Summary of Benefits
$0 Monthly Premium (Part C Benefits)*
$0 Annual Deductible (Part C Benefits)*
$0 Preventive Care
Part D Prescription Drug Coverage
Over-The-Counter (OTC) Benefits
- $105 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
- 20% co-insurance of Medicare-covered services
Vision Services
- 20% co-insurance of Medicare-covered services
- $0 co-insurance for routine exam. 1 per year. Routine eye wear - lenses &
frames. - $355 upgrade available for frames, lenses, or contact lenses per year
Hearing Services
- 1 Routine hearing exam; fitting/evaluation for hearing aid
- $1,200 hearing aid coverage (both ears)
maximum yearly benefit - 20% co-insurance of Medicare-covered
services
Telemedicine
- Receive quality, virtual care from any device, anywhere
*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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