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Service area 
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Monthly Plan Premium
You must continue to pay your Medicare Part B premium. If you have a late enrollment penalty, it will still apply.
$0*
Max Out-of-Pocket
$5,600
Deductible
$0
Primary Care Physician/Specialist Copays
$0/$45
Dental

$0 preventive - 2 cleanings, 2 exams, 2 fluoride treatments and 1 set of bitewing X-rays per year. Full mouth X-rays once every 5 years. Comprehensive dental covered 50%. Crowns and crown repairs covered 25%. Implants and dentures are not covered. No deductible and maximum benefit of $1,500 per year. Delta Dental PPO™ network only (members who select the optional dental buy-up have access to Delta Dental PPO and Premier networks).

Over-the-Counter Benefit

Not covered.

Vision
$0 routine exam. $150 yearly allowance towards the purchase of eyeglasses or contact lenses. 20% discount over the $150 base allowance for frames, lenses and lens options. 40% discount on the purchase of any additional eyeglasses. Must use EyeMed provider.
Hearing and Hearing Aids
$0 routine exam. Copays for hearing aids cover 1 hearing aid per ear per year and 60 batteries per year per hearing aid. Copay will depend upon the technology level of the hearing aid. Must use NationsHearing provider.
Inpatient Hospital
$375 per day for days 1-6. $0 per day for days 7-90. Unlimited days.
Preventive Care
$0 copay for many preventive health services. These may include checkups, screenings, vaccines and health education. Please see the Evidence of Coverage (EOC) for more information on covered preventive services.
Outpatient Diagnostic Labs, Procedures and Tests
$0 lab tests. $0 - $150 copay depending on service.
Emergency and Urgent Care
$130 emergency room copay (waived if admitted).  $0-$50 urgent care copay (depending on provider). Worldwide coverage.
Physical, Occupational and Speech Therapy
$40 copay. CMS annual maximum applies.
Prescription Coverage
Yes
Flex Card
Not covered.
Transportation
Not covered.

Call our licensed Medicare Advantage agents today.

Oct. 1 – March 31, 8 a.m. to 8 p.m., Seven days a week or April 1 – Sept. 30, 8 a.m. to 8 p.m., Monday through Friday

(888) 447-3850 (TTY: 711)
or
Schedule an appointmentScheduleEnroll now

Call our licensed Medicare Advantage agents today.

Oct. 1 – March 31, 8 a.m. to 8 p.m., Seven days a week or April 1 – Sept. 30, 8 a.m. to 8 p.m., Monday through Friday

(888) 447-3850 (TTY: 711)

*You must continue to pay your Medicare Part B premium. If you have a late enrollment penalty, it will still apply.

The Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a five-star rating system. Star Ratings are calculated each year and may change.