Summary of Benefits
$0 Annual Premium*
$0 Deductible
Part D Prescription Drug Coverage
$0 Preventative Care and Screenings
Over-The-Counter Benefits
- $100 per month over-the counter drug benefit
- Covers health-related drugs and supplies including cough, cold and allergy medications, first aid supplies and much more at no cost
Dental Coverage
- Up to $750 in preventive and comprehensive dental benefits annually
- 2 oral exams and cleanings per year
- 1 x-ray per year
Vision Coverage
- $100 annual allowance for frames, lenses or contact lenses
- 1 routine annual eye exam
Transportation
- 8 one-way medically necessary trips per year
Hearing Aids
- $1,000 every two years (both ears)
*Member must continue to pay their Medicare Part B premium
Download 2020 Summary of Benefits Documents
If you want to know more about the coverage and costs of original Medicare, view it online at https://www.medicare.gov, or get a copy by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
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