2021 Benefit Highlights
$0 Annual Premium*
$0 Deductible
$0 Preventative Care and Screenings
Part D Prescription Drug Coverage

Over-The-Counter (OTC) Benefits
- $130 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 Services
- Up to $1,000 in preventive and comprehensive dental benefits
annually - 2 oral exams and cleanings per year
- 1 x-ray per year

Telemedicine
- Quality virtual healthcare from any device, anywhere
- $0 co-insurance
- No referral required

Vision Services
- 1 routine annual eye exam
- $355 annual upgrade for frames, lenses or contact lenses

Hearing Aids
- $1,200 (both ears) yearly
*Member must continue to pay their Medicare Part B premium

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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