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2021 Medicare

2021 Preview

$0
Monthly Premium

Get Started

Aetna Medicare Elite Plan (PPO)

$10
Primary Doctor Co‑Pay
$45
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network Deductible$1000 for in-network and out-of-network combined

Out-of-Pocket Maximum$7550 for services you receive from in-network providers. $11300 for services you receive from any provider.

Office Visit for Primary DoctorIn-network: $10 copay
Out-of-network: $50 copay

Office Visit for SpecialistIn-network: $45 copay
Out-of-network: $60 copay

Inpatient Hospital CoverageInpatient hospital-acute:
In-network:
Our plan covers an unlimited number of days for an inpatient hospital stay.
Copayment amount for the medicare-covered stay: $850 copay
Out-of-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$500 copay per day for days 1 through 20
$0 copay per day for days 21 through 90
Inpatient hospital psychiatric:
Copayment amount for the medicare-covered stay: $1871 copay

Prescription Drug Deductible$250
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$15.00 copay

Tier 2: Generic$20.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier28% coinsurance (after deductible)

Other Coverage Highlights

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $60 copay
Fitting/evaluation for hearing aid (for up to 1 every year):
In-network: $0 copay
Out-of-network: $60 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every year):
In-network: $0 copay
Out-of-network: $0 copay
Our plan pays up to $1250 every year for hearing aids. The maximum plan benefit coverage amount applies to both in-network and out-of-network services. The maximum plan benefit coverage amount applies Per ear.

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $60 copay
Other service:
In-network: $45 copay
Out-of-network: $60 copay
Medicare-covered glaucoma screening:
In-network: $0 copay
Out-of-network: 30% coinsurance

Fitness BenefitsIn-network: $0 copay
Out-of-network: $0 copay

SilverSneakersYes Find participating gyms

Telehealth Services$0-$65 copay, depending on the service

2021 Preview

$0
Monthly Premium

Get Started

Aetna Medicare Eagle Plan (PPO)

$0
Primary Doctor Co‑Pay
$45
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers. $11300 for services you receive from any provider.

Office Visit for Primary DoctorIn-network: $0 copay
Out-of-network: $25 copay

Office Visit for SpecialistIn-network: $45 copay
Out-of-network: $55 copay

Inpatient Hospital CoverageInpatient hospital-acute:
In-network:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$395 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
You pay nothing per day for days 91 and beyond
Out-of-network:
Coinsurance percentage for OON inpatient hospital-acute stay: 50% coinsurance
Inpatient hospital psychiatric:
In-network:
Copayment amount for the medicare-covered stay: $1871 copay
Out-of-network:
Coinsurance percentage for OON inpatient psychiatric hospital stay: 50% coinsurance

Other Coverage Highlights

Dental ServicesOral exams:
In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment:
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays:
In-network: $0 copay
Out-of-network: $0 copay
Non-routine services:
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the service
Diagnostic services:
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the service
Restorative services:
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the service
Endodontics:
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the service
Periodontics:
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the service
Extractions:
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the service
Prosthodontics, other oral/maxillofacial surgery, other services:
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the service
Our plan reimburses you up to $300 every year for dental services shown above. The maximum plan benefit coverage amount applies to both in-network and out-of-network services.

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $55 copay
Fitting/evaluation for hearing aid (for up to 1 every year):
In-network: $0 copay
Out-of-network: $55 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every year):
In-network: $0 copay
Out-of-network: $0 copay
Our plan pays up to $1250 every year for hearing aids. The maximum plan benefit coverage amount applies to both in-network and out-of-network services. The maximum plan benefit coverage amount applies Per ear.

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $55 copay
Other service:
In-network: $45 copay
Out-of-network: $55 copay
Eyewear:
Contact lenses:
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the service
Eyeglasses (lenses and frames):
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the service
Eyeglass lenses:
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the service
Eyeglass frames:
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the service
Upgrades:
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the service
Our plan reimburses you up to $150 every year for all eyewear.The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Medicare-covered glaucoma screening:
In-network: $0 copay
Out-of-network: 50% coinsurance

Fitness BenefitsIn-network: $0 copay
Out-of-network: 0% coinsurance

SilverSneakersYes Find participating gyms

Telehealth Services$0-$65 copay, depending on the service

2021 Preview

$22.00
Monthly Premium

Get Started

Aetna Medicare Value Plan (PPO)

$10
Primary Doctor Co‑Pay
$45
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers. $11300 for services you receive from any provider.

Office Visit for Primary DoctorIn-network: $10 copay
Out-of-network: $50 copay

Office Visit for SpecialistIn-network: $45 copay
Out-of-network: $60 copay

Inpatient Hospital CoverageInpatient hospital-acute:
In-network:
Our plan covers an unlimited number of days for an inpatient hospital stay.
Copayment amount for the medicare-covered stay: $850 copay
Out-of-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$500 copay per day for days 1 through 20
$0 copay per day for days 21 through 90
Inpatient hospital psychiatric:
Copayment amount for the medicare-covered stay: $1871 copay

Prescription Drug Deductible$250
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$15.00 copay

Tier 2: Generic$20.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier28% coinsurance (after deductible)

Other Coverage Highlights

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $60 copay
Fitting/evaluation for hearing aid (for up to 1 every year):
In-network: $0 copay
Out-of-network: $60 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every year):
In-network: $0 copay
Out-of-network: $0 copay
Our plan pays up to $1250 every year for hearing aids. The maximum plan benefit coverage amount applies to both in-network and out-of-network services. The maximum plan benefit coverage amount applies Per ear.

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $60 copay
Other service:
In-network: $45 copay
Out-of-network: $60 copay
Eyewear:
Contact lenses:
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Eyeglasses (lenses and frames):
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Eyeglass lenses:
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Eyeglass frames:
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Upgrades:
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Our plan reimburses you up to $150 every year for all eyewear.The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Medicare-covered glaucoma screening:
In-network: $0 copay
Out-of-network: 30% coinsurance

Fitness BenefitsIn-network: $0 copay
Out-of-network: $0 copay

SilverSneakersYes Find participating gyms

Telehealth Services$0-$65 copay, depending on the service

2021 Preview

$39.00
Monthly Premium

Get Started

Aetna Medicare Elite Plan 3 (PPO)

$10
Primary Doctor Co‑Pay
$45
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network Deductible$1000 for in-network and out-of-network combined

Out-of-Pocket Maximum$7550 for services you receive from in-network providers. $11300 for services you receive from any provider.

Office Visit for Primary DoctorIn-network: $10 copay
Out-of-network: $50 copay

Office Visit for SpecialistIn-network: $45 copay
Out-of-network: $60 copay

Inpatient Hospital CoverageInpatient hospital-acute:
In-network:
Our plan covers an unlimited number of days for an inpatient hospital stay.
Copayment amount for the medicare-covered stay: $850 copay
Out-of-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$500 copay per day for days 1 through 20
$0 copay per day for days 21 through 90
Inpatient hospital psychiatric:
Copayment amount for the medicare-covered stay: $1871 copay

Prescription Drug Deductible$300
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$15.00 copay

Tier 2: Generic$20.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier27% coinsurance (after deductible)

Other Coverage Highlights

Dental ServicesOral exams:
In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment:
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays:
In-network: $0 copay
Out-of-network: $0 copay
Non-routine services:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Diagnostic services:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Restorative services:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Endodontics:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Periodontics:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Extractions:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Prosthodontics, other oral/maxillofacial surgery, other services:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Our plan reimburses you up to $250 every year for dental services shown above. The maximum plan benefit coverage amount applies to both in-network and out-of-network services.

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $60 copay
Fitting/evaluation for hearing aid (for up to 1 every year):
In-network: $0 copay
Out-of-network: $60 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every year):
In-network: $0 copay
Out-of-network: $0 copay
Our plan pays up to $1250 every year for hearing aids. The maximum plan benefit coverage amount applies to both in-network and out-of-network services. The maximum plan benefit coverage amount applies Per ear.

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $60 copay
Other service:
In-network: $45 copay
Out-of-network: $60 copay
Eyewear:
Contact lenses:
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Eyeglasses (lenses and frames):
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Eyeglass lenses:
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Eyeglass frames:
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Upgrades:
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Our plan reimburses you up to $150 every year for all eyewear.The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Medicare-covered glaucoma screening:
In-network: $0 copay
Out-of-network: 30% coinsurance

Fitness BenefitsIn-network: $0 copay
Out-of-network: $0 copay

SilverSneakersYes Find participating gyms

Telehealth Services$0-$65 copay, depending on the service

2021 Preview

$39.00
Monthly Premium

Get Started

Aetna Medicare Elite Plan (HMO)

$20
Primary Doctor Co‑Pay
$45
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network Deductible$500

Out-of-Pocket Maximum$7550 for services you receive from in-network providers.

Office Visit for Primary Doctor$20 copay

Office Visit for Specialist$50 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
Copayment amount for the medicare-covered stay: $795 copay
Inpatient hospital psychiatric:
Copayment amount for the medicare-covered stay: $1871 copay

Prescription Drug Deductible$300
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$15.00 copay

Tier 2: Generic$20.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier27% coinsurance (after deductible)

Other Coverage Highlights

Dental ServicesOral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 2 every year): $0 copay
Dental x-rays (for up to 1): $0 copay

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every year): $0 copay
Our plan pays up to $1250 every year for hearing aids. The maximum plan benefit coverage amount applies Per ear.

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year): $0 copay
Other service: $45 copay
Eyewear:
Contact lenses: $0 copay
Eyeglasses (lenses and frames): $0 copay
Eyeglass lenses: $0 copay
Eyeglass frames: $0 copay
Upgrades: $0 copay
Our plan reimburses you up to $200 every year for all eyewear.
Medicare-covered glaucoma screening: $0 copay

Fitness Benefits$0 copay

SilverSneakersYes Find participating gyms

Telehealth Services$0-$65 copay, depending on the service

2021 Preview

$99.00
Monthly Premium

Get Started

Aetna Medicare Premier Plan (PPO)

$15
Primary Doctor Co‑Pay
$45
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers. $11300 for services you receive from any provider.

Office Visit for Primary DoctorIn-network: $15 copay
Out-of-network: $50 copay

Office Visit for SpecialistIn-network: $45 copay
Out-of-network: $60 copay

Inpatient Hospital CoverageInpatient hospital-acute:
In-network:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$400 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
You pay nothing per day for days 91 and beyond
Out-of-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$500 copay per day for days 1 through 20
$0 copay per day for days 21 through 90
Inpatient hospital psychiatric:
Copayment amount for the medicare-covered stay: $1871 copay

Prescription Drug Deductible$200
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$15.00 copay

Tier 2: Generic$20.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier29% coinsurance (after deductible)

Other Coverage Highlights

Dental ServicesOral exams:
In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment:
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays:
In-network: $0 copay
Out-of-network: $0 copay
Non-routine services:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Diagnostic services:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Restorative services:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Endodontics:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Periodontics:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Extractions:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Prosthodontics, other oral/maxillofacial surgery, other services:
In-network: $0 copay
Out-of-network: $0-$60 copay, depending on the service
Our plan reimburses you up to $350 every year for dental services shown above. The maximum plan benefit coverage amount applies to both in-network and out-of-network services.

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $60 copay
Fitting/evaluation for hearing aid (for up to 1 every year):
In-network: $0 copay
Out-of-network: $60 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every year):
In-network: $0 copay
Out-of-network: $0 copay
Our plan pays up to $1250 every year for hearing aids. The maximum plan benefit coverage amount applies to both in-network and out-of-network services. The maximum plan benefit coverage amount applies Per ear.

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $60 copay
Other service:
In-network: $45 copay
Out-of-network: $60 copay
Eyewear:
Contact lenses:
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Eyeglasses (lenses and frames):
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Eyeglass lenses:
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Eyeglass frames:
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Upgrades:
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Our plan reimburses you up to $175 every year for all eyewear.The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Medicare-covered glaucoma screening:
In-network: $0 copay
Out-of-network: 30% coinsurance

Fitness BenefitsIn-network: $0 copay
Out-of-network: $0 copay

SilverSneakersYes Find participating gyms

Telehealth Services$0-$65 copay, depending on the service

2021 Preview

$0
Monthly Premium

Get Started

Empire MediBlue Select (HMO)

$10
Primary Doctor Co‑Pay
$45
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers.

Office Visit for Primary Doctor$10 copay

Office Visit for Specialist$45 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$400 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
You pay nothing per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$370 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
You pay nothing per day for days 91 and beyond

Prescription Drug Deductible$350
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$8.00 copay

Tier 2: Generic$20.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$99.00 copay (after deductible)

Tier 5: Specialty Tier26% coinsurance (after deductible)

Tier 6: Select Care Drugs$0.00 copay

Other Coverage Highlights

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses: $0 copay
Eyeglasses (lenses and frames): $0 copay
Eyeglass lenses: $0 copay
Eyeglass frames: $0 copay
Our plan pays up to $100 every year for all eyewear.
For Medicare-covered benefits see attached Summary of Benefits

Fitness Benefits$0 copay

SilverSneakersYes Find participating gyms

Over-the-Counter Benefits$0 copay. Up to $27 every three months

Telehealth Services$0 copay

2021 Preview

$0
Monthly Premium

Get Started

Empire MediBlue HealthPlus (HMO)

$0
Primary Doctor Co‑Pay
$40
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$6900 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$40 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$375 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
You pay nothing per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$350 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
You pay nothing per day for days 91 and beyond

Prescription Drug Deductible$350
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$8.00 copay

Tier 2: Generic$20.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$99.00 copay (after deductible)

Tier 5: Specialty Tier26% coinsurance (after deductible)

Tier 6: Select Care Drugs$0.00 copay

Other Coverage Highlights

Dental Services Oral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 2 every year): $0 copay
Dental x-rays (for up to 1 every year): $0 copay
Our plan pays up to $1000 every year for dental services shown above.
For Medicare-covered benefits see attached Summary of Benefits

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types): $0 copay
Our plan pays up to $1500 every year for hearing aids. The maximum plan benefit coverage amount applies for both ears combined.
For Medicare-covered benefits see attached Summary of Benefits

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses: $0 copay
Eyeglasses (lenses and frames): $0 copay
Eyeglass lenses: $0 copay
Eyeglass frames: $0 copay
Our plan pays up to $150 every year for all eyewear.
For Medicare-covered benefits see attached Summary of Benefits

Fitness Benefits$0 copay

SilverSneakersYes Find participating gyms

Over-the-Counter Benefits$0 copay. Up to $35 every three months

Telehealth Services$0 copay

2021 Preview

$0
Monthly Premium

Get Started

Empire MediBlue Core Select (HMO)

$10
Primary Doctor Co‑Pay
$30
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Hospital & Medical
  • Vision
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$6700 for services you receive from in-network providers.

Office Visit for Primary Doctor$10 copay

Office Visit for Specialist$30 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$350 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
You pay nothing per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$415 copay per day for days 1 through 4
$0 copay per day for days 5 through 90
You pay nothing per day for days 91 and beyond

Other Coverage Highlights

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year): $0 copay
For Medicare-covered benefits see attached Summary of Benefits

Fitness Benefits$0 copay

SilverSneakersYes Find participating gyms

Over-the-Counter Benefits$0 copay. Up to $64 every three months

Telehealth Services$0 copay

2021 Preview

$0
Monthly Premium

Get Started

Empire MediBlue Core (HMO)

$20
Primary Doctor Co‑Pay
$50
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Hospital & Medical
  • Dental
  • Vision
  • SilverSneakers
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers.

Office Visit for Primary Doctor$20 copay

Office Visit for Specialist$50 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$400 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
You pay nothing per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$465 copay per day for days 1 through 4
$0 copay per day for days 5 through 90
You pay nothing per day for days 91 and beyond

Other Coverage Highlights

Dental ServicesOral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 2 every year): $0 copay
Dental x-rays (for up to 1 every year): $0 copay
Our plan pays up to $125 every three months for dental services shown above.
For Medicare-covered benefits see attached Summary of Benefits

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year): $0 copay
For Medicare-covered benefits see attached Summary of Benefits

Fitness Benefits$0 copay

SilverSneakersYes Find participating gyms

Telehealth Services$0 copay

2021 Preview

$16.00
Monthly Premium

Get Started

Empire MediBlue Plus (HMO)

$20
Primary Doctor Co‑Pay
$50
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Vision
  • SilverSneakers
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers.

Office Visit for Primary Doctor$20 copay

Office Visit for Specialist$50 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$500 copay per day for days 1 through 4
$0 copay per day for days 5 through 90
You pay nothing per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$465 copay per day for days 1 through 4
$0 copay per day for days 5 through 90
You pay nothing per day for days 91 and beyond

Prescription Drug Deductible$350
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$20.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$99.00 copay (after deductible)

Tier 5: Specialty Tier26% coinsurance (after deductible)

Other Coverage Highlights

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year): $0 copay
For Medicare-covered benefits see attached Summary of Benefits

Fitness Benefits$0 copay

SilverSneakersYes Find participating gyms

Telehealth Services$0 copay

2021 Preview

$42.30
Monthly Premium

Get Started

Empire MediBlue Extra Select (HMO)

$5
Primary Doctor Co‑Pay
$25
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$5900 for services you receive from in-network providers.

Office Visit for Primary Doctor$5 copay

Office Visit for Specialist$25 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$300 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
You pay nothing per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$395 copay per day for days 1 through 4
$0 copay per day for days 5 through 90
You pay nothing per day for days 91 and beyond

Prescription Drug Deductible$445
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$15.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier25% coinsurance (after deductible)

Tier 6: Select Care Drugs$0.00 copay

Other Coverage Highlights

Dental ServicesOral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 2 every year): $0 copay
Dental x-rays (for up to 1 every year): $0 copay
Our plan pays up to $375 every three months for dental services shown above.
For Medicare-covered benefits see attached Summary of Benefits

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types): $0 copay
Our plan pays up to $2000 every year for hearing aids. The maximum plan benefit coverage amount applies for both ears combined.
For Medicare-covered benefits see attached Summary of Benefits

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses: $0 copay
Eyeglasses (lenses and frames): $0 copay
Eyeglass lenses: $0 copay
Eyeglass frames: $0 copay
Our plan pays up to $150 every year for all eyewear.
For Medicare-covered benefits see attached Summary of Benefits

Fitness Benefits$0 copay

SilverSneakersYes Find participating gyms

Over-the-Counter Benefits$0 copay. Up to $112 every three months

Transportation Services$0 copay. 12, one-way, routine transportation services every year.

Telehealth Services$0 copay

2021 Preview

$0
Monthly Premium

Get Started

Empire MediBlue HealthPlus Dual Advantage (HMO D-SNP)

$0
Primary Doctor Co‑Pay
$0
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$0 copay

Inpatient Hospital Coverage$0.00 copay per stay.
Our plan covers 90 days for an inpatient hospital stay.

Prescription Drug Deductible$445
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$0.00 – $3.70 copay

Tier 3: Preferred Brand$0.00 – $9.20 copay

Tier 4: Non-Preferred Drug$0.00 – $9.20 copay

Tier 5: Specialty Tier$0.00 – $9.20 copay for One-month supply

Tier 6: Select Care Drugs$0 copay

Other Coverage Highlights

Fitness BenefitsYes

SilverSneakersYes Find participating gyms

Over-the-Counter BenefitsThis plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $158 every quarter. Unused OTC amounts do roll over to the next quarter. Unused OTC amounts do not roll over to the next calendar year.

Telehealth ServicesYes

2021 Preview

$0
Monthly Premium

Get Started

Empire MediBlue HealthPlus Dual Connect (HMO D-SNP)

$0
Primary Doctor Co‑Pay
$0
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$0 copay

Inpatient Hospital Coverage$0.00 copay per stay.
Our plan covers 90 days for an inpatient hospital stay.

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$0.00 – $3.70 copay

Tier 3: Preferred Brand$0.00 – $9.20 copay

Tier 4: Non-Preferred Drug$0.00 – $9.20 copay

Tier 5: Specialty Tier$0.00 – $9.20 copay for One-month supply

Tier 6: Select Care Drugs$0 copay

Other Coverage Highlights

Dental ServicesOral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 2 every year): $0 copay
Dental x-rays (for up to 1 every year): $0 copay
Our plan pays up to $575 every three months for dental services shown above.
For Medicare-covered benefits see attached Summary of Benefits

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types): $0 copay
Our plan pays up to $3000 every year for hearing aids. The maximum plan benefit coverage amount applies for both ears combined.
For Medicare-covered benefits see attached Summary of Benefits

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses: $0 copay
Eyeglasses (lenses and frames): $0 copay
Eyeglass lenses: $0 copay
Eyeglass frames: $0 copay
Our plan pays up to $300 every year for all eyewear.
For Medicare-covered benefits see attached Summary of Benefits

Fitness BenefitsYes

SilverSneakersYes Find participating gyms

Over-the-Counter BenefitsThis plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $300 every quarter. Unused OTC amounts do roll over to the next quarter. Unused OTC amounts do not roll over to the next calendar year.

Transportation Services$0 copay. 12, one-way, routine transportation services every year.

Telehealth ServicesYes

2021 Preview

$0
Monthly Premium

Get Started

Empire MediBlue Dual Advantage (HMO D-SNP)

$0
Primary Doctor Co‑Pay
$0
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$0 copay

Inpatient Hospital Coverage$0 copay per stay.
Our plan covers 90 days for an inpatient hospital stay.

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$0.00 – $3.70 copay

Tier 3: Preferred Brand$0.00 – $9.20 copay

Tier 4: Non-Preferred Drug$0.00 – $9.20 copay

Tier 5: Specialty Tier$0.00 – $9.20 copay for One-month supply

Tier 6: Select Care Drugs$0 copay

Other Coverage Highlights

Fitness BenefitsYes

SilverSneakersYes Find participating gyms

Over-the-Counter BenefitsThis plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $52 every quarter. Unused OTC amounts do roll over to the next quarter. Unused OTC amounts do not roll over to the next calendar year.

Telehealth ServicesYes

2021 Preview

$0
Monthly Premium

Get Started

Empire MediBlue Dual Advantage Select (HMO D-SNP)

$0
Primary Doctor Co‑Pay
$0
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$0 copay

Inpatient Hospital Coverage$0 copay per stay.
Our plan covers 90 days for an inpatient hospital stay.

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$0.00 – $3.70 copay

Tier 3: Preferred Brand$0.00 – $9.20 copay

Tier 4: Non-Preferred Drug$0.00 – $9.20 copay

Tier 5: Specialty Tier$0.00 – $9.20 copay for One-month supply

Tier 6: Select Care Drugs$0 copay

Other Coverage Highlights

Dental ServicesOral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 2 every year): $0 copay
Dental x-rays (for up to 1 every year): $0 copay
Our plan pays up to $450 every three months for dental services shown above.
For Medicare-covered benefits see attached Summary of Benefits

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types): $0 copay
Our plan pays up to $1500 every year for hearing aids. The maximum plan benefit coverage amount applies for both ears combined.
For Medicare-covered benefits see attached Summary of Benefits

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses: $0 copay
Eyeglasses (lenses and frames): $0 copay
Eyeglass lenses: $0 copay
Eyeglass frames: $0 copay
Our plan pays up to $300 every year for all eyewear.
For Medicare-covered benefits see attached Summary of Benefits

Fitness BenefitsYes

SilverSneakersYes Find participating gyms

Over-the-Counter BenefitsThis plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $210 every quarter. Unused OTC amounts do roll over to the next quarter. Unused OTC amounts do not roll over to the next calendar year.

Telehealth ServicesYes

2021 Preview

$0
Monthly Premium

Get Started

Healthfirst Signature (HMO)

$10
Primary Doctor Co‑Pay
$45
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers.

Office Visit for Primary Doctor$10 copay

Office Visit for Specialist$45 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$403 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
You pay nothing per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers up to 90 days in an inpatient hospital stay.
$311 copay per day for days 1 through 6
$0 copay per day for days 7 through 90

Prescription Drug Deductible$350
Applies to Tier 2: Generic, Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$10.00 copay (after deductible)

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier26% coinsurance (after deductible)

Other Coverage Highlights

Dental ServicesOral exams (for up to 1 every six months): You pay nothing
Prophylaxis (cleaning) (for up to 1 every six months): You pay nothing
Fluoride treatment (for up to 1 every six months): You pay nothing
Dental x-rays (for up to 1 every six months): You pay nothing
$100 deductible for Comprehensive Dental services:
Non-routine services: You pay nothing
Diagnostic services (for up to 1 every three years): You pay nothing
Restorative services (for up to 1): You pay nothing
Endodontics (for up to 1): You pay nothing
Periodontics (for up to 1): You pay nothing
Extractions (for up to 1): You pay nothing
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 1): You pay nothing
Our plan pays up to $1500 every year for dental services shown above.
Note: Under the Combined Supplemental Benefit Package, you must select one of three options: 1) OTC benefit, 2) Transportation Services benefit, or 3) Reduction in Cost-Sharing (Deductible) for Comprehensive Dental Services, benefit should correspond to the type you selected. Plan will not include all three benefits.

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types): You pay nothing
Our plan pays up to $500 every three years for hearing aids. The maximum plan benefit coverage amount applies Per ear.

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year): you pay nothing
Eyewear:
Upgrades: $0-$50 copay, depending on the service
Contact lenses (for up to 1 every two years): you pay nothing
Eyeglasses (lenses and frames) (for up to 1 every two years): you pay nothing
Glaucoma screening: You pay nothing

Fitness BenefitsYou pay nothing

SilverSneakersYes Find participating gyms

Over-the-Counter Benefits Up to $35 every three months, no rollover.
Note: Under the Combined Supplemental Benefit Package, you must select one of three options: 1) OTC benefit, 2) Transportation Services benefit, or 3) Reduction in Cost-Sharing (Deductible) for Comprehensive Dental Services, benefit should correspond to the type you selected. Plan will not include all three benefits.

Transportation ServicesYou pay nothing, 12 trips every year by other forms of conveyances (one-way) to plan approved health-related location.
Note: Under the Combined Supplemental Benefit Package, you must select one of three options: 1) OTC benefit, 2) Transportation Services benefit, or 3) Reduction in Cost-Sharing (Deductible) for Comprehensive Dental Services, benefit should correspond to the type you selected. Plan will not include all three benefits.

Telehealth ServicesYou pay nothing

2021 Preview

$0
Monthly Premium

Get Started

Healthfirst 65 Plus Plan (HMO)

$10
Primary Doctor Co‑Pay
$45
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers.

Office Visit for Primary Doctor$10 copay

Office Visit for Specialist$45 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$403 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
You pay nothing per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers up to 90 days in an inpatient hospital stay.
$311 copay per day for days 1 through 6
$0 copay per day for days 7 through 90

Prescription Drug Deductible$350
Applies to Tier 2: Generic, Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$10.00 copay (after deductible)

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier26% coinsurance (after deductible)

Other Coverage Highlights

Dental ServicesOral exams (for up to 1 every six months): You pay nothing
Prophylaxis (cleaning) (for up to 1 every six months): You pay nothing
Fluoride treatment (for up to 1 every six months): You pay nothing
Dental x-rays (for up to 1 every six months): You pay nothing
$100 deductible for Comprehensive Dental services:
Non-routine services: You pay nothing
Diagnostic services (for up to 1 every three years): You pay nothing
Restorative services (for up to 1): You pay nothing
Endodontics (for up to 1): You pay nothing
Periodontics (for up to 1): You pay nothing
Extractions (for up to 1): You pay nothing
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 1): You pay nothing
Our plan pays up to $1500 every year for dental services shown above.

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types): You pay nothing
Our plan pays up to $500 every three years for hearing aids. The maximum plan benefit coverage amount applies Per ear.

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year): you pay nothing
Eyewear:
Upgrades: $0-$50 copay, depending on the service
Contact lenses (for up to 1 every two years): you pay nothing
Eyeglasses (lenses and frames) (for up to 1 every two years): you pay nothing
Glaucoma screening: You pay nothing

Fitness BenefitsYou pay nothing

SilverSneakersYes Find participating gyms

Telehealth ServicesYou pay nothing

2021 Preview

$42.30
Monthly Premium

Get Started

Healthfirst Increased Benefits Plan (HMO)

$0
Primary Doctor Co‑Pay
$40
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers.

Office Visit for Primary DoctorYou pay nothing

Office Visit for Specialist$40 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$403 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
You pay nothing per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers up to 90 days in an inpatient hospital stay.
$311 copay per day for days 1 through 6
$0 copay per day for days 7 through 90

Prescription Drug Deductible$445
Applies to Tier 1: Generic, Tier 2: All Other Drugs

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic25% coinsurance (after deductible)

Tier 2: All Other Drugs25% coinsurance (after deductible)(after deductible)

Other Coverage Highlights

Dental ServicesOral exams (for up to 1 every six months): You pay nothing
Prophylaxis (cleaning) (for up to 1 every six months): You pay nothing
Fluoride treatment (for up to 1 every six months): You pay nothing
Dental x-rays (for up to 1 every six months): You pay nothing
Non-routine services: You pay nothing
Diagnostic services (for up to 1 every three years): You pay nothing
Restorative services (for up to 1): You pay nothing
Endodontics (for up to 1): You pay nothing
Periodontics (for up to 1): You pay nothing
Extractions (for up to 1): You pay nothing
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 1): You pay nothing

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types): You pay nothing
Our plan pays up to $500 every three years for hearing aids. The maximum plan benefit coverage amount applies Per ear.

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year): you pay nothing
Eyewear:
Upgrades: $0-$20 copay, depending on the service
Contact lenses (for up to 1 every year): you pay nothing
Eyeglasses (lenses and frames) (for up to 1 every year): you pay nothing
Glaucoma screening: You pay nothing

Fitness BenefitsYou pay nothing

SilverSneakersYes Find participating gyms

Over-the-Counter BenefitsUp to $15 per month, no rollover.

Transportation ServicesYou pay nothing, 40 trips every year by other forms of conveyances (one-way) to plan approved health-related location.

Telehealth ServicesYou pay nothing

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$0
Monthly Premium

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Healthfirst Life Improvement Plan (HMO D-SNP)

$0
Primary Doctor Co‑Pay
$0
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network Deductible$0

Out-of-Pocket Maximum$3450 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$0 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Inpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$0 copay
Inpatient hospital psychiatric:
Our plan covers up to 190 days in an inpatient hospital stay.
$0 copay per day for days 1 through 190

Prescription Drug Deductible$0

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0 copay or $1.30 copay or $3.70 copay or 15% of the cost for 30 – 90 day supply depending on your level of Extra Help

Tier 2: All Other Drugs$0 copay or $4.00 copay or $9.20 copay or 15% of the cost for 30 – 90 day supply depending on your level of Extra Help

Other Coverage Highlights

Dental ServicesOral exams (for up to 1 every six months): $0 copay
Prophylaxis (cleaning) (for up to 1 every six months): $0 copay
Fluoride treatment (for up to 1 every six months): $0 copay
Dental x-rays (for up to 1 every six months): $0 copay
Non-routine services: $0 copay
Diagnostic services: $0 copay
Restorative services: $0 copay
Endodontics: $0 copay
Periodontics: $0 copay
Extractions: $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services: $0 copay

Hearing ServicesHearing exams:
Routine hearing exams: $0 copay
Fitting/evaluation for hearing aid: $0 copay
Hearing aids:
Hearing aids (all types): $0 copay
Our plan pays up to $500 every three years for hearing aids. The maximum plan benefit coverage amount applies Per ear.

Vision ServicesEye exams:
Routine eye exams: $0 copay
Eyewear:
Upgrades: $0-$20 copay, depending on the service
Contact lenses : $0 copay
Eyeglasses (lenses and frames): $0 copay
Medicare-covered glaucoma screening: $0 copay

Fitness Benefits$0 copay

SilverSneakersYes Find participating gyms

Over-the-Counter Benefits$145 allowance per month toward approved over-the-counter (nonprescription) medications, health-related items, and healthy foods and produce at participating providers (retail locations and mail order) for your personal use.

Transportation Services$0 copay, 28 trips every year by other forms of conveyances (one-way) to plan approved health-related location.

Telehealth Services$0 copay

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$0
Monthly Premium

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Humana Honor (PPO)

0
Primary Doctor Co‑Pay
$40
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Part B Give Back
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$4500 for services you receive from in-network providers. $10000 for services you receive from any provider.

Office Visit for Primary DoctorIn-network: $0 copay
Out-of-network: 30% coinsurance

Office Visit for SpecialistIn-network: $40 copay
Out-of-network: 30% coinsurance

Inpatient Hospital CoverageInpatient hospital-acute:
In-network:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$350 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
$0 copay per day for days 91 and beyond
Out-of-network:
Coinsurance percentage for OON inpatient hospital-acute stay: 30% coinsurance
Inpatient hospital psychiatric:
In-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$324 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
Out-of-network:
Coinsurance percentage for OON inpatient psychiatric hospital stay: 30% coinsurance

Other Coverage Highlights

Dental Services Eye exams:
Oral exams (for up to 3):
In-network: 0% coinsurance
Out-of-network: 50% coinsurance
Prophylaxis (cleaning) (for up to 2 every year):
In-network: 0% coinsurance
Out-of-network: 50% coinsurance
Fluoride treatment (for up to 2 every year):
In-network: 0% coinsurance
Out-of-network: 50% coinsurance
Dental x-rays (for up to 3):
In-network: 0% coinsurance
Out-of-network: 50% coinsurance
Restorative services (for up to 2 every year):
In-network: 50% coinsurance
Out-of-network: 55%-75% coinsurance, depending on the service
Periodontics (for up to 5):
In-network: 70% coinsurance
Out-of-network: 55%-75% coinsurance, depending on the service
Extractions (for up to 2 every year):
In-network: 50% coinsurance
Out-of-network: 55%-75% coinsurance, depending on the service
Our plan pays up to $2000 every year for dental services shown above. The maximum plan benefit coverage amount applies to both in-network and out-of-network services.

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Fitting/evaluation for hearing aid (for up to 1 every year):
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Hearing aids:
Hearing aids (all types) (for up to 2 every year):
In-network: $399-$699 copay, depending on the service
Out-of-network: $399-$699 copay, depending on the service.

Vision ServicesEye exams:
Routine eye exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $0 copay or 30% coinsurance, depending on the service
Our plan pays up to $75 every year for eye exams. The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Eyewear:
Contact lenses (for up to 1 every year):
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (lenses and frames) (for up to 1 every year):
In-network: $0 copay
Out-of-network: $0 copay
Our plan pays up to $200 every year for all eyewear.The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Medicare-covered glaucoma screening:
In-network: $0 copay
Out-of-network: 30% coinsurance

Fitness BenefitsIn-network: You pay nothing
Out-of-network: 50% coinsurance

SilverSneakersYes Find participating gyms

Over-the-Counter BenefitsIn-network: You pay nothing. Up to $50 every three months
Out-of-network: 50% coinsurance

Transportation ServicesIn-network: $0 copay, 24 trips every year by Van or other forms of conveyances (one-way) to plan approved health-related location.
Out-of-network: 50% coinsurance

Telehealth Services$0-$40 copay, depending on the service

2021 Preview

$0
Monthly Premium

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Humana Gold Plus H3533-027 (HMO)

0
Primary Doctor Co‑Pay
$50
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Telehealth Services
  • Part B Give Back
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network Deductible$800

Out-of-Pocket Maximum$7550 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$50 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
Copayment amount for the medicare-covered stay: $700 copay
Inpatient hospital psychiatric:
Copayment amount for the medicare-covered stay: $700 copay

Prescription Drug Deductible$400
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$10.00 copay

Tier 2: Generic$20.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier25% coinsurance (after deductible)

Other Coverage Highlights

Hearing Services Hearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every year): $699-$999 copay, depending on the service

Vision Services Eye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses (for up to 1 every year): $0 copay
Eyeglasses (lenses and frames) (for up to 1 every year): $0 copay
Our plan pays up to $100 every year for all eyewear.
Medicare-covered glaucoma screening: $0 copay

Fitness BenefitsYou pay nothing

SilverSneakersYes Find participating gyms

Telehealth Services$0-$50 copay, depending on the service

2021 Preview

$0
Monthly Premium

Get Started

Humana Gold Plus H3533-027 (HMO)

0
Primary Doctor Co‑Pay
$45
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible

Out-of-Pocket Maximum$7550 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$45 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$495 copay per day for days 1 through 4
$0 copay per day for days 5 through 90
$0 copay per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers up to 90 days in an inpatient hospital stay.
$465 copay per day for days 1 through 4
$0 copay per day for days 5 through 90

Prescription Drug Deductible$350
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$10.00 copay

Tier 2: Generic$20.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier26% coinsurance (after deductible)

Other Coverage Highlights

Dental Services
Oral exams (for up to 3): 0% coinsurance
Prophylaxis (cleaning) (for up to 2 every year): 0% coinsurance
Dental x-rays (for up to 3): 0% coinsurance
Restorative services (for up to 3 every year): 50%-70% coinsurance, depending on the service
Extractions: 50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 4): 70% coinsurance
Our plan pays up to $2000 every year for dental services shown above.

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every year): $699-$999 copay, depending on the service

Vision Services Eye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses (for up to 1 every year): $0 copay
Eyeglasses (lenses and frames) (for up to 1 every year): $0 copay
Our plan pays up to $200 every year for all eyewear.
Medicare-covered glaucoma screening: $0 copay

Fitness BenefitsYou pay nothing

SilverSneakersYes Find participating gyms

Over-the-Counter BenefitsYou pay nothing. Up to $45 every three months

Transportation Services $0 copay, 36 trips every year by Van or other forms of conveyances (one-way) to plan approved health-related location.

Telehealth Services$0-$50 copay, depending on the service

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$0
Monthly Premium

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HumanaChoice H5970-024 (PPO)

0
Primary Doctor Co‑Pay
$40
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullThird rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible

Out-of-Pocket Maximum$7200 for services you receive from in-network providers. $11000 for services you receive from any provider.

Office Visit for Primary DoctorIn-network: $0 copay
Out-of-network: $15 copay

Office Visit for SpecialistIn-network: $40 copay
Out-of-network: $50 copay

Inpatient Hospital CoverageInpatient hospital-acute:
In-network:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$350 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
$0 copay per day for days 91 and beyond
Out-of-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$500 copay per day for days 1 through 7
$0 copay per day for days 8 through 90
Inpatient hospital psychiatric:
In-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$350 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
Out-of-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$500 copay per day for days 1 through 7
$0 copay per day for days 8 through 90

Prescription Drug Deductible$350
Applies to Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$10.00 copay

Tier 2: Generic$20.00 copay

Tier 3: Preferred Brand$47.00 copay

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier26% coinsurance (after deductible)

Other Coverage Highlights

Hearing ServicesHearing exams:
Routine hearing exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $0-$50 copay, depending on the service
Fitting/evaluation for hearing aid (for up to 1 every year):
In-network: $0 copay
Out-of-network: $0-$50 copay, depending on the service
Hearing aids:
Hearing aids (all types) (for up to 2 every year):
In-network: $699-$999 copay, depending on the service
Out-of-network: $699-$999 copay, depending on the service

Vision Services Eye exams:
Routine eye exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $0-$50 copay, depending on the service
Our plan pays up to $75 every year for eye exams. The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Eyewear:
Contact lenses (for up to 1 every year):
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (lenses and frames) (for up to 1 every year):
In-network: $0 copay
Out-of-network: $0 copay
Our plan pays up to $100 every year for all eyewear.The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Medicare-covered glaucoma screening:
In-network: $0 copay
Out-of-network: $50 copay

Fitness BenefitsIn-network: You pay nothing
Out-of-network: 50% coinsurance

SilverSneakersYes Find participating gyms

Telehealth Services$0-$40 copay, depending on the service

2021 Preview

$21.00
Monthly Premium

Get Started

Humana Gold Plus H3533-032 (HMO)

0
Primary Doctor Co‑Pay
$40
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFifth rating star:emptyFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible

Out-of-Pocket Maximum$6500 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$40 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Inpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$325 copay per day for days 1 through 6
$0 copay per day for days 7 through 90
$0 copay per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers up to 90 days in an inpatient hospital stay.
$290 copay per day for days 1 through 6
$0 copay per day for days 7 through 90

Prescription Drug Deductible$200
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$10.00 copay

Tier 2: Generic$20.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier29% coinsurance (after deductible)

Other Coverage Highlights

Dental Services
Oral exams (for up to 3): 0% coinsurance
Prophylaxis (cleaning) (for up to 2 every year): 0% coinsurance
Dental x-rays (for up to 3): 0% coinsurance
Restorative services (for up to 3 every year): 50%-70% coinsurance, depending on the service
Extractions: 50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 4): 70% coinsurance
Our plan pays up to $2000 every year for dental services shown above.

Hearing Services Hearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every year): $399-$699 copay, depending on the service

Vision Services Eye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses (for up to 1 every year): $0 copay
Eyeglasses (lenses and frames) (for up to 1 every year): $0 copay
Our plan pays up to $200 every year for all eyewear.
Medicare-covered glaucoma screening: $0 copay

Fitness BenefitsYou pay nothing

SilverSneakersYes Find participating gyms

Over-the-Counter Benefits You pay nothing. Up to $45 every three months

Transportation Services$0 copay, 48 trips every year by Van or other forms of conveyances (one-way) to plan approved health-related location.

Telehealth Services$0-$40 copay, depending on the service

2021 Preview

$0
Monthly Premium

Get Started

Humana Gold Plus SNP-DE H3533-031 (HMO D-SNP)

0
Primary Doctor Co‑Pay
$0
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • SilverSneakers
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFifth rating star:emptyFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible

Out-of-Pocket MaximumThis plan does not have a maximum out-of-pocket responsibility

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$0 copay

Inpatient Hospital Coverage$0 copay

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic30-day supply:For generic drugs (including brand drugs treated as generic), either:$0 copay; or $1.30 copay; or $3.70 copay.For all other drugs, either:$0 copay; or $4 copay; or $9.20 copay.90-day supply:For generic drugs (including brand drugs treated as generic), either:$0 copay; or $1.30 copay; or $3.70 copay.For all other drugs, either:$0 copay; or $4 copay; or $9.20 copay.

Tier 2: Generic30-day supply:For generic drugs (including brand drugs treated as generic), either:$0 copay; or $1.30 copay; or $3.70 copay.For all other drugs, either:$0 copay; or $4 copay; or $9.20 copay.90-day supply:For generic drugs (including brand drugs treated as generic), either:$0 copay; or $1.30 copay; or $3.70 copay.For all other drugs, either:$0 copay; or $4 copay; or $9.20 copay.

Tier 3: Preferred Brand30-day supply:For generic drugs (including brand drugs treated as generic), either:$0 copay; or $1.30 copay; or $3.70 copay.For all other drugs, either:$0 copay; or $4 copay; or $9.20 copay.90-day supply:For generic drugs (including brand drugs treated as generic), either:$0 copay; or $1.30 copay; or $3.70 copay.For all other drugs, either:$0 copay; or $4 copay; or $9.20 copay.

Tier 4: Non-Preferred Drug30-day supply:For generic drugs (including brand drugs treated as generic), either:$0 copay; or $1.30 copay; or $3.70 copay.For all other drugs, either:$0 copay; or $4 copay; or $9.20 copay.90-day supply:For generic drugs (including brand drugs treated as generic), either:$0 copay; or $1.30 copay; or $3.70 copay.For all other drugs, either:$0 copay; or $4 copay; or $9.20 copay.

Tier 5: Specialty Tier30-day supply:For generic drugs (including brand drugs treated as generic), either:$0 copay; or $1.30 copay; or $3.70 copay.For all other drugs, either:$0 copay; or $4 copay; or $9.20 copay.90-day supply:For generic drugs (including brand drugs treated as generic), either:$0 copay; or $1.30 copay; or $3.70 copay.For all other drugs, either:$0 copay; or $4 copay; or $9.20 copay.

Other Coverage Highlights

Dental Services Medicare-covered dental $0 copay
Routine dental In-network: DEN175
• $0 copayment for scaling and root planing (deep cleaning) up to 1per quadrant every 3 years.
• $0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years.
• $0 copayment for complete dentures, partial dentures up to 1set(s) every 5 years.
• $0 copayment for panoramic film or diagnostic x-rays, recementation up to 1every 5 years.
• $0 copayment for bitewing x-rays up to 1set(s) per year.
• $0 copayment for adjustments to dentures, denture reline, intraoral x-rays, root canal up to 1per year.
• $0 copayment for amalgam and/or composite filling, crown, emergency treatment for pain, fluoride treatment, oral surgery, periodic oral exam and/or emergency diagnostic exam, prophylaxis (cleaning) up to 2 per year.
• $0 copayment for periodontal maintenance up to 4per year.
• $0 copayment for necessary anesthesia with covered service, simple or surgical extraction up to unlimited per year.
• $1000 maximum benefit coverage amount per year for preventive and comprehensive benefits

Hearing Services Medicare-covered hearing $0 copay
Routine hearing In-network: HER814
• $0 copayment for fitting/evaluation, routine hearing exams up to 1per year.
• $1000 maximum benefit coverage amount for hearing aids (all types) up to 2 every 3 years.

Vision Services Medicare-covered vision services $0 copay
Medicare-covered diabetic eye exam $0 copay
Medicare-covered glaucoma screening $0 copay
Medicare-covered eyewear (post-cataract) $0 copay
Routine vision In-Network VIS733
• $0 copayment for refraction, routine exam up to 1per year.
• $300 maximum benefit coverage amount per year for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames.
• Eyeglasses include ultraviolet protection and scratch resistant coating.

Fitness BenefitsSilverSneakers ® fitness program: Basic fitness center membership including fitness classes.

SilverSneakersYes Find participating gyms

Over-the-Counter Benefits $100 every month for approved over-the-counter items at participating retailers

Transportation Services$0 copay for up to 48 one-way trips to plan approved locations. Not to exceed 25 miles per trip. The member must contact transportation vendor to arrange transportation

Telehealth Services$0 copay

2021 Preview

$0
Monthly Premium

Get Started

AARP Medicare Advantage Patriot (HMO)

$20
Primary Doctor Co‑Pay
$40
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$6700 for services you receive from in-network providers.

Office Visit for Primary Doctor$20 copay

Office Visit for Specialist$40 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$345 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
$0 copay per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers up to 90 days in an inpatient hospital stay.
$345 copay per day for days 1 through 5
$0 copay per day for days 6 through 90

Other Coverage Highlights

Dental Services Oral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 3 every year): $0 copay
Fluoride treatment (for up to 2 every year): $0 copay
Dental x-rays (for up to 1 every three years): $0 copay

Hearing Services Hearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every two years): $375-$2075 copay, depending on the services

Vision Services Eye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses: $0 copay
Eyeglasses (lenses and frames) (for up to 1 every two years): $0 copay
Our plan pays up to $100 every two years for all eyewear.
Medicare-covered glaucoma screening: $0 copay

Fitness Benefits$0 copay

Telehealth Services$0 copay

2021 Preview

$0
Monthly Premium

Get Started

AARP Medicare Advantage Prime (HMO)

$10
Primary Doctor Co‑Pay
$40
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network Deductible$500

Out-of-Pocket Maximum$6700 for services you receive from in-network providers.

Office Visit for Primary Doctor$10 copay

Office Visit for Specialist$40 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$345 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
$0 copay per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers up to 90 days in an inpatient hospital stay.
$345 copay per day for days 1 through 5
$0 copay per day for days 6 through 90

Prescription Drug Deductible$295
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$3.00 copay

$3.00 copayTier 2: Generic$12.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier27% coinsurance (after deductible)

Other Coverage Highlights

Dental Services Oral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 3 every year): $0 copay
Fluoride treatment (for up to 2 every year): $0 copay
Dental x-rays (for up to 1 every three years): $0 copay

Hearing Services Hearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every two years): $375-$2075 copay, depending on the services

Vision Services Eye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses: $0 copay
Eyeglasses (lenses and frames) (for up to 1 every two years): $0 copay
Our plan pays up to $100 every two years for all eyewear.
Medicare-covered glaucoma screening: $0 copay

Fitness Benefits$0 copay

Telehealth Services$0 copay

2021 Preview

$0
Monthly Premium

Get Started

AARP Medicare Advantage Mosaic Choice (PPO)

$0-$25
Primary Doctor Co‑Pay
$25-$50
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Annual In-Network Deductible$1000

Out-of-Pocket Maximum$6700 for services you receive from in-network providers. $10000 for services you receive from any provider.

Office Visit for Primary DoctorIn-network: $0-$25 copay, depending on the services
Out-of-network: 50% coinsurance

Office Visit for SpecialistIn-network: $25-$50 copay, depending on the services
Out-of-network: 50% coinsurance

Inpatient Hospital CoverageInpatient hospital-acute:
In-network:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$360 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
$0 copay per day for days 91 and beyond
Out-of-network:
Coinsurance percentage for OON inpatient hospital-acute stay: 50% coinsurance
Inpatient hospital psychiatric:
In-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$360 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
Out-of-network:
Coinsurance percentage for OON inpatient psychiatric hospital stay: 50% coinsurance

Prescription Drug Deductible$250
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tie

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$3.00 copay

$3.00 copayTier 2: Generic$12.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier28% coinsurance (after deductible)

Other Coverage Highlights

Dental Services Oral exams (for up to 2 every year):
In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning) (for up to 3 every year):
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment (for up to 2 every year):
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays (for up to 1 every three years):
In-network: $0 copay
Out-of-network: $0 copay

Hearing Services Hearing exams:
Routine hearing exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: 50% coinsurance
Hearing aids:
Hearing aids (all types) (for up to 2 every two years):
In-network: $375-$2075 copay, depending on the services
Out-of-network: $375 copay

Vision Services Eye exams:
Routine eye exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: 50% coinsurance
Eyewear:
Contact lenses:
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the services
Eyeglasses (lenses and frames) (for up to 1 every two years):
In-network: $0 copay
Out-of-network: 50% coinsurance or $0 copay, depending on the services
Our plan pays up to $300 every two years for all eyewear.The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Medicare-covered glaucoma screening:
In-network: $0 copay
Out-of-network: 50% coinsurance

Fitness BenefitsIn-network: $0 copay
Out-of-network: $0 copay

Telehealth Services$0 copay

2021 Preview

$34.00
Monthly Premium

Get Started

AARP Medicare Advantage Plan 2 (HMO)

$20
Primary Doctor Co‑Pay
$50
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Vision
  • Hearing
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:full Fourth rating star:half-fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$6700 for services you receive from in-network providers.

Office Visit for Primary Doctor$20 copay

Office Visit for Specialist$50 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$390 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
$0 copay per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers up to 90 days in an inpatient hospital stay.
$390 copay per day for days 1 through 4
$0 copay per day for days 5 through 90

Prescription Drug Deductible$395
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$3.00 copay

Tier 2: Generic$12.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier28% coinsurance (after deductible)

Other Coverage Highlights

Hearing Services Hearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every two years): $375-$2075 copay, depending on the services

Vision Services Eye exams:
Routine eye exams (for up to 1 every year): $0 copay
Medicare-covered glaucoma screening: $0 copay

Telehealth Services$0 copay

2021 Preview

$54.00
Monthly Premium

Get Started

AARP Medicare Advantage Plan 2 (HMO)

$10
Primary Doctor Co‑Pay
$50
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • Fitness Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:full Fifth rating star:emptyFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$6700 for services you receive from in-network providers.

Office Visit for Primary Doctor$10 copay

Office Visit for Specialist$50 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$390 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
$0 copay per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers up to 90 days in an inpatient hospital stay.
$390 copay per day for days 1 through 4
$0 copay per day for days 5 through 90

Prescription Drug Deductible$395
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$3.00 copay

Tier 2: Generic$12.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay (after deductible)

Tier 5: Specialty Tier25% coinsurance (after deductible)

Other Coverage Highlights

Dental Services Oral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 3 every year): $0 copay
Fluoride treatment (for up to 2 every year): $0 copay
Dental x-rays (for up to 1 every three years): $0 copay

Hearing Services Hearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every two years): $375-$2075 copay, depending on the services

Vision Services Eye exams:
Routine eye exams (for up to 1 every year): $0 copay
Medicare-covered glaucoma screening: $0 copay

Fitness Benefits$0 copay

Telehealth Services$0 copay

2021 Preview

$0
Monthly Premium

Get Started

UnitedHealthcare Dual Complete (HMO D-SNP)

$0
Primary Doctor Co‑Pay
$0
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:full Fourth rating star:half-fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$0 annually for Medicare-covered services from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$0 copay

Inpatient Hospital CoverageInpatient hospital-acute:
$0 copay per stay
Our plan covers an unlimited number of days for an inpatient hospital stay.
Inpatient hospital psychiatric:
$0 copay per stay
Our plan covers 90 days for an inpatient hospital stay.

Prescription Drug Deductible$0

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred GenericFor 30-day or 90-day supply from retail network pharmacy:
All Covered Drugs: $0 copay
Some covered drugs limited to a 30-day supply

Tier 2: GenericFor 30-day or 90-day supply from retail network pharmacy:
All Covered Drugs: $0 copay
Some covered drugs limited to a 30-day supply

Tier 3: Preferred BrandFor 30-day or 90-day supply from retail network pharmacy:
All Covered Drugs: $0 copay
Some covered drugs limited to a 30-day supply

Tier 4: Non-Preferred DrugFor 30-day or 90-day supply from retail network pharmacy:
All Covered Drugs: $0 copay
Some covered drugs limited to a 30-day supply

Tier 5: Specialty TierFor 30-day or 90-day supply from retail network pharmacy:
All Covered Drugs: $0 copay
Some covered drugs limited to a 30-day supply

Other Coverage Highlights

Dental Services Preventive:
$0 copay
Comprehensive:
$0 copay
Benefit limit:
$1,000

Hearing Services Exam to diagnose and treat hearing and balance issues:
$0 copay
Routine hearing exam:
$0 copay; 1 per year
Hearing aid:
$2,000 allowance for hearing aids, up to 2 hearing aids every 2 years.

Vision Services Exam to diagnose and treat diseases and conditions of the eye:
$0 copay
Eyewear after cataract surgery:
$0 copay
Routine eye exam:
$0 copay; 1 every year
Eyewear:
$0 copay every year; up to $200 for lenses/frames and contacts

Fitness Benefits $0 copay

Over-the-Counter Benefits$300 credit per quarter to use on approved health products from network retail locations. Order online, over the phone, or by mail through your FirstLine Select Catalog.

Telehealth Services$0 copay; Speak to network telehealth providers using your computer or mobile device.

2021 Preview

$0
Monthly Premium

Get Started

WellCare Choice (HMO)

$0
Primary Doctor Co‑Pay
$45
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket MaximumThis plan does not have a deductible. $6700 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$45 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers up to 90 days in an inpatient hospital stay.
$650 copay per day for days 1 through 3
$0 copay per day for days 4 through 90
Inpatient hospital psychiatric:
Our plan covers up to 90 days in an inpatient hospital stay.
$575 copay per day for days 1 through 3
$0 copay per day for days 4 through 90

Prescription Drug Deductible$0

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$10.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug48% coinsurance

Tier 5: Specialty Tier33% coinsurance

Other Coverage Highlights

Dental Services Oral exams (for up to 1 every six months): $0 copay
Prophylaxis (cleaning) (for up to 1 every six months): $0 copay
Fluoride treatment (for up to 1 every year): $0 copay
Dental x-rays (for up to 1): $0 copay
Non-routine services (for up to 1): $0 copay
Restorative services (for up to 1 every three years): $0 copay
Periodontics (for up to 1): $0 copay
Extractions (for up to 1): $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 1): $0 copay
Our plan pays up to $500 every year for dental services shown above.

Hearing Services Hearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every year): $0 copay
Our plan pays up to $1500 every year for hearing aids. The maximum plan benefit coverage amount applies for both ears combined.

Vision Services Eye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses: $0 copay
Eyeglasses (lenses and frames): $0 copay
Eyeglass lenses: $0 copay
Eyeglass frames: $0 copay
Upgrades: $0 copay
Our plan pays up to $100 every year for all eyewear.
Medicare-covered glaucoma screening: $0 copay

Fitness Benefits$0 copay

Over-the-Counter Benefits$0 copay. Up to $55 every three months copay

Transportation Services$0 copay, 12 trips every year by Taxi or Rideshare Services or Van (one-way) to plan approved health-related location.

Telehealth Services$0-$45 copay, depending on the service

2021 Preview

$0
Monthly Premium

Get Started

WellCare Element (HMO)

$0
Primary Doctor Co‑Pay
$25
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:half-fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$6700 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$25 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers up to 90 days in an inpatient hospital stay.
$500 copay per day for days 1 through 3
$0 copay per day for days 4 through 90
Inpatient hospital psychiatric:
Our plan covers up to 90 days in an inpatient hospital stay.
$475 copay per day for days 1 through 3
$0 copay per day for days 4 through 90

Prescription Drug Deductible$0

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$15.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug48% coinsurance

Tier 5: Specialty Tier33% coinsurance

Other Coverage Highlights

Dental Services Oral exams (for up to 1 every six months): $0 copay
Prophylaxis (cleaning) (for up to 1 every six months): $0 copay
Fluoride treatment (for up to 1 every year): $0 copay
Dental x-rays (for up to 1): $0 copay
Non-routine services (for up to 1): $0 copay
Restorative services (for up to 1 every three years): $0 copay
Periodontics (for up to 1): $0 copay
Extractions (for up to 1): $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 1): $0 copay
Our plan pays up to $750 every year for dental services shown above.

Vision Services Medicare-covered glaucoma screening:$0 copay

Fitness Benefits$0 copay

Over-the-Counter Benefits$0 copay. Up to $35 every three months

Transportation Services$0 copay, 12 trips every year by Taxi or Rideshare Services or Van (one-way) to plan approved health-related location.

Telehealth Services$0-$40 copay, depending on the service

2021 Preview

$0
Monthly Premium

Get Started

WellCare Today’s Options Advantage Plus 550B (PPO)

$5
Primary Doctor Co‑Pay
$35
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:half-fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$6700 for services you receive from in-network providers. $6700 for services you receive from any provider.

Office Visit for Primary DoctorIn-network: $5 copay
Out-of-network: $25 copay

Office Visit for SpecialistIn-network: $35 copay
Out-of-network: $60 copay

Inpatient Hospital CoverageInpatient hospital-acute:
In-network:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$325 copay per day for days 1 through 6
$0 copay per day for days 7 through 90
You pay nothing per day for days 91 and beyond
Out-of-network:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$388 copay per day for days 1 through 7
$0 copay per day for days 8 and beyond
Inpatient hospital psychiatric:
In-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$295 copay per day for days 1 through 5
$0 copay per day for days 6 through 90
Out-of-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$300 copay per day for days 1 through 7
$0 copay per day for days 8 through 90

Prescription Drug Deductible$0

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$5.00 copay

Tier 2: Generic$12.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay coinsurance

Tier 5: Specialty Tier33% coinsurance

Other Coverage Highlights

Dental Services Oral exams (for up to 1 every six months):
In-network: $0 copay
Out-of-network: 50% coinsurance
Prophylaxis (cleaning) (for up to 1 every six months):
In-network: $0 copay
Out-of-network: 50% coinsurance
Fluoride treatment (for up to 1 every year):
In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays (for up to 1):
In-network: $0 copay
Out-of-network: 50% coinsurance
Non-routine services (for up to 1):
In-network: $0 copay
Out-of-network: 50% coinsurance or $60 copay, depending on the service
Restorative services (for up to 1 every three years):
In-network: $0 copay
Out-of-network: 50% coinsurance or $60 copay, depending on the service
Periodontics (for up to 1):
In-network: $0 copay
Out-of-network: 50% coinsurance or $60 copay, depending on the service
Extractions (for up to 1):
In-network: $0 copay
Out-of-network: 50% coinsurance or $60 copay, depending on the service
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 1):
In-network: $0 copay
Out-of-network: 50% coinsurance or $60 copay, depending on the service
Our plan pays up to $500 every year for dental services shown above. The maximum plan benefit coverage amount applies to both in-network and out-of-network services.

Hearing Services Hearing exams:Routine hearing exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance or $60 copay, depending on the service
Fitting/evaluation for hearing aid (for up to 1 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance or $60 copay, depending on the service
Hearing aids:
Hearing aids (all types) (for up to 2 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance
Our plan pays up to $1500 every year for hearing aids. The maximum plan benefit coverage amount applies to both in-network and out-of-network services. The maximum plan benefit coverage amount applies for both ears combined.

Vision Services Eye exams:Routine eye exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance or $0-$60 copay, depending on the service
Eyewear:
Contact lenses:
In-network: $0 copay
Out-of-network: 40% coinsurance or $60 copay, depending on the service
Eyeglasses (lenses and frames):
In-network: $0 copay
Out-of-network: 40% coinsurance or $60 copay, depending on the service
Eyeglass lenses:
In-network: $0 copay
Out-of-network: 40% coinsurance or $60 copay, depending on the service
Eyeglass frames:
In-network: $0 copay
Out-of-network: 40% coinsurance or $60 copay, depending on the service
Upgrades:
In-network: $0 copay
Out-of-network: 40% coinsurance or $60 copay, depending on the service
Our plan pays up to $100 every year for all eyewear.The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Medicare-covered glaucoma screening:
In-network: $0 copay
Out-of-network: $0 copay

Fitness BenefitsIn-network: $0 copay
Out-of-network: $0 copay

Over-the-Counter BenefitsIn-network: $0 copay. Up to $90 every three months
Out-of-network: The in-network provider must be used for the out-of-network benefit.

Telehealth Services$0-$40 copay, depending on the service

2021 Preview

$0
Monthly Premium

Get Started

WellCare Absolute (PPO)

$0
Primary Doctor Co‑Pay
$45
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Telehealth Services
  • Part B Give Back
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:half-fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$7550 for services you receive from in-network providers. $11300 for services you receive from any provider.

Office Visit for Primary DoctorIn-network: $0 copay
Out-of-network: $25 copay

Office Visit for SpecialistIn-network: $45 copay
Out-of-network: 40% coinsurance

Inpatient Hospital CoverageInpatient hospital-acute:
In-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$275 copay per day for days 1 through 6
$0 copay per day for days 7 through 90
Out-of-network:
Our plan covers up to 90 days in an inpatient hospital stay.
20% coinsurance per day for days 1 through 90
Inpatient hospital psychiatric:
In-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$300 copay per day for days 1 through 6
$0 copay per day for days 7 through 90
Out-of-network:
Our plan covers up to 90 days in an inpatient hospital stay.
40% coinsurance per day for days 1 through 90

Prescription Drug Deductible$150
Applies to Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$12.00 copay

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug$100.00 copay coinsurance

Tier 5: Specialty Tier30% coinsurance

Other Coverage Highlights

Dental Services Oral exams (for up to 1 every six months):
In-network: $0 copay
Out-of-network: 50% coinsurance
Prophylaxis (cleaning) (for up to 1 every six months):
In-network: $0 copay
Out-of-network: 50% coinsurance
Fluoride treatment (for up to 1 every year):
In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays (for up to 1):
In-network: $0 copay
Out-of-network: 50% coinsurance
Non-routine services (for up to 1):
In-network: $0 copay
Out-of-network: 40%-50% coinsurance, depending on the service
Periodontics (for up to 1):
In-network: $0 copay
Out-of-network: 40%-50% coinsurance, depending on the service

Hearing Services Hearing exams:Routine hearing exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance
Fitting/evaluation for hearing aid (for up to 1 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance
Hearing aids:
Hearing aids (all types) (for up to 2 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance
Our plan pays up to $700 every year for hearing aids. The maximum plan benefit coverage amount applies to both in-network and out-of-network services. The maximum plan benefit coverage amount applies for both ears combined.

Vision Services Eye exams:Routine eye exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $0 copay or 40% coinsurance, depending on the service
Eyewear:
Contact lenses:
In-network: $0 copay
Out-of-network: 40% coinsurance
Eyeglasses (lenses and frames):
In-network: $0 copay
Out-of-network: 40% coinsurance
Eyeglass lenses:
In-network: $0 copay
Out-of-network: 40% coinsurance
Eyeglass frames:
In-network: $0 copay
Out-of-network: 40% coinsurance
Upgrades:
In-network: $0 copay
Out-of-network: 40% coinsurance
Our plan pays up to $100 every year for all eyewear.The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Medicare-covered glaucoma screening:
In-network: $0 copay
Out-of-network: $0 copay

Fitness BenefitsIn-network: $0 copay
Out-of-network: $0 copay

Over-the-Counter BenefitsIn-network: $0 copay. Up to $25 every three months
Out-of-network: The in-network provider must be used for the out-of-network benefit.

Telehealth Services$0-$40 copay, depending on the service

2021 Preview

$5.10
Monthly Premium

Get Started

WellCare Summit (PPO)

$0
Primary Doctor Co‑Pay
$35
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:half-fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$6700 for services you receive from in-network providers. $10000 for services you receive from any provider.

Office Visit for Primary DoctorIn-network: $0 copay
Out-of-network: $0 copay

Office Visit for SpecialistIn-network: $35 copay
Out-of-network: $35 copay

Inpatient Hospital CoverageInpatient hospital-acute:
In-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$450 copay per day for days 1 through 4
$0 copay per day for days 5 through 90
Out-of-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$450 copay per day for days 1 through 4
$0 copay per day for days 5 through 90
Inpatient hospital psychiatric:
In-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$465 copay per day for days 1 through 4
$0 copay per day for days 5 through 90
Out-of-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$465 copay per day for days 1 through 4
$0 copay per day for days 5 through 90

Prescription Drug Deductible$445
Applies to Tier 2: Generic, Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$20.00 copay (after deductible)

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug50% coinsurance (after deductible)

Tier 5: Specialty Tier25% coinsurance (after deductible)

Other Coverage Highlights

Dental Services Oral exams (for up to 1 every six months):
In-network: $0 copay
Out-of-network: 50% coinsurance
Prophylaxis (cleaning) (for up to 1 every six months):
In-network: $0 copay
Out-of-network: 50% coinsurance
Fluoride treatment (for up to 1 every year):
In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays (for up to 1):
In-network: $0 copay
Out-of-network: 50% coinsurance
Non-routine services (for up to 1):
In-network: $0 copay
Out-of-network: $35 copay or 50% coinsurance, depending on the service
Diagnostic services (for up to 1 every year):
In-network: $0 copay
Out-of-network: $35 copay or 50% coinsurance, depending on the service
Restorative services (for up to 1 every three years):
In-network: $0 copay
Out-of-network: $35 copay or 50% coinsurance, depending on the service
Endodontics (for up to 1):
In-network: $0 copay
Out-of-network: $35 copay or 50% coinsurance, depending on the service
Periodontics (for up to 1):
In-network: $0 copay
Out-of-network: $35 copay or 50% coinsurance, depending on the service
Extractions (for up to 1):
In-network: $0 copay
Out-of-network: $35 copay or 50% coinsurance, depending on the service
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 1):
In-network: $0 copay
Out-of-network: $35 copay or 50% coinsurance, depending on the service
Our plan pays up to $1000 every year for dental services shown above. The maximum plan benefit coverage amount applies to both in-network and out-of-network services.

Hearing Services Hearing exams:Routine hearing exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: $35 copay or 40% coinsurance, depending on the service
Fitting/evaluation for hearing aid (for up to 1 every year):
In-network: $0 copay
Out-of-network: $35 copay or 40% coinsurance, depending on the service
Hearing aids:
Hearing aids (all types) (for up to 2 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance
Our plan pays up to $1500 every year for hearing aids. The maximum plan benefit coverage amount applies to both in-network and out-of-network services. The maximum plan benefit coverage amount applies for both ears combined.

Vision Services Eye exams:Routine eye exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance or $0-$35 copay, depending on the service
Eyewear:
Contact lenses:
In-network: $0 copay
Out-of-network: 40% coinsurance or $35 copay, depending on the service
Eyeglasses (lenses and frames):
In-network: $0 copay
Out-of-network: 40% coinsurance or $35 copay, depending on the service
Eyeglass lenses:
In-network: $0 copay
Out-of-network: 40% coinsurance or $35 copay, depending on the service
Eyeglass frames:
In-network: $0 copay
Out-of-network: 40% coinsurance or $35 copay, depending on the service
Upgrades:
In-network: $0 copay
Out-of-network: 40% coinsurance or $35 copay, depending on the service
Our plan pays up to $100 every year for all eyewear.The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Medicare-covered glaucoma screening:
In-network: $0 copay
Out-of-network: $0 copay

Fitness Benefitsn-network: $0 copay
Out-of-network: $0 copay

Over-the-Counter BenefitsIn-network: $0 copay. Up to $120 every three months
Out-of-network: The in-network provider must be used for the out-of-network benefit.

Telehealth Services$0-$40 copay, depending on the service

2021 Preview

$12.30
Monthly Premium

Get Started

WellCare Compass (HMO)

$0
Primary Doctor Co‑Pay
$40
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:half-fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$6700 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$40 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$600 copay per day for days 1 through 3
$0 copay per day for days 4 through 90
You pay nothing per day for days 91 and beyond
Inpatient hospital psychiatric:
Our plan covers up to 90 days in an inpatient hospital stay.
$575 copay per day for days 1 through 3
$0 copay per day for days 4 through 90

Prescription Drug Deductible$445
Applies to Tier 2: Generic, Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$20.00 copay (after deductible)

Tier 3: Preferred Brand$47.00 copay (after deductible)

Tier 4: Non-Preferred Drug50% coinsurance (after deductible)

Tier 5: Specialty Tier25% coinsurance (after deductible)

Other Coverage Highlights

Dental Services Oral exams (for up to 1 every six months): $0 copay
Prophylaxis (cleaning) (for up to 1 every six months): $0 copay
Fluoride treatment (for up to 1 every year): $0 copay
Dental x-rays (for up to 1): $0 copay
Non-routine services (for up to 1): $0 copay
Restorative services (for up to 1 every three years): $0 copay
Periodontics (for up to 1): $0 copay
Extractions (for up to 1): $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 1): $0 copay
Our plan pays up to $500 every year for dental services shown above.

Hearing Services Hearing exams:Routine hearing exams (for up to 1 every year):
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every year): $0 copay
Our plan pays up to $1500 every year for hearing aids. The maximum plan benefit coverage amount applies for both ears combined.

Vision Services Eye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses: $0 copay
Eyeglasses (lenses and frames): $0 copay
Eyeglass lenses: $0 copay
Eyeglass frames: $0 copay
Upgrades: $0 copay
Our plan pays up to $100 every year for all eyewear.
Medicare-covered glaucoma screening: $0 copay

Fitness Benefits$0 copay

Over-the-Counter Benefits$0 copay. Up to $95 every three months

Transportation Services$0 copay, 36 trips every year by Taxi or Rideshare Services or Van (one-way) to plan approved health-related location.

Telehealth Services$0-$40 copay, depending on the service

2021 Preview

$81.00
Monthly Premium

Get Started

WellCare Preferred (HMO)

$0
Primary Doctor Co‑Pay
$30
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:half-fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$6700 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 copay

Office Visit for Specialist$30 copay

Inpatient Hospital CoverageInpatient hospital-acute:
Our plan covers up to 90 days in an inpatient hospital stay.
$295 copay per day for days 1 through 6
$0 copay per day for days 7 through 90
Inpatient hospital psychiatric:
Our plan covers up to 90 days in an inpatient hospital stay.
$200 copay per day for days 1 through 6
$0 copay per day for days 7 through 90

Prescription Drug Deductible$0

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$0.00 copay

Tier 2: Generic$15.00 copay

Tier 3: Preferred Brand$47.00 copay

Tier 4: Non-Preferred Drug48% coinsurance

Tier 5: Specialty Tier33% coinsurance

Other Coverage Highlights

Dental Services Oral exams (for up to 1 every six months): $0 copay
Prophylaxis (cleaning) (for up to 1 every six months): $0 copay
Fluoride treatment (for up to 1 every year): $0 copay
Dental x-rays (for up to 1): $0 copay
Non-routine services (for up to 1): $0 copay
Diagnostic services (for up to 1 every year): $0 copay
Restorative services (for up to 1 every three years): $0 copay
Endodontics (for up to 1): $0 copay
Periodontics (for up to 1): $0 copay
Extractions (for up to 1): $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 1): $0 copay
Our plan pays up to $1000 every year for dental services shown above.

Hearing Services Hearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every year): $0 copay
Our plan pays up to $1500 every year for hearing aids. The maximum plan benefit coverage amount applies for both ears combined.

Vision Services Eye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses: $0 copay
Eyeglasses (lenses and frames): $0 copay
Eyeglass lenses: $0 copay
Eyeglass frames: $0 copay
Upgrades: $0 copay
Our plan pays up to $200 every year for all eyewear.
Medicare-covered glaucoma screening: $0 copay

Fitness Benefits$0 copay

Over-the-Counter Benefits$0 copay. Up to $30 every three months

Transportation Services$0 copay, 12 trips every year by Taxi or Rideshare Services or Van (one-way) to plan approved health-related location.

Telehealth Services$0-$40 copay, depending on the service

2021 Preview

$121.00
Monthly Premium

Get Started

WellCare Today’s Options Advantage Plus 150A (PPO)

$0
Primary Doctor Co‑Pay
$25
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:half-fullFifth rating star:empty

Annual In-Network DeductibleThis plan does not have a deductible.

Out-of-Pocket Maximum$3400 for services you receive from in-network providers. $3400 for services you receive from any provider.

Office Visit for Primary DoctorIn-network: $0 copay
Out-of-network: $10 copay

Office Visit for SpecialistIn-network: $25 copay
Out-of-network: $35 copay

Inpatient Hospital CoverageInpatient hospital-acute:
In-network:
Our plan covers an unlimited number of days for an inpatient hospital stay.
Copayment amount for the medicare-covered stay: $600 copay
Out-of-network:
Our plan covers an unlimited number of days for an inpatient hospital stay.
$350 copay per day for days 1 through 7
$0 copay per day for days 8 and beyond
Inpatient hospital psychiatric:
In-network:
Copayment amount for the medicare-covered stay: $500 copay
Out-of-network:
Our plan covers up to 90 days in an inpatient hospital stay.
$300 copay per day for days 1 through 7
$0 copay per day for days 8 through 90

Prescription Drug Deductible$0

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred Generic$5.00 copay/span>

Tier 2: Generic$10.00 copay

Tier 3: Preferred Brand$45.00 copay

Tier 4: Non-Preferred Drug$85.00 copay

Tier 5: Specialty Tier33% coinsurance

Other Coverage Highlights

Dental Services Oral exams (for up to 1 every six months):
In-network: $0 copay
Out-of-network: 50% coinsurance
Prophylaxis (cleaning) (for up to 1 every six months):
In-network: $0 copay
Out-of-network: 50% coinsurance
Fluoride treatment (for up to 1 every year):
In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays (for up to 1):
In-network: $0 copay
Out-of-network: 50% coinsurance
Non-routine services (for up to 1):
In-network: $0 copay
Out-of-network: $35 copay or 50% coinsurance, depending on the service
Restorative services (for up to 1 every three years):
In-network: $0 copay
Out-of-network: $35 copay or 50% coinsurance, depending on the service
Periodontics (for up to 1):
In-network: $0 copay
Out-of-network: $35 copay or 50% coinsurance, depending on the service
Extractions (for up to 1):
In-network: $0 copay
Out-of-network: $35 copay or 50% coinsurance, depending on the service
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 1):
In-network: $0 copay
Out-of-network: $35 copay or 50% coinsurance, depending on the service
Our plan pays up to $500 every year for dental services shown above. The maximum plan benefit coverage amount applies to both in-network and out-of-network services.

Hearing Services Hearing exams:
Routine hearing exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance or $35 copay, depending on the service
Fitting/evaluation for hearing aid (for up to 1 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance or $35 copay, depending on the service
Hearing aids:
Hearing aids (all types) (for up to 2 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance
Our plan pays up to $1500 every year for hearing aids. The maximum plan benefit coverage amount applies to both in-network and out-of-network services. The maximum plan benefit coverage amount applies for both ears combined.

Vision Services Eye exams:
Routine eye exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance or $0-$35 copay, depending on the service
Eyewear:
Contact lenses:
In-network: $0 copay
Out-of-network: 40% coinsurance or $35 copay, depending on the service
Eyeglasses (lenses and frames):
In-network: $0 copay
Out-of-network: 40% coinsurance or $35 copay, depending on the service
Eyeglass lenses:
In-network: $0 copay
Out-of-network: 40% coinsurance or $35 copay, depending on the service
Eyeglass frames:
In-network: $0 copay
Out-of-network: 40% coinsurance or $35 copay, depending on the service
Upgrades:
In-network: $0 copay
Out-of-network: 40% coinsurance or $35 copay, depending on the service
Our plan pays up to $100 every year for all eyewear.The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Medicare-covered glaucoma screening:
In-network: $0 copay
Out-of-network: $0 copay

Fitness BenefitsIn-network: $0 copay
Out-of-network: $0 copay

Over-the-Counter BenefitsIn-network: $0 copay. Up to $90 every three months
Out-of-network: The in-network provider must be used for the out-of-network benefit.

Telehealth Services$0-$40 copay, depending on the service

2021 Preview

$0
Monthly Premium

Get Started

WellCare Imperial (PPO D-SNP)

$0
Primary Doctor Co‑Pay
$0
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

View More Details

Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:half-fullFifth rating star:empty

Annual In-Network Deductible0$

Out-of-Pocket Maximum$3450 for services you receive from in-network providers. $5150 for services you receive from any provider.

Office Visit for Primary DoctorIn-network: $0 co-pay
Out-of-network: $0 co-pay

Office Visit for SpecialistIn-network: $0 co-pay
Out-of-network: $0 co-pay

Inpatient Hospital CoverageInpatient hospital-acute:
In-network:
$0 co-pay up to 90 days per admission
Out-of-network:
$0 co-pay up to 90 days per admission
Inpatient hospital psychiatric:
In-network:
$0 co-pay up to 90 days per admission
Out-of-network:
$0 co-pay up to 90 days per admission

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred GenericOne-month supply:
You pay $0

Tier 2: GenericOne-month supply:
Generics: You pay $0 or $1.30 or $3.70 or 15%
Brands: You pay $0 or $4.00 or $9.20 or 15%

Tier 3: Preferred BrandOne-month supply:
Generics: You pay $0 or $1.30 or $3.70 or 15%
Brands: You pay $0 or $4.00 or $9.20 or 15%

Tier 4: Non-Preferred DrugOne-month supply:
Generics: You pay $0 or $1.30 or $3.70 or 15%
Brands: You pay $0 or $4.00 or $9.20 or 15%

Tier 5: Specialty TierOne-month supply:
Generics: You pay $0 or $1.30 or $3.70 or 15%
Brands: You pay $0 or $4.00 or $9.20 or 15%

Other Coverage Highlights

Dental Services Oral exams (for up to 1 every six months):
In-network: $0 copay
Out-of-network: 50% coinsurance
Prophylaxis (cleaning) (for up to 1 every six months):
In-network: $0 copay
Out-of-network: 50% coinsurance
Fluoride treatment (for up to 1 every year):
In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays (for up to 1):
In-network: $0 copay
Out-of-network: 50% coinsurance
Routine services:
In-network: $0 copay
Out-of-network: 50% coinsurance
Non-routine services (for up to 1):
$0 copay
Restorative services (for up to 1 every three years):
$0 copay
Endodontics (for up to 1):
$0 copay
Periodontics (for up to 1):
$0 copay
Extractions (for up to 1):
$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 1):
$0 copay
Our plan pays up to $1000 every year for dental services shown above. The maximum plan benefit coverage amount applies to both in-network and out-of-network services.

Hearing Services Hearing exams:
Routine hearing exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance
Fitting/evaluation for hearing aid (for up to 1 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance, depending on the service
Hearing aids:
Hearing aids (all types) (for up to 2 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance
Our plan pays up to $2000 every year for hearing aids. The maximum plan benefit coverage amount applies to both in-network and out-of-network services. The maximum plan benefit coverage amount applies for both ears combined.

Vision Services Eye exams:
Routine eye exams (for up to 1 every year):
In-network: $0 copay
Out-of-network: 40% coinsurance
Eyewear:
Contact lenses:
In-network: $0 copay
Out-of-network: 40% coinsurance
Eyeglasses (lenses and frames):
In-network: $0 copay
Out-of-network: 40% coinsurance
Eyeglass lenses:
In-network: $0 copay
Out-of-network: 40% coinsurance
Eyeglass frames:
In-network: $0 copay
Out-of-network: 40% coinsurance
Our plan pays up to $200 every year for all eyewear.The maximum plan benefit coverage amount applies to both in-network and out-of-network services.
Medicare-covered glaucoma screening:
In-network: $0 copay
Out-of-network: $0 copay

Fitness Benefits$0 copay

Over-the-Counter BenefitsThe maximum total annual benefit is $960.

Transportation ServicesIn-network: $0 copay, 12 trips every year by Taxi or Rideshare Services or Van (one-way) to plan approved health-related location.
Out-of-network: 75% coinsurance

Telehealth ServicesIn-network:$0 copay
Out-of-network:$0 copay

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$0
Monthly Premium

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WellCare Access (HMO D-SNP)

$0
Primary Doctor Co‑Pay
$0
Specialist Co‑Pay
Drugs Covered
Plan Features:
  • Rx Drugs
  • Hospital & Medical
  • Dental
  • Vision
  • Hearing
  • Fitness Benefits
  • Over-the-Counter Benefits
  • Transportation Services
  • Telehealth Services
  • Mental Health Care
  • Chiropractic Care

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Coverage Highlights

Star RatingFirst rating star:fullSecond rating star:fullThird rating star:fullFourth rating star:half-fullFifth rating star:empty

Annual In-Network Deductible0$

Out-of-Pocket Maximum$3450 for services you receive from in-network providers.

Office Visit for Primary Doctor$0 co-pay

Office Visit for Specialist$0 co-pay

Inpatient Hospital CoverageInpatient hospital-acute:
$0 co-pay up to 90 days per admission
Inpatient hospital psychiatric:
$0 co-pay up to 90 days per admission

Prescription Drug Deductible$0
Applies to Tier 2: Generic, Tier 3: Preferred Brand, Tier 4: Non-Preferred Drug, Tier 5: Specialty Tier

Prescription Drug Coverage (Initial Coverage, Standard Retail Cost-Sharing, 30-Day)

Tier 1: Preferred GenericOne-month supply:
You pay $0

Tier 2: GenericOne-month supply:
Generics: You pay $0 or $1.30 or $3.70 or 15%
Brands: You pay $0 or $4.00 or $9.20 or 15%

Tier 3: Preferred BrandOne-month supply:
Generics: You pay $0 or $1.30 or $3.70 or 15%
Brands: You pay $0 or $4.00 or $9.20 or 15%

Tier 4: Non-Preferred DrugOne-month supply:
Generics: You pay $0 or $1.30 or $3.70 or 15%
Brands: You pay $0 or $4.00 or $9.20 or 15%

Tier 5: Specialty TierOne-month supply:
Generics: You pay $0 or $1.30 or $3.70 or 15%
Brands: You pay $0 or $4.00 or $9.20 or 15%

Other Coverage Highlights

Dental Services Oral exams (for up to 1 every six months): $0 copay
Prophylaxis (cleaning) (for up to 1 every six months): $0 copay
Fluoride treatment (for up to 1 every year): $0 copay
Dental x-rays (for up to 1): $0 copay
Non-routine services (for up to 1): $0 copay
Diagnostic services (for up to 1 every year): $0 copay
Restorative services (for up to 1 every three years): $0 copay
Endodontics (for up to 1): $0 copay
Periodontics (for up to 1): $0 copay
Extractions (for up to 1): $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services (for up to 1): $0 copay
Our plan pays up to $1000 every year for dental services shown above.

Hearing Services Hearing exams:
Routine hearing exams (for up to 1 every year): $0 copay
Fitting/evaluation for hearing aid (for up to 1 every year): $0 copay
Hearing aids:
Hearing aids (all types) (for up to 2 every year): $0 copay
Our plan pays up to $1500 every year for hearing aids. The maximum plan benefit coverage amount applies for both ears combined.

Vision Services Eye exams:
Routine eye exams (for up to 1 every year): $0 copay
Eyewear:
Contact lenses: $0 copay
Eyeglasses (lenses and frames): $0 copay
Eyeglass lenses: $0 copay
Eyeglass frames: $0 copay
Our plan pays up to $100 every year for all eyewear.
Medicare-covered glaucoma screening: $0 copay

Fitness Benefits$0 copay

Over-the-Counter BenefitsThe maximum total annual benefit is $1,800.

Transportation Services$0 copay, 24 trips every year by Taxi or Rideshare Services or Van (one-way) to plan approved health-related location.

Telehealth Services$0 copay

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