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2023 第一保健 / 安泰 / 藍十字 / Humana / UHC 聯合 / WellCare 維康 Medicare

241,514 Views

2023 Preview

$0
每月保費醫療自付扣除金

免費諮詢

Healthfirst Signature (PPO)

$0 定額手續費
醫生門診(主治護理)
$45 定額手續費
專科醫生護理
覆蓋藥物
計劃特點:
  • 預防性牙科服務
  • 常規視覺檢查
  • 常規聽覺檢查
  • 每週七天每天24小時獲取電話看診護理和使用護士協助專線
  • 優惠副廠藥
  • 出院後餐食
  • SilverSneakers® 健身計劃

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Coverage Highlights

Star RatingPlan too new to be measured

Annual In-Network DeductibleOut-of-network: $1,000

Out-of-Pocket Maximum In-network: $7,000
Any provider: $11,000

Office Visit for Primary DoctorIn-network: $0 copay
Out-of-network: $50 copay after deductible

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

Inpatient Hospital CoverageInpatient hospital-acute:

  • In-network
  • Unlimited days covered
  • $502 per day for days 1 – 3
  • $0 per day for days 4 – 90
  • $0 per day for days 91 and beyond
  • Out-of-network
  • 40% coinsurance after deductible

Inpatient hospital psychiatric:

  • In-network
  • Up to 90 days covered
  • $420 per day for days 1 – 3
  • $0 per day for days 4 – 90
  • Out-of-network
  • 40% coinsurance after deductible

Prescription Drug Deductible$250 (applies to Tier 4 and 5)

Other Coverage Highlights

牙科 ServicesDental Allowance:
$1,500 allowance every year (applies to both in-network and out-of-network services)
Prophylaxis (cleaning):
In-network: $0 – Up to 2 every year
Out-of-network: $20
Oral exams:
In-network: $0 – Up to 2 every year
Out-of-network: $0
Fluoride treatment:
In-network: $0 – Up to 2 every year
Out-of-network: $0
Dental x-rays:
In-network: $0 – Up to 1
Out-of-network: $0
Non-routine services:
In-network: $0 – Up to 1
Out-of-network: $0 – $100*
Diagnostic services:
In-network: $0 – Up to 1
Out-of-network: $0 – $20*
Restorative services:
In-network: $0 – Up to 1
Out-of-network: $0 – $100*
Endodontics:
In-network: $0 – Up to 1
Out-of-network: $0 – $100*
Periodontics:
In-network: $0 – Up to 1
Out-of-network: $0 – $100*
Extractions:
In-network: $0 – Up to 1
Out-of-network: $0 – $40*
Prosthodontics, other oral/maxillofacial surgery and other services:
In-network: $0 – Up to 1
Out-of-network: $0 – $100*

聽覺 ServicesRoutine hearing exams:
In-network: $0 – Up to 1 every year
Out-of-network: $0
Hearing aid fitting or evaluation:
In-network: $0 – Up to 1 every year
Out-of-network: $0
Hearing aids of all types:
In-network: $0 – $1,475* – Up to 2 hearing aids every year
Out-of-network: $0 – $1,475*

眼科 ServicesVision allowance:
$250 allowance every two years (applies to both in-network and out-of-network services)
Routine eye exams:
In-network: $0 – Up to 1 every year
Out-of-network: $0
Glaucoma screening:
In-network: $0
Out-of-network: 50% coinsurance after deductible
Other services:
In-network: $0 – Up to 1 every year
Out-of-network: $0
Eyeglasses (lenses and frames):
In-network: $0
Out-of-network: $0
Contact lenses:
In-network: $0
Out-of-network: $0

Fitness Benefits In-network: $0 copay
Out-of-network: $0 copay

Telehealth Services In-network: $0 – $45* copay
*Limitation applies

Insulin Savings Initial Coverage, Standard Retail Cost-Sharing, 30-DayTier 3 (Preferred Brand): $35.00 copay no deductible (one-month supply) for select insulins

2023 Preview

$0
月保費

免費諮詢

Healthfirst – 第一保健 Signature (HMO)

$10
家庭醫生診療費
$40
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 非處方藥福利
  • 網上看診
  • 心理精神健康
  • 整脊保健

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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

牙科 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
牙科 x-rays (for up to 1 every six months): You pay nothing
$100 deductible for Comprehensive 牙科 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) 免費接送 benefit, or 3) Reduction in Cost-Sharing (Deductible) for Comprehensive 牙科 Services, benefit should correspond to the type you selected. Plan will not include all three benefits.

聽覺 Services聽覺 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
聽覺 aids:
聽覺 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.

眼科 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

健身You pay nothing

SilverSneakers健身運動項目Yes Find participating gyms

非處方藥福利 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) 免費接送 benefit, or 3) Reduction in Cost-Sharing (Deductible) for Comprehensive 牙科 Services, benefit should correspond to the type you selected. Plan will not include all three benefits.

免費接送You 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) 免費接送 benefit, or 3) Reduction in Cost-Sharing (Deductible) for Comprehensive 牙科 Services, benefit should correspond to the type you selected. Plan will not include all three benefits.

網上看診You pay nothing

2023 Preview

$29.60
月保費

免費諮詢

Healthfirst – 第一保健 Increased Benefits Plan (HMO)

$0
家庭醫生診療費
$25
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 非處方藥福利
  • 免費接送
  • 網上看診
  • 心理精神健康
  • 整脊保健

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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

牙科 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
牙科 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

聽覺 Services聽覺 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
聽覺 aids:
聽覺 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.

眼科 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

健身You pay nothing

SilverSneakers健身運動項目Yes Find participating gyms

非處方藥福利Up to $15 per month, no rollover.

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

網上看診You pay nothing


2023 Preview

$0
月保費

免費諮詢

Healthfirst – 第一保健 Life Improvement Plan (HMO D-SNP)

$0
家庭醫生診療費
$0
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 非處方藥福利
  • 免費接送
  • 網上看診
  • 心理精神健康
  • 整脊保健

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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

牙科 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
牙科 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

聽覺 Services聽覺 exams:
Routine hearing exams: $0 copay
Fitting/evaluation for hearing aid: $0 copay
聽覺 aids:
聽覺 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.

眼科 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

健身$0 copay

SilverSneakers健身運動項目Yes Find participating gyms

非處方藥福利$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.

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

網上看診$0 copay

2023 Preview

$0
月保費

免費諮詢

Aetna – 安泰 Medicare Elite Plan (PPO)

$0
家庭醫生診療費
$40
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

聽覺 Services聽覺 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
聽覺 aids:
聽覺 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.

眼科 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

健身In-network: $0 copay
Out-of-network: $0 copay

SilverSneakers健身運動項目Yes Find participating gyms

網上看診$0-$65 copay, depending on the service

2023 Preview

$0
月保費

免費諮詢

Aetna – 安泰 Medicare Value Plan (HMO)

$5
家庭醫生診療費
$45
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

聽覺 Services聽覺 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
聽覺 aids:
聽覺 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.

眼科 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

健身In-network: $0 copay
Out-of-network: $0 copay

SilverSneakers健身運動項目Yes Find participating gyms

網上看診$0-$65 copay, depending on the service

2023 Preview

$23.00
月保費

免費諮詢

Aetna – 安泰 Medicare Elite Plan 3 (PPO)

$0
家庭醫生診療費
$35
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 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
牙科 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.

聽覺 Services聽覺 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
聽覺 aids:
聽覺 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.

眼科 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

健身In-network: $0 copay
Out-of-network: $0 copay

SilverSneakers健身運動項目Yes Find participating gyms

網上看診$0-$65 copay, depending on the service

2023 Preview

$30.00
月保費

免費諮詢

Aetna – 安泰 Medicare Discover Value Plan (PPO)

$0
家庭醫生診療費
$40
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

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

聽覺 Services聽覺 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
聽覺 aids:
聽覺 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.

眼科 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

健身$0 copay

SilverSneakers健身運動項目Yes Find participating gyms

網上看診$0-$65 copay, depending on the service

2023 Preview

$97.00
月保費

免費諮詢

Aetna – 安泰 Medicare Premier Plan (PPO)

$5
家庭醫生診療費
$40
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 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
牙科 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.

聽覺 Services聽覺 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
聽覺 aids:
聽覺 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.

眼科 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

健身In-network: $0 copay
Out-of-network: $0 copay

SilverSneakers健身運動項目Yes Find participating gyms

網上看診$0-$65 copay, depending on the service

2023 Preview

$0
月保費

免費諮詢

Aetna – 安泰 Medicare Assure Plan (HMO D-SNP)

$0
家庭醫生診療費
$0
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 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
牙科 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.

聽覺 Services聽覺 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
聽覺 aids:
聽覺 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.

眼科 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

健身In-network: $0 copay
Out-of-network: $0 copay

SilverSneakers健身運動項目Yes Find participating gyms

網上看診$0-$65 copay, depending on the service

2023 Preview

$0
月保費

免費諮詢

Empire MediBlue HealthPlus Select (HMO)

$0
家庭醫生診療費
$25
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 非處方藥福利
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

眼科 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

健身$0 copay

SilverSneakers健身運動項目Yes Find participating gyms

非處方藥福利$0 copay. Up to $27 every three months

網上看診$0 copay

2023 Preview

$0
月保費

免費諮詢

Empire MediBlue Dual Advantage (HMO D-SNP)

$0
家庭醫生診療費
$0
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 非處方藥福利
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 Services Oral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 2 every year): $0 copay
牙科 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

聽覺 Services聽覺 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
聽覺 aids:
聽覺 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

眼科 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

健身$0 copay

SilverSneakers健身運動項目Yes Find participating gyms

非處方藥福利$0 copay. Up to $35 every three months

網上看診$0 copay

2023 Preview

$0
月保費

免費諮詢

Empire MediBlue Dual Advantage Select (HMO D-SNP)

$0
家庭醫生診療費
$0
專科醫生診療費
覆蓋藥物
計劃特點:
  • 醫院和看病
  • 眼科
  • SilverSneakers健身運動項目
  • 健身
  • 非處方藥福利
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

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

健身$0 copay

SilverSneakers健身運動項目Yes Find participating gyms

非處方藥福利$0 copay. Up to $64 every three months

網上看診$0 copay

2023 Preview

$0
月保費

免費諮詢

Empire MediBlue HealthPlus Dual Connect (HMO D-SNP)

$0
家庭醫生診療費
$0
專科醫生診療費
覆蓋藥物
計劃特點:
  • 醫院和看病
  • 牙科
  • 眼科
  • SilverSneakers健身運動項目
  • 健身
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 ServicesOral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 2 every year): $0 copay
牙科 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

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

健身$0 copay

SilverSneakers健身運動項目Yes Find participating gyms

網上看診$0 copay

2023 Preview

$0
月保費

免費諮詢

EmblemHealth VIP Reserve Classic (HMO)

$0
家庭醫生診療費
$25
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 非處方藥福利
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

眼科 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

健身$0 copay

SilverSneakers健身運動項目Yes Find participating gyms

非處方藥福利$0 copay. Up to $27 every three months

網上看診$0 copay

2023 Preview

$93.00
月保費

免費諮詢

EmblemHealth VIP Gold (HMO)

$0
家庭醫生診療費
$25
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 非處方藥福利
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 Services Oral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 2 every year): $0 copay
牙科 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

聽覺 Services聽覺 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
聽覺 aids:
聽覺 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

眼科 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

健身$0 copay

SilverSneakers健身運動項目Yes Find participating gyms

非處方藥福利$0 copay. Up to $35 every three months

網上看診$0 copay

2023 Preview

$254.00
月保費

免費諮詢

EmblemHealth VIP Gold Plus (HMO)

$0
家庭醫生診療費
$0
專科醫生診療費
覆蓋藥物
計劃特點:
  • 醫院和看病
  • 眼科
  • SilverSneakers健身運動項目
  • 健身
  • 非處方藥福利
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

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

健身$0 copay

SilverSneakers健身運動項目Yes Find participating gyms

非處方藥福利$0 copay. Up to $64 every three months

網上看診$0 copay

2023 Preview

$0
月保費

免費諮詢

EmblemHealth VIP Dual Reserve (HMO D-SNP)

$0
家庭醫生診療費
$0
專科醫生診療費
覆蓋藥物
計劃特點:
  • 醫院和看病
  • 牙科
  • 眼科
  • SilverSneakers健身運動項目
  • 健身
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 ServicesOral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 2 every year): $0 copay
牙科 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

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

健身$0 copay

SilverSneakers健身運動項目Yes Find participating gyms

網上看診$0 copay

2023 Preview

$0
月保費

免費諮詢

EmblemHealth VIP Dual (HMO D-SNP)

$0
家庭醫生診療費
$0
專科醫生診療費
覆蓋藥物
計劃特點:
  • 醫院和看病
  • 牙科
  • 眼科
  • SilverSneakers健身運動項目
  • 健身
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 ServicesOral exams (for up to 2 every year): $0 copay
Prophylaxis (cleaning) (for up to 2 every year): $0 copay
牙科 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

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

健身$0 copay

SilverSneakers健身運動項目Yes Find participating gyms

網上看診$0 copay

2023 Preview

$0
月保費

免費諮詢

HumanaChoice H5970-024 (PPO)

0
家庭醫生診療費
$50
專科醫生診療費
覆蓋藥物
計劃特點:
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 非處方藥福利
  • 免費接送
  • 網上看診
  • Part B Give Back
  • 心理精神健康
  • 整脊保健

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

牙科 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
牙科 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.

聽覺 Services聽覺 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
聽覺 aids:
聽覺 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.

眼科 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

健身In-network: You pay nothing
Out-of-network: 50% coinsurance

SilverSneakers健身運動項目Yes Find participating gyms

非處方藥福利In-network: You pay nothing. Up to $50 every three months
Out-of-network: 50% coinsurance

免費接送In-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

網上看診$0-$40 copay, depending on the service

2023 Preview

$0
月保費

免費諮詢

Humana Gold Plus H3533-027 (HMO)

0
家庭醫生診療費
$50
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 網上看診
  • Part B Give Back
  • 心理精神健康
  • 整脊保健

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

聽覺 Services 聽覺 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
聽覺 aids:
聽覺 aids (all types) (for up to 2 every year): $699-$999 copay, depending on the service

眼科 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

健身You pay nothing

SilverSneakers健身運動項目Yes Find participating gyms

網上看診$0-$50 copay, depending on the service

2023 Preview

$23
月保費

免費諮詢

Humana Gold Plus H3533-032 (HMO)

0
家庭醫生診療費
$45
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 非處方藥福利
  • 免費接送
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 Services
Oral exams (for up to 3): 0% coinsurance
Prophylaxis (cleaning) (for up to 2 every year): 0% coinsurance
牙科 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.

聽覺 Services聽覺 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
聽覺 aids:
聽覺 aids (all types) (for up to 2 every year): $699-$999 copay, depending on the service

眼科 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

健身You pay nothing

SilverSneakers健身運動項目Yes Find participating gyms

非處方藥福利You pay nothing. Up to $45 every three months

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

網上看診$0-$50 copay, depending on the service

2023 Preview

$0
月保費

免費諮詢

Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP)

0
家庭醫生診療費
$0
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 眼科
  • 聽覺
  • SilverSneakers健身運動項目
  • 健身
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

聽覺 Services聽覺 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
聽覺 aids:
聽覺 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

眼科 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

健身In-network: You pay nothing
Out-of-network: 50% coinsurance

SilverSneakers健身運動項目Yes Find participating gyms

網上看診$0-$40 copay, depending on the service

2023 Preview

$0
月保費

免費諮詢

AARP Medicare Advantage Prime (HMO-POS)

$0
家庭醫生診療費
$45
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • 健身
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 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
牙科 x-rays (for up to 1 every three years): $0 copay

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

眼科 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

健身$0 copay

網上看診$0 copay

2023 Preview

$0
月保費

免費諮詢

AARP Medicare Advantage Mosaic Choice (PPO)

$0-$25
家庭醫生診療費
$25-$50
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • 健身
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 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
牙科 x-rays (for up to 1 every three years):
In-network: $0 copay
Out-of-network: $0 copay

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

眼科 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

健身In-network: $0 copay
Out-of-network: $0 copay

網上看診$0 copay

2023 Preview

$34.00
月保費

免費諮詢

AARP Medicare Advantage Plan 2 (HMO-POS)

$0
家庭醫生診療費
$50
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 眼科
  • 聽覺
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

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

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

網上看診$0 copay

2023 Preview

$52.00
月保費

免費諮詢

AARP Medicare Advantage Plan 1 (HMO-POS)

$0
家庭醫生診療費
$45
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • 健身
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 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
牙科 x-rays (for up to 1 every three years): $0 copay

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

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

健身$0 copay

網上看診$0 copay

2023 Preview

$0
月保費

免費諮詢

UnitedHealthcare Dual Complete Choice (PPO D-SNP)

$0
家庭醫生診療費
$0
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • 健身
  • 非處方藥福利
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

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

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

眼科 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

健身 $0 copay

非處方藥福利$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.

網上看診$0 copay; Speak to network telehealth providers using your computer or mobile device.

2023 Preview

$0
月保費

免費諮詢

UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP)

$0
家庭醫生診療費
$0
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • 健身
  • 非處方藥福利
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

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

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

眼科 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

健身 $0 copay

非處方藥福利$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.

網上看診$0 copay; Speak to network telehealth providers using your computer or mobile device.

2023 Preview

$0
月保費

免費諮詢

UnitedHealthcare Dual Complete Plan 2 (HMO-POS D-SNP)

$0
家庭醫生診療費
$0
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • 健身
  • 非處方藥福利
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

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

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

眼科 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

健身 $0 copay

非處方藥福利$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.

網上看診$0 copay; Speak to network telehealth providers using your computer or mobile device.

2023 Preview

$0
月保費

免費諮詢

Wellcare Giveback Open (PPO)

$0
家庭醫生診療費
$50
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • 健身
  • 非處方藥福利
  • 免費接送
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 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
牙科 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.

聽覺 Services 聽覺 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
聽覺 aids:
聽覺 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.

眼科 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

健身$0 copay

非處方藥福利$0 copay. Up to $55 every three months copay

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

網上看診$0-$45 copay, depending on the service

2023 Preview

$0
月保費

免費諮詢

Wellcare No Premium Open (PPO)

$0
家庭醫生診療費
$40
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 健身
  • 非處方藥福利
  • 免費接送
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 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
牙科 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.

眼科 Services Medicare-covered glaucoma screening:$0 copay

健身$0 copay

非處方藥福利$0 copay. Up to $35 every three months

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

網上看診$0-$40 copay, depending on the service

2023 Preview

$0
月保費

免費諮詢

Wellcare No Premium (HMO)

$0
家庭醫生診療費
$45
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 健身
  • 非處方藥福利
  • 免費接送
  • 網上看診
  • 心理精神健康
  • 整脊保健

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

牙科 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
牙科 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.

聽覺 Services 聽覺 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
聽覺 aids:
聽覺 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.

眼科 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

健身In-network: $0 copay
Out-of-network: $0 copay

非處方藥福利In-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.

網上看診$0-$40 copay, depending on the service

2023 Preview

$16.90
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Wellcare Assist (HMO)

$0
家庭醫生診療費
$35
專科醫生診療費
覆蓋藥物
計劃特點:
  • Rx藥物
  • 醫院和看病
  • 牙科
  • 眼科
  • 聽覺
  • 健身
  • 非處方藥福利
  • 網上看診
  • Part B Give Back
  • 心理精神健康
  • 整脊保健

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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 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

牙科 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
牙科 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

聽覺 Services 聽覺 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
聽覺 aids:
聽覺 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.

眼科 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

健身In-network: $0 copay
Out-of-network: $0 copay

非處方藥福利In-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.

網上看診$0-$40 copay, depending on the service