Other Important Information | |||||
| Package: 3 - MyOption Points of Caregiving: | |||||
$20 monthly premium in addition to your $71 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits:
| |||||
| ** Important Information ** | |||||
| Package: 3 - MyOption Points of Caregiving: | |||||
$20 monthly premium in addition to your $71 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits:
| |||||
Pets are Family Too!
Use your drug discount card to save on medications for the entire family ‐ including your pets.
- No enrollment fee and no limits on usage
- Everyone in your household can use the same card, including your pets
Your drug discount card is available to you at no cost.
Q1 Quick Links
- Sign-up for our Medicare Part D Newsletter.
- PDP-Facts: 2024 Medicare Part D plan Facts & Figures
- 2024 PDP-Finder: Medicare Part D (Drug Only) Plan Finder
- PDP-Compare: 2023/2024 Medicare Part D plan changes
- 2024 MA-Finder: Medicare Advantage Plan Finder
- MA plan changes 2023 to 2024
- Drug Finder: 2024 Medicare Part D drug search
- Formulary Browser: View any 2024 Medicare plan's drug list
- 2024 Browse Drugs By Letter
- Guide to 2023/2024 Mailings from CMS, Social Security and Plans
- Out-of-Pocket Cost Calculator
- Q1Medicare FAQs: Most Read and Newest Questions & Answers
- Q1Medicare News: Latest Articles
- 2025 Medicare Part D Reminder Service