** Cost ** |
Premium and Other Important Information |
$20.00 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 a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B 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. |
This plan does not allow providers to balance bill (charging more than your cost share amount). |
$5 000 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 |
You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment. |
** Extra Benefits ** |
Prescription Drugs |
Most drugs not covered. |
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 does not offer prescription drug coverage. |
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. |
$0 copay for routine exams. |
Vision Services |
In general routine eye exams and eye wear not covered. However this plan covers some vision benefits for an extra cost (see 'Optional Benefits'). |
$25 copay for one pair of eyeglasses or contact lenses after cataract surgery. |
$0 to $35 copay for exams to diagnose and treat diseases and conditions of the eye. |
$0 to $35 copay for eye exams. |
$25 copay for eye wear. |
Dental Services |
$35 copay for Medicare-covered dental benefits. |
$0 copay for up to 1 oral exam(s) every year |
$0 copay for up to 1 cleaning(s) every year |
$0 copay for up to 1 dental x-ray(s) every year |
Plan offers additional comprehensive dental benefits. |
50% of the cost for preventive dental benefits. |
$35 copay for comprehensive dental benefits. |
50% of the cost for comprehensive dental benefits. |
** Important Information ** |
Premium and Other Important Information |
$20.00 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 a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B 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. |
This plan does not allow providers to balance bill (charging more than your cost share amount). |
$5 000 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 |
You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment. |
** Inpatient Care ** |
Inpatient Hospital Care (Acute) |
You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment except in emergencies. |
No limit to the number of days covered by the plan each benefit period. |
For Medicare-covered hospital stays: |
Days 1 - 8: $220 copay per day |
Days 9 - 90: $0 copay per day |
$0 copay for each additional hospital day. |
For hospital stays: |
Days 1 - 8: $220 copay per day |
Days 9 - 90: $0 copay per day |
Inpatient Mental Health Care |
You get up to 190 days in a Psychiatric Hospital in a lifetime. |
For Medicare-covered hospital stays: |
Days 1 - 8: $220 copay per day |
Days 9 - 90: $0 copay per day |
For hospital stays: |
Days 1 - 8: $220 copay per day |
Days 9 - 90: $0 copay per day |
Skilled Nursing Facility (SNF) |
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 |
For each SNF stay: |
Days 1 - 8: $0 copay per SNF day |
Days 9 - 100: $50 copay per SNF day |
Home Health Care |
$0 copay for each Medicare-covered home health visit. |
$0 copay for home health visits. |
Hospice |
You must get care from a Medicare-certified hospice. |
** Outpatient Care ** |
Doctor Office Visits |
You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment. |
See 'Welcome to Medicare; and Annual Wellness Visit' for more information. |
$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. |
$15 copay for each primary care doctor visit. |
$35 copay for each specialist visit. |
Chiropractic Services |
$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. |
$15 copay for chiropractic benefits. |
Podiatry Services |
$35 copay for each Medicare-covered visit. |
Medicare-covered podiatry benefits are for medically-necessary foot care. |
$35 copay for podiatry benefits. |
Outpatient Mental Health Care |
$35 copay for each Medicare-covered individual or group therapy visit. |
$35 copay for Mental Health benefits. |
$35 copay for Mental Health benefits with a psychiatrist. |
Outpatient Substance Abuse Care |
$35 copay [or 25% of the cost] for Medicare-covered individual or group visits. |
$35copay [or 20% to 25% of the cost] for outpatient substance abuse benefits. |
Outpatient Hospital Services |
20% of the cost for each Medicare-covered ambulatory surgical center visit. |
20% to 25% of the cost for each Medicare-covered outpatient hospital facility visit. |
20% of the cost for ambulatory surgical center benefits. |
20% to 25% of the cost for outpatient hospital facility benefits. |
Emergency Care |
$50 copay for Medicare-covered emergency room visits. |
$25 000 plan coverage limit for emergency services outside the U.S. every year. |
Outpatient Rehabilitation Services |
There may be limits on physical therapy occupational therapy and speech and language pathology services. If so there may be exceptions to these limits. |
$35 [or 20% to 25% of the cost] for Medicare-covered Occupational Therapy visits. |
$35 copay [or 20% to 25% of the cost] for Medicare-covered Physical and/or Speech and Language Therapy visits. |
$35 copay [or 25% of the cost] for Medicare-covered Cardiac Rehab services. |
$35 [or 20% to 25% of the cost] for Occupational Therapy benefits. |
$35 copay [or 20% to 25% of the cost] for Physical and/or Speech and Language Therapy visits. |
$35 [or 20% to 25% of the cost] for Cardiac Rehab services. |
** Outpatient Medical Services and Supplies ** |
Durable Medical Equipment |
20% of the cost for Medicare-covered items. |
20% of the cost for durable medical equipment. |
Prosthetic Devices |
20% of the cost for Medicare-covered items. |
20% of the cost for prosthetic devices. |
Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies |
$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. |
$0 copay for Diabetes self-monitoring training. |
$0 copay 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. |
$0 copay for Medicare-covered bone mass measurement. |
Colorectal Screening Exams |
$0 copay for Medicare-covered colorectal screenings. |
$0 copay for colorectal screenings. |
Immunizations |
$0 copay for Flu and Pneumonia vaccines. |
$0 copay for Hepatitis B vaccine. |
$0 copay for immunizations. |
Pap Smears and Pelvic Exams |
$0 copay for Medicare-covered pap smears and pelvic exams |
$0 copay for pap smears and pelvic exams. |
Prostate Cancer Screening Exams |
$0 copay for Medicare-covered prostate cancer screening. |
$0 copay for prostate cancer screening. |
** Additional Benefits ** |
Dialysis |
20% of the cost for renal dialysis |
$0 copay for Nutrition Therapy for End-Stage Renal Disease. |
20% of the cost for renal dialysis. |
$0 copay for Nutrition Therapy for End-Stage Renal Disease. |
Prescription Drugs |
Most drugs not covered. |
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 does not offer prescription drug coverage. |
Dental Services |
$35 copay for Medicare-covered dental benefits. |
$0 copay for up to 1 oral exam(s) every year |
$0 copay for up to 1 cleaning(s) every year |
$0 copay for up to 1 dental x-ray(s) every year |
Plan offers additional comprehensive dental benefits. |
50% of the cost for preventive dental benefits. |
$35 copay for comprehensive dental benefits. |
50% of the cost for comprehensive dental benefits. |
Hearing Services |
In general routine hearing exams and hearing aids not covered. |
$35 copay for Medicare-covered diagnostic hearing exams |
$35 copay for hearing exams. |
Vision Services |
In general routine eye exams and eye wear not covered. However this plan covers some vision benefits for an extra cost (see 'Optional Benefits'). |
$25 copay for one pair of eyeglasses or contact lenses after cataract surgery. |
$0 to $35 copay for exams to diagnose and treat diseases and conditions of the eye. |
$0 to $35 copay for eye exams. |
$25 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. |
$0 copay for routine exams. |
Health/Wellness Education |
The plan covers the following health/wellness education benefits: |
Written health education materials including Newsletters |
Additional Smoking Cessation |
Health Club Membership/Fitness Classes |
Nursing Hotline |
$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. |
$0 copay 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 $20 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: |
** Extra Benefits ** |
Vision Services |
$0 copay for contacts |
$0 copay for lenses |
$290 plan coverage limit for eye wear every year. |
$0 copay for up to 1 routine eye exam(s) every year |
$0 copay for glasses |
$0 copay for frames |
** Important Information ** |
Premium and Other Important Information |
Package: 1 - MyOption Vision: |
$14 monthly premium in addition to your $20 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: |
** Additional Benefits ** |
Vision Services |
$0 copay for contacts |
$0 copay for lenses |
$290 plan coverage limit for eye wear every year. |
$0 copay for up to 1 routine eye exam(s) every year |
$0 copay for glasses |
$0 copay for frames |
** Cost ** |
Premium and Other Important Information |
Package: 2 - MyOption Enhanced Dental PPO: |
$30 monthly premium in addition to your $20 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: - Preventive Dental
- Comprehensive Dental
|
** Extra Benefits ** |
Dental Services |
Plan offers additional comprehensive dental benefits. |
$0 copay for up to 2 cleaning(s) every year |
$0 copay for up to 2 oral exam(s) every year |
$0 copay for up to 1 dental x-ray(s) every year |
$1 500 plan coverage limit for comprehensive dental benefits every year. |
50% of the cost for preventive dental services. |
50% to 75% of the cost for comprehensive dental services. |
** Important Information ** |
Premium and Other Important Information |
Package: 2 - MyOption Enhanced Dental PPO: |
$30 monthly premium in addition to your $20 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: - Preventive Dental
- Comprehensive Dental
|
** Additional Benefits ** |
Dental Services |
Plan offers additional comprehensive dental benefits. |
$0 copay for up to 2 cleaning(s) every year |
$0 copay for up to 2 oral exam(s) every year |
$0 copay for up to 1 dental x-ray(s) every year |
$1 500 plan coverage limit for comprehensive dental benefits every year. |
50% of the cost for preventive dental services. |
50% to 75% of the cost for comprehensive dental services. |
** Cost ** |
Premium and Other Important Information |
Package: 3 - MyOption Points of Caregiving: |
$20 monthly premium in addition to your $20 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 $20 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: |