Last updated December 12, 2024
Medicare Advantage Plans
Medicare Advantage Plans are a type of Medicare health plan. Advantage Plans are offered by private companies that contract with Medicare to provide all your Medicare benefits. This type of plan is also known as Medicare Part C. You must be enrolled in Part A and Part B to enroll in an Advantage Plan.
Medicare Savings Programs (MSP)
- QR: Financial assistance for people with low to modest income
- Senior LinkAge Line website: Help with Medicare Costs
This information is to be used with results from the Medicare.gov plan finder tool.
The information shown is a condensed version and does not include all benefits. Always contact the insurance company to confirm benefits and costs.
Insurance companies that sell Advantage Plans
Insurance companies are listed alphabetically, and plans are listed by ascending premium amount within each company.
There are no five star plans in Minnesota in 2025.
AARP Medicare Advantage from UnitedHealthcare
New member enrollment: 800-555-5757
Customer service: 844-867-3487
TTY: 711
Website: AARPMedicarePlans.com
AARP Medicare Advantage from UHC FG-0002
H2001-119
PPO
Monthly premium: $0
| Travel coverage | Access to UnitedHealthcare® Medicare National Network |
| Dental | In and out-of-network: $0 copay for exams, cleanings, X-rays and fluoride. Dental Platinum Rider available for an additional $54/month. See Evidence of Coverage for details. |
| Vision | Routine Eye Exam: In-Network: $0 copay, 1 per year Out-of-Network: $0 copay, 1 per year Routine Eyewear: In and out-of-network: $0 copay; Plan pays up to $200 every 2 years toward your purchase of 1 pair of frames (with a $0 copay for standard lenses and a $40 - $153 copay for other covered lenses) or contact lenses (fitting and evaluation may be an additional cost) through network providers. |
| Hearing | Routine Hearing Exam: In-Network: $0 copay, 1 per year Out-of-Network: $70 copay, 1 per year Hearing Aids: In and out-of-network: $99 - $829 copay for each OTC hearing aid. $199 - $1,249 copay for each prescription hearing aid. Limited to 2 devices every year. |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $570/tiers 3-5 |
| Discounts & programs | Virtual medical and mental health visits; meal benefit package; fitness program; Personal Emergency Response System (PERS) devices and fitness trackers available through a member discount |
AARP Medicare Advantage from UHC MN-0001
H2001-116
PPO
Monthly premium: $0
| Travel coverage | Passport benefit included |
| Dental | In and out-of-network: $0 copay for exams, cleanings, X-rays and fluoride: 50% coinsurance on dentures and bridges, $0 copay for all other covered comprehensive services: $1,000 combined limit on all covered dental services |
| Vision | Routine Eye Exam: In-Network: $0 copay, 1 per year Out-of-Network: $0 copay, 1 per year Routine Eyewear: In and out-of-network: $0 copay; Plan pays up to $300 every 2 years toward your purchase of 1 pair of frames (with a $0 copay for standard lenses and a $40 - $153 copay for other covered lenses) or contact lenses (fitting and evaluation may be an additional cost) through network providers. |
| Hearing | Routine Hearing Exam: In-Network: $0 copay, 1 per year Out-of-Network: $65 copay, 1 per year Hearing Aids: In and out-of-network: $99 - $829 copay for each OTC hearing aid. $199 - $1,249 copay for each prescription hearing aid. Limited to 2 devices every year. |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $420/tiers 3-5 |
| Discounts & programs | Virtual medical and mental health visits; meal benefit package; fitness program; $35/quarter over-the-counter debit card and catalog, amount expires quarterly; Personal Emergency Response System (PERS) devices and fitness trackers available through a member discount |
AARP Medicare Advantage Patriot No Rx SI-MA01
H1278-019
PPO
Monthly premium: $0
$100 Part B premium reduction
| Travel coverage | Access to UnitedHealthcare® Medicare National Network |
| Dental | In and out-of-network: $0 copay for exams, cleanings, X-rays and fluoride: 50% coinsurance on dentures and bridges, $0 copay for all other covered comprehensive services: $1,000 combined limit on all covered dental services |
| Vision | Routine Eye Exam: In-Network: $0 copay, 1 per year Out-of-Network: $0 copay, 1 per year Routine Eyewear: In and out-of-network: $0 copay; Plan pays up to $200 every 2 years toward your purchase of 1 pair of frames (with a $0 copay for standard lenses and a $40 - $153 copay for other covered lenses) or contact lenses (fitting and evaluation may be an additional cost) through network providers. |
| Hearing | Routine Hearing Exam: In-Network: $0 copay, 1 per year Out-of-Network: $60 copay, 1 per year Hearing Aids: In and out-of-network: $99 - $829 copay for each OTC hearing aid. $199 - $1,249 copay for each prescription hearing aid. Limited to 2 devices every year. |
| Medicare Part D coverage | No, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Discounts & programs | Virtual medical and mental health visits; meal benefit package; fitness program; $25/quarter over-the-counter debit card and catalog, amount expires quarterly; Personal Emergency Response System (PERS) devices and fitness trackers available through a member discount |
AARP Medicare Advantage Patriot No Rx FG-MA01
H2001-124
PPO
Monthly premium: $0
$125 Part B premium reduction
| Travel coverage | Access to UnitedHealthcare® Medicare National Network |
| Dental | In and out-of-network: $0 copay for exams, cleanings, X-rays and fluoride: 50% coinsurance on dentures and bridges, $0 copay for all other covered comprehensive services: $2,500 combined limit on all covered dental services |
| Vision | Routine Eye Exam: In-Network: $0 copay, 1 per year Out-of-Network: $0 copay, 1 per year Routine Eyewear: In and out-of-network: $0 copay; Plan pays up to $250 every 2 years toward your purchase of 1 pair of frames (with a $0 copay for standard lenses and a $40 - $153 copay for other covered lenses) or contact lenses (fitting and evaluation may be an additional cost) through network providers. |
| Hearing | Routine Hearing Exam: In-Network: $0 copay, 1 per year Out-of-Network: $60 copay, 1 per year Hearing Aids: In and out-of-network: $99 - $829 copay for each OTC hearing aid. $199 - $1,249 copay for each prescription hearing aid. Limited to 2 devices every year. |
| Medicare Part D coverage | No, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Discounts & programs | Virtual medical and mental health visits; meal benefit package; fitness program; $40/quarter over-the-counter debit card and catalog, amount expires quarterly; Personal Emergency Response System (PERS) devices and fitness trackers available through a member discount |
AARP Medicare Advantage from UHC MN-0003
H2001-121
PPO
Monthly premium: $18
| Travel coverage | Access to UnitedHealthcare® Medicare National Network |
| Dental | In and out-of-network: $0 copay for exams, cleanings, X-rays and fluoride. Dental Platinum Rider available for an additional $54/month. See Evidence of Coverage for details. |
| Vision | Routine Eye Exam: In-Network: $0 copay, 1 per year Out-of-Network: $0 copay, 1 per year Routine Eyewear: In and out-of-network: $0 copay; Plan pays up to $300 every 2 years toward your purchase of 1 pair of frames (with a $0 copay for standard lenses and a $40 - $153 copay for other covered lenses) or contact lenses (fitting and evaluation may be an additional cost) through network providers. |
| Hearing | Routine Hearing Exam: In-Network: $0 copay, 1 per year Out-of-Network: $70 copay, 1 per year Hearing Aids: In and out-of-network: $99 - $829 copay for each OTC hearing aid. $199 - $1,249 copay for each prescription hearing aid. Limited to 2 devices every year. |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $570/tiers 3-5 |
| Discounts & programs | Virtual medical and mental health visits; meal benefit package; fitness program; Personal Emergency Response System (PERS) devices and fitness trackers available through a member discount |
AARP Medicare Advantage from UHC SI-0001
H1278-007
PPO
Monthly premium: $24
| Travel coverage | Access to UnitedHealthcare® Medicare National Network |
| Dental | In and out-of-network: $0 copay for exams, cleanings, X-rays and fluoride. Dental Platinum Rider available for an additional $54/month. See Evidence of Coverage for details. |
| Vision | Routine Eye Exam: In-Network: $0 copay, 1 per year Out-of-Network: $0 copay, 1 per year Routine Eyewear: In and out-of-network: $0 copay; Plan pays up to $300 every 2 years toward your purchase of 1 pair of frames (with a $0 copay for standard lenses and a $40 - $153 copay for other covered lenses) or contact lenses (fitting and evaluation may be an additional cost) through network providers. |
| Hearing | Routine Hearing Exam: In-Network: $0 copay, 1 per year Out-of-Network: $60 copay, 1 per year Hearing Aids: In and out-of-network: $99 - $829 copay for each OTC hearing aid. $199 - $1,249 copay for each prescription hearing aid. Limited to 2 devices every year. |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $495/tiers 3-5 |
| Discounts & programs | Virtual medical and mental health visits; meal benefit package; fitness program; $25/quarter over-the-counter debit card and catalog, amount expires quarterly; Personal Emergency Response System (PERS) devices and fitness trackers available through a member discount |
AARP Medicare Advantage from UHC MN-0002
H2001-117
PPO
Monthly premium: $36
| Travel coverage | Access to UnitedHealthcare® Medicare National Network |
| Dental | In and out-of-network: $0 copay for exams, cleanings, X-rays and fluoride: 50% coinsurance on dentures and bridges, $0 copay for all other covered comprehensive services: $1,500 combined limit on all covered dental services |
| Vision | Routine Eye Exam: In-Network: $0 copay, 1 per year Out-of-Network: $0 copay, 1 per year Routine Eyewear: In and out-of-network: $0 copay; Plan pays up to $200 every 2 years toward your purchase of 1 pair of frames (with a $0 copay for standard lenses and a $40 - $153 copay for other covered lenses) or contact lenses (fitting and evaluation may be an additional cost) through network providers. |
| Hearing | Routine Hearing Exam: In-Network: $0 copay, 1 per year Out-of-Network: $60 copay, 1 per year Hearing Aids: In and out-of-network: $99 - $829 copay for each OTC hearing aid. $199 - $1,249 copay for each prescription hearing aid. Limited to 2 devices every year. |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $340/tiers 3-5 |
| Discounts & programs | Virtual medical and mental health visits; meal benefit package; fitness program; $25/quarter over-the-counter debit card and catalog, amount expires quarterly; Personal Emergency Response System (PERS) devices and fitness trackers available through a member discount |
AARP Medicare Advantage from UHC FG-0001
H2001-118
PPO
Monthly premium: $40.60
| Travel coverage | Access to UnitedHealthcare® Medicare National Network |
| Dental | In and out-of-network: $0 copay for exams, cleanings, X-rays and fluoride: 50% coinsurance on dentures and bridges, $0 copay for all other covered comprehensive services: $1,250 combined limit on all covered dental services |
| Vision | Routine Eye Exam: In-Network: $0 copay, 1 per year Out-of-Network: $0 copay, 1 per year Routine Eyewear: In and out-of-network: $0 copay; Plan pays up to $200 every 2 years toward your purchase of 1 pair of frames (with a $0 copay for standard lenses and a $40 - $153 copay for other covered lenses) or contact lenses (fitting and evaluation may be an additional cost) through network providers. |
| Hearing | Routine Hearing Exam: In-Network: $0 copay, 1 per year Out-of-Network: $60 copay, 1 per year Hearing Aids: In and out-of-network: $99 - $829 copay for each OTC hearing aid. $199 - $1,249 copay for each prescription hearing aid. Limited to 2 devices every year. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $590/all tiers |
| Discounts & programs | Virtual medical and mental health visits; meal benefit package; fitness program; $65/quarter over-the-counter debit card and catalog, amount expires quarterly; Personal Emergency Response System (PERS) devices and fitness trackers available through a member discount |
AARP Medicare Advantage from UHC FG-0003
H2001-120
PPO
Monthly premium: $59
| Travel coverage | Access to UnitedHealthcare® Medicare National Network |
| Dental | In and out-of-network: $0 copay for exams, cleanings, X-rays and fluoride: 50% coinsurance on dentures and bridges, $0 copay for all other covered comprehensive services: $750 combined limit on all covered dental services. Dental Platinum Rider available for an additional $37/month. See Evidence of Coverage for details. |
| Vision | Routine Eye Exam: In-Network: $0 copay, 1 per year Out-of-Network: $0 copay, 1 per year Routine Eyewear: In and out-of-network: $0 copay; Plan pays up to $300 every 2 years toward your purchase of 1 pair of frames (with a $0 copay for standard lenses and a $40 - $153 copay for other covered lenses) or contact lenses (fitting and evaluation may be an additional cost) through network providers. |
| Hearing | Routine Hearing Exam: In-Network: $0 copay, 1 per year Out-of-Network: $60 copay, 1 per year Hearing Aids: In and out-of-network: $99 - $829 copay for each OTC hearing aid. $199 - $1,249 copay for each prescription hearing aid. Limited to 2 devices every year. |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2; $495/tiers 3- 5 |
| Discounts & programs | Virtual medical and mental health visits; meal benefit package; fitness program; $40/quarter over-the-counter debit card and catalog, amount expires quarterly; Personal Emergency Response System (PERS) devices and fitness trackers available through a member discount |
AARP Medicare Advantage from UHC MN-0004
H2001-122
PPO
Monthly premium: $66
| Travel coverage | Access to UnitedHealthcare® Medicare National Network |
| Dental | In and out-of-network: $0 copay for exams, cleanings, X-rays and fluoride. Dental Platinum Rider available for an additional $54/month. See Evidence of Coverage for details. |
| Vision | Routine Eye Exam: In-Network: $0 copay, 1 per year Out-of-Network: $0 copay, 1 per year Routine Eyewear: In and out-of-network: $0 copay; Plan pays up to $150 every 2 years toward your purchase of 1 pair of frames (with a $0 copay for standard lenses and a $40 - $153 copay for other covered lenses) or contact lenses (fitting and evaluation may be an additional cost) through network providers. |
| Hearing | Routine Hearing Exam: In-Network: $0 copay, 1 per year Out-of-Network: $65 copay, 1 per year Hearing Aids: In and out-of-network: $99 - $829 copay for each OTC hearing aid. $199 - $1,249 copay for each prescription hearing aid. Limited to 2 devices every year. |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2; $495/tiers 3-5 |
| Discounts & programs | Virtual medical and mental health visits; meal benefit package; fitness program; $25/quarter over-the-counter debit card and catalog, amount expires quarterly; Personal Emergency Response System (PERS) devices and fitness trackers available through a member discount |
AARP Medicare Advantage from UHC MN-0005
H2001-123
PPO
Monthly premium: $66
| Travel coverage | Access to UnitedHealthcare® Medicare National Network |
| Dental | In and out-of-network: $0 copay for exams, cleanings, X-rays and fluoride: 50% coinsurance on dentures and bridges, $0 copay for all other covered comprehensive services: $2,000 combined limit on all covered dental services |
| Vision | Routine Eye Exam: In-Network: $0 copay, 1 per year Out-of-Network: $0 copay, 1 per year Routine Eyewear: In and out-of-network: $0 copay; Plan pays up to $200 every 2 years toward your purchase of 1 pair of frames (with a $0 copay for standard lenses and a $40 - $153 copay for other covered lenses) or contact lenses (fitting and evaluation may be an additional cost) through network providers. |
| Hearing | Routine Hearing Exam: In-Network: $0 copay, 1 per year Out-of-Network: $55 copay, 1 per year Hearing Aids: In and out-of-network: $99 - $829 copay for each OTC hearing aid. $199 - $1,249 copay for each prescription hearing aid. Limited to 2 devices every year. |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $340/tiers 3-5 |
| Discounts & programs | Virtual medical and mental health visits; meal benefit package; fitness program; $50/quarter over-the-counter debit card and catalog, amount expires quarterly; Personal Emergency Response System (PERS) devices and fitness trackers available through a member discount |
Align by Sanford Health Plan
New member enrollment: 888-605-9277
Customer service: 888-278-6485
TTY: 711
Website: https://www.sanfordhealthplan.com/align
Align ChoicePlus
H3186-002
PPO
Monthly premium: $0
| Travel coverage | Call the plan for details. |
| Dental | Preventive: $0 copay/oral exam, cleaning and x-rays, limits apply Comprehensive: $0 copay/restorative services, endodontics, periodeontics, extractions, prosthodontics, other oral/maxillofacial surgery and other services, limits apply. $750 annual allowance for dental Healthy Benefits+ Flex Card. |
| Vision | In-Network: $0 copay/routine eye exam, $0 copay for glasses/eyewear/contacts Out-of-Network: 0-50% coinsurance/eye exam, glasses/eyewear/contacts. Limits apply. $1,000 annual allowance for vision Healthy Benefits+ Flex Card. |
| Hearing | In-Network: $0 copay/hearing exams Out-of-Network: 0-50% coinsurance/hearing exams. $1,000 annual allowance for hearing Healthy Benefits+ Flex Card. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $300 |
| Discounts & programs | $70 quarterly OTC benefit, 2 meals/daily up to 4 weeks post inpatient discharge meal benefit, $5 standard gym membership fitness benefit |
Align ChoiceElite
H3186-001
PPO
Monthly premium: $79
| Travel coverage | Call the plan for details. |
| Dental | Preventive: $0 copay/oral exam, cleaning and x-rays, limits apply Comprehensive: $0 copay/restorative services, endodontics, periodeontics, extractions, prosthodontics, other oral/maxillofacial surgery and other services, limits apply. $1,000 annual allowance for dental Healthy Benefits+ Flex Card. |
| Vision | In-Network: $0 copay/routine eye exam, $0 copay for glasses/eyewear/contacts Out-of-Network: 0-50% coinsurance/eye exam, glasses/eyewear/contacts. Limits apply. $1,000 annual allowance for vision Healthy Benefits+ Flex Card. |
| Hearing | In-Network: $0 copay/hearing exams Out-of-Network: 0-50% coinsurance/hearing exams. $1,000 annual allowance for hearing Healthy Benefits+ Flex Card. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $200 |
| Discounts & programs | $80 quarterly OTC benefit, 2 meals/daily up to 4 weeks post inpatient discharge meal benefit, $5 standard gym membership fitness benefit |
Allina Aetna
New member enrollment: 833-206-8764
Customer service: 833-570-6671
TTY: 711
Website: www.allinahealthaetnamedicare.com
Allina Health | Aetna Medicare Eagle
H3219-005
PPO
Monthly premium: $0
$100 Part B premium reduction
| Travel coverage | $125 copay/emergency or urgent care outside the U.S., emergency copay waived if admitted to the hospital, members can access in-network providers across the U.S. for routine or non-emergency care when they travel |
| Dental | In-Network: $35 copay/Medicare-covered dental service Out-of-Network: $60 copay/Medicare-covered dental service Note: dental allowance of up to $2,100/preventive and comprehensive dental services/year. 20% coinsurance applies to out-of-network preventive and comprehensive dental services. |
| Vision | In-Network: $0 copay/glaucoma screening and diabetic eye exam; $35 copay/other Medicare-covered eye exam; $0 copay/1 routine eye exam/year Out-of-Network: $60 copay/Medicare-covered vision service; $60 copay/1 routine eye exam/year Note: eyewear allowance up to $200 for contacts and glasses/year |
| Hearing | In-Network: $35 copay/Medicare-covered hearing service; $0 copay/1 routine hearing exam/year Out-of-Network: $60 copay/Medicare-covered hearing service; $60 copay/1 routine hearing exam/year; Hearing aids: Up to $1,000 per ear per year through NationsHearing |
| Medicare Part D coverage | No, Part D coverage is not available on this plan. If you enroll in a separate Part D stand-alone plan you will be disenrolled from this health plan |
| Discounts & programs | Extra Benefits: SilverSneakers, $90 quarterly/over-the-counter drugs and supplies, meal benefit (14 meals/7 days post discharge), and 24/7 NurseLine. Telehealth: in-network primary care, specialty care, mental health, urgent care, physical therapy, speech therapy, occupational therapy, substance abuse, opioid treatment services, diabetes self-management training, and kidney disease education services through a virtual visit are the same cost as an in-person visit, Other Benefits: Routine podiatry $35 copay, 12 visits per year; Routine chiropractic and acupuncture $20 copay, 18 visits per year. |
Allina Health | Aetna Medicare Essential
H3219-012
PPO
Monthly premium: $0
| Travel coverage | $125 copay/emergency or urgent care outside the U.S., emergency copay waived if admitted to the hospital, members can access in-network providers across the U.S. for routine or non-emergency care when they travel |
| Dental | In-Network: $45 copay/Medicare-covered dental service Out-of-Network: 50% coinsurance/Medicare-covered dental service Note: Dental allowance of up to $600/preventive and comprehensive dental service/year. 50% coinsurance applies to out-of-network preventive and comprehensive dental services. |
| Vision | In-Network: $0 copay/glaucoma screening and diabetic eye exam; $45 copay/other Medicare-covered eye exam; $0 copay/1 routine eye exam/year Out-of-Network: 50% coinsurance/Medicare-covered vision service; 50% coinsurance/1 routine eye exam/year Note: Eyewear allowance up to $100 for contacts and glasses/year |
| Hearing | In-Network: $40 copay/Medicare-covered hearing service; $0 copay/1 routine hearing exam/year Out-of-Network: 50% coinsurance/Medicare-covered hearing service; 50% coinsurance/1 routine hearing exam/year; Hearing aids: Up to $500 per ear per year through NationsHearing |
| Medicare Part D coverage | Yes, this plan includes part D coverage. If you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2; $590/tiers 3-5 |
| Discounts & programs | Extra Benefits: SilverSneakers, $45 quarterly/over-the-counter drugs and supplies, meal benefit (14 meals/7 days post discharge), and 24/7 NurseLine. Telehealth: in-network primary care, specialty care, mental health, urgent care, physical therapy, speech therapy, occupational therapy, substance abuse, opioid treatment services, diabetes self-management training, and kidney disease education services through a virtual visit are the same cost as an in-person visit. Other Benefits: Routine podiatry $45 copay, 12 visits per year; Routine chiropractic $20 copay, 12 visits per year. |
Allina Health | Aetna Medicare SmartFit
H3219-008
PPO
Monthly premium: $0
$20 Part B premium reduction
| Travel coverage | $125 copay/emergency or urgent care outside the U.S., emergency copay waived if admitted to the hospital, members can access in-network providers across the U.S. for routine or non-emergency care when they travel |
| Dental | In-Network: $40 copay/Medicare-covered dental service Out-of-Network: $60 copay/Medicare-covered dental service Note: dental allowance of up to $2,050/preventive and comprehensive dental services/year. 50% coinsurance applies to out-of-network preventive and comprehensive dental services. |
| Vision | In-Network: $0 copay/glaucoma screening and diabetic eye exam; $40 copay/other Medicare-covered eye exam; $0 copay/1 routine eye exam/year Out-of-Network: $60 copay/Medicare-covered vision service; $60 copay/1 routine eye exam/year Note: eyewear allowance up to $225 for contacts and glasses/year |
| Hearing | In-Network: $40 copay/Medicare-covered hearing service; $0 copay/1 routine hearing exam/year Out-of-Network: $60 copay/Medicare-covered hearing service; $60 copay/1 routine hearing exam/year; Hearing aids: Up to $500 per ear per year through NationsHearing |
| Medicare Part D coverage | Yes, this plan includes part d coverage. If you enroll in a separate Part D stand-alone plan you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2; $590/tiers 3-5 |
| Discounts & programs | Extra Benefits: SilverSneakers, $45 quarterly/over-the-counter drugs and supplies, meal benefit (14 meals/7 days post discharge) and 24/7 NurseLine. Fitness Reimbursement: $150 quarterly allowance for certain exercise and strength training equipment like free weights or fitness activity fees, lessons, classes and more. Telehealth: in-network primary care, specialty care, mental health, urgent care, physical therapy, speech therapy, occupational therapy, substance abuse, opioid treatment services, diabetes self-management training, and kidney disease education services through a virtual visit are the same cost as an in-person visit. Other Benefits: Routine podiatry $40 copay, 12 visits per year; Routine chiropractic and acupuncture $20 copay, 18 visits per year. |
Allina Health | Aetna Medicare Plus
H3219-001
PPO
Monthly premium: $0
| Travel coverage | $140 copay/emergency or urgent care outside the U.S., emergency copay waived if admitted to the hospital, members can access in-network providers across the U.S. for routine or non-emergency care when they travel |
| Dental | In-Network: $35 copay/Medicare-covered dental service Out-of-Network: $50 copay/Medicare-covered dental service Note: Dental allowance of up to $1,550/preventive and comprehensive dental service/year. 20% coinsurance applies to out-of-network preventive and comprehensive dental services. |
| Vision | In-Network: $0 copay/glaucoma screening and diabetic eye exam; $35 copay/other Medicare-covered eye exam; $0 copay/1 routine eye exam/year Out-of-Network: $50 copay/Medicare-covered vision service; $50 copay/1 routine eye exam/year Note: Eyewear allowance up to $200 for contacts and glasses/year |
| Hearing | In-Network: $35 copay/Medicare-covered hearing service; $0 copay/1 routine hearing exam/year Out-of-Network: $50 copay/Medicare-covered hearing service; $50 copay/1 routine hearing exam/year; Hearing aids: Up to $500 per ear per year through NationsHearing |
| Medicare Part D coverage | Yes, this plan includes part d coverage. If you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2; $250/tiers 3-5 |
| Discounts & programs | Healthy Rewards Program, SilverSneakers, $75 quarterly/over-the-counter drugs and supplies, meal benefit (14 meals/7 days post discharge) and 24/7 NurseLine, PERS included; Telehealth: in-network primary care, specialty care, mental health, urgent care, physical therapy, speech therapy, occupational therapy, substance abuse, opioid treatment services, diabetes self-management training, and kidney disease education services through a virtual visit are the same cost as an in-person visit, Allina Health | Aetna Medicare Payment Card $200 added to a debit card quarterly for certain in- and out-of-network cost shares for covered medical services. Fitness Reimbursement: up to $360 every year for qualified non‑participating fitness location enrollment and/or membership fees, health activity fees, health related supplies and health equipment, Routine Podiatry Services: $35 copay, 12 visits per year. |
Allina Health | Aetna Medicare Premier
H3219-002
PPO
Monthly premium: $25
| Travel coverage | $140 copay/emergency or urgent care outside the U.S., emergency copay waived if admitted to the hospital, members can access in-network providers across the U.S. for routine or non-emergency care when they travel |
| Dental | In-Network: $25 copay/Medicare-covered dental service Out-of-Network: $25 copay/Medicare-covered dental service Note: dental allowance of up to $1,500/preventive and comprehensive dental services/year. 20% coinsurance applies to out-of-network preventive and comprehensive dental services. |
| Vision | In-Network: $0 copay/glaucoma screening and diabetic eye exam; $25 copay/other Medicare covered eye exam; $0 copay/1 routine eye exam/year Out-of-Network: $25 copay/Medicare-covered vision service; $25 copay/1 routine eye exam/year Note: eyewear allowance up to $200 for contacts and glasses/year |
| Hearing | In-Network: $25 copay/Medicare-covered hearing service; $0 copay/1 routine hearing exam/year Out-of-Network: $25 copay/Medicare-covered hearing service; $25 copay/1 routine hearing exam/year; Hearing aids: Up to $750 per ear per year through NationsHearing |
| Medicare Part D coverage | Yes, this plan includes part D coverage. If you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2; $250/tiers 3- 5 |
| Discounts & programs | Extra Benefits: SilverSneakers, meal benefit (14 meals/7 days post discharge), 24/7 NurseLine. Includes the Allina Health | Aetna Medicare Extra Benefits card – with a $60 quarterly over-the-counter allowance to use at CVS pharmacy, and for those who qualify a $30 quarterly allowance for healthy foods, personal care items, transportation costs and utilities. See Allina Health | Aetna Assist Program for qualification criteria. Telehealth: in-network primary care, specialty care, mental health, urgent care, physical therapy, speech therapy, occupational therapy, substance abuse, opioid treatment services, diabetes self-management training, and kidney disease education services through a virtual visit are the same cost as an in-person visit. Other Benefits: Routine podiatry $25 copay, 12 visits per year; Routine chiropractic and acupuncture $20 copay, 18 visits per year. Allina Health |Aetna Medicare Assist program: Members with low-income subsidy (Extra Help) may be eligible for $0 Part D prescription drugs and $30/quarter allowance on the Extra Benefits Card to pay for everyday expenses when enrolled in this plan. |
Allina Health | Aetna Medicare Select
H3219-014
PPO
Monthly premium: $61
| Travel coverage | $140 copay/emergency or urgent care outside the U.S., emergency copay waived if admitted to the hospital, members can access in-network providers across the U.S. for routine or non-emergency care when they travel |
| Dental | In-Network: $35 copay/Medicare-covered dental service Out-of-Network: 50% coinsurance/Medicare-covered dental service Note: Dental allowance of up to $1,000/preventive and comprehensive dental service/year. 20% coinsurance applies to out-of-network preventive and comprehensive dental services. |
| Vision | In-Network: $0 copay/glaucoma screening and diabetic eye exam; $35 copay/other Medicare-covered eye exam; $0 copay/1 routine eye exam/year Out-of-Network: 50% coinsurance/Medicare-covered vision service; 50% coinsurance/1 routine eye exam/year Note: Eyewear allowance up to $175 for contacts and glasses/year |
| Hearing | In-Network: $35 copay/Medicare-covered hearing service; $0 copay/1 routine hearing exam/year Out-of-Network: 50% coinsurance/Medicare-covered hearing service; 50% coinsurance/1 routine hearing exam/year; Hearing aids: Up to $750 per ear per year through NationsHearing |
| Medicare Part D coverage | Yes, this plan includes Part D coverage. If you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2; $250/tiers 3-5 |
| Discounts & programs | Extra Benefits: SilverSneakers, $60 quarterly/over-the-counter drugs and supplies, meal benefit (14 meals/7 days post discharge), and 24/7 NurseLine. Telehealth: in-network primary care, specialty care, mental health, urgent care, physical therapy, speech therapy, occupational therapy, substance abuse, opioid treatment services, diabetes self-management training, and kidney disease education services through a virtual visit are the same cost as an in-person visit. Other Benefits: Routine podiatry $35 copay, 12 visits per year; Routine chiropractic and acupuncture $20 copay, 12 visits per year. |
Allina Health | Aetna Medicare Grand
H3219-003
PPO
Monthly premium: $66
| Travel coverage | $140 copay/emergency or urgent care outside the U.S., emergency copay waived if admitted to the hospital, members can access in-network providers across the U.S. for routine or non-emergency care when they travel |
| Dental | In-Network: $20 copay/Medicare-covered dental service Out-of-Network: $40 copay/Medicare-covered dental service Note: dental allowance of up to $1,800/preventive and comprehensive dental services/year. 20% coinsurance applies to out-of-network preventive and comprehensive dental services. |
| Vision | In-Network: $0 copay/glaucoma screening and diabetic eye exam; $20 copay/other eye exam; $0 copay/1 routine eye exam/year Out-of-Network: $40 copay/Medicare-covered vision service; $40 copay/1 routine eye exam/year Note: eyewear allowance of up to $200 for contacts and eyeglasses/year |
| Hearing | In-Network: $20 copay/Medicare-covered hearing service; $0 copay/1 routine hearing exam/year Out-of-Network: $40 copay/Medicare-covered hearing service; $40 copay/1 routine hearing exam/year Hearing aids: up to $1,000 per ear per year through NationsHearing |
| Medicare Part D coverage | Yes, this plan includes part D coverage. If you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2; $0/deductible |
| Discounts & programs | Extra Benefits: SilverSneakers, $75 quarterly/over-the-counter drugs and supplies, meal benefit (14 meals/7 days post discharge), and 24/7 NurseLine. Telehealth: in-network primary care, specialty care, mental health, urgent care, physical therapy, speech therapy, occupational therapy, substance abuse, opioid treatment services, diabetes self-management training, and kidney disease education services through a virtual visit are the same cost as an in-person visit. Other Benefits: Routine podiatry $20 copay, 12 visits per year; Routine chiropractic and acupuncture $20 copay, 18 visits per year. |
Allina Health | Aetna Medicare Signature
H3219-013
PPO
Monthly premium: $106
| Travel coverage | $140 copay/emergency or urgent care outside the U.S., emergency copay waived if admitted to the hospital, members can access in-network providers across the U.S. for routine or non-emergency care when they travel |
| Dental | In-Network: $30 copay/Medicare-covered dental service Out-of-Network: 50% coinsurance/Medicare-covered dental service Note: Dental allowance of up to $1,250/preventive and comprehensive dental service/year. 20% coinsurance applies to out-of-network preventive and comprehensive dental services. |
| Vision | In-Network: $0 copay/glaucoma screening and diabetic eye exam; $30 copay/other Medicare-covered eye exam; $0 copay/1 routine eye exam/year Out-of-Network: 50% coinsurance/Medicare-covered vision service; 50% coinsurance/1 routine eye exam/year Note: Eyewear allowance up to $200 for contacts and glasses/year |
| Hearing | In-Network: $30 copay/Medicare-covered hearing service; $0 copay/1 routine hearing exam/year Out-of-Network: 50% coinsurance/Medicare-covered hearing service; 50% coinsurance/1 routine hearing exam/year; Hearing aids: Up to $1,000 per ear per year through NationsHearing |
| Medicare Part D coverage | Yes, this plan includes Part D coverage. If you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2; $250/tiers 3-5 |
| Discounts & programs | Extra Benefits: SilverSneakers, $60 quarterly/over-the-counter drugs and supplies, meal benefit (14 meals/7 days post discharge), and 24/7 NurseLine. Telehealth: in-network primary care, specialty care, mental health, urgent care, physical therapy, speech therapy, occupational therapy, substance abuse, opioid treatment services, diabetes self-management training, and kidney disease education services through a virtual visit are the same cost as an in-person visit. Other Benefits: Routine podiatry $30 copay, 12 visits per year; Routine chiropractic and acupuncture $20 copay, 12 visits per year. |
Allina Health | Aetna Medicare Elite
H3219-004
PPO
Monthly premium: $134
| Travel coverage | $140 copay/emergency or urgent care outside the U.S., emergency copay waived if admitted to the hospital, members can access in-network providers across the U.S. for routine or non-emergency care when they travel |
| Dental | In-Network: $15 copay/Medicare-covered dental service Out-of-Network: $35 copay/Medicare-covered dental service Note: dental allowance of up to $2,100/preventive and comprehensive dental services/year. 20% coinsurance applies to out-of-network preventive and comprehensive dental services. |
| Vision | In-Network: $0 copay/glaucoma screening and diabetic eye exam; $15 copay/other Medicare-covered eye exam; $0 copay/1 routine eye exam/year Out-of-Network: $35 copay/Medicare-covered vision service; $35 copay/1 routine eye exam/year Note: eyewear allowance of up to $275 for contacts and eyeglasses/year |
| Hearing | In-Network: $15 copay/Medicare-covered hearing service; $0 copay/1 routine hearing exam/year Out-of-Network: $35 copay/Medicare-covered hearing service; $35 copay/1 routine hearing exam/year Hearing aids: up to $1,500 per ear per year through NationsHearing |
| Medicare Part D coverage | Yes, this plan includes part D coverage. If you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2; $0/deductible |
| Discounts & programs | Extra Benefits: SilverSneakers, $75 quarterly/over-the-counter drugs and supplies, meal benefit (14 meals/7 days post discharge), and 24/7 NurseLine. Telehealth: in-network primary care, specialty care, mental health, urgent care, physical therapy, speech therapy, occupational therapy, substance abuse, opioid treatment services, diabetes self-management training, and kidney disease education services through a virtual visit are the same cost as an in-person visit. Other Benefits: Routine podiatry $15 copay, 12 visits per year; Routine chiropractic and acupuncture $20 copay, 18 visits per year. |
BlueCross BlueShield of Minnesota
New member enrollment: 855-579-7658
Customer service: 800-711-9865
TTY: 711
Website: bluecrossmn.com/medicare
Blue Cross Medicare Advantage Core
H5959-013-1
PPO
Monthly premium: $0
Up to $5.80 Part B premium reduction
| Travel coverage | Coverage when you are outside of Minnesota for up to 12 months |
| Dental | In-Network: $50 copay/Medicare-covered dental services Out-of-Network: 45% coinsurance/Medicare-covered dental Preventive: $0 copay/2 cleanings, 2 oral exams, 1 x-ray, 2 periodontal cleanings, 2 fluoride treatments Maximum Dental Plan Benefit: $2,000 |
| Vision | In-Network: $0 copay/2 routine eye exams, 1 annual glaucoma screening for people at risk, diabetic retinopathy exams, eyewear after cataract, $0 copay/Medicare-covered exams to diagnose and treat diseases and conditions of the eye, $275 allowance for non-Medicare-covered eyewear Out-of-Network: 45% coinsurance/Medicare-covered services |
| Hearing | In-Network: $0 copay/each Medicare-covered diagnostic hearing exam, $0 copay/2 routine hearing exams per year, $699 copay/Advanced hearing aids, $999 copay/Premium hearing aids, you must see TruHearing provider to use this benefit Out-of-Network: 45% coinsurance/Medicare-covered visit |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $350/tiers 3-5 |
| Discounts & programs | SilverSneakers exercise, E-visits, 24-hour nurse advice line, $60 quarterly/over-the-counter drugs and supplies, 2 medically tailored meals per day for 14 days at no extra cost following an authorized inpatient or skilled nursing facility discharge |
Blue Cross Medicare Advantage Core
H5959-013-2
PPO
Monthly premium: $0
Up to $5.80 Part B premium reduction
| Travel coverage | Coverage when you are outside of Minnesota for up to 12 months |
| Dental | In-Network: $50 copay/Medicare-covered dental services Out-of-Network: 45% coinsurance/Medicare-covered dental Preventive: $0 copay/2 cleanings, 2 oral exams, 1 x-ray, 2 periodontal cleanings, 2 fluoride treatments Maximum Dental Plan Benefit: $2,000 |
| Vision | In-Network: $0 copay/2 routine eye exams, 1 annual glaucoma screening for people at risk, diabetic retinopathy exams, eyewear after cataract, $0 copay/Medicare-covered exams to diagnose and treat diseases and conditions of the eye, $275 allowance for non-Medicare-covered eyewear Out-of-Network: 45% coinsurance/Medicare-covered services |
| Hearing | In-Network: $0 copay/each Medicare-covered diagnostic hearing exam, $0 copay/2 routine hearing exams per year, $699 copay/Advanced hearing aids, $999 copay/Premium hearing aids, you must see TruHearing provider to use this benefit Out-of-Network: 45% coinsurance/Medicare-covered visit |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $350/tiers 3-5 |
| Discounts & programs | SilverSneakers exercise, E-visits, 24-hour nurse advice line, $60 quarterly/over-the-counter drugs and supplies, 2 medically tailored meals per day for 14 days at no extra cost following an authorized inpatient or skilled nursing facility discharge |
Blue Cross Medicare Advantage Freedom Blue No Rx
H5959-018
PPO
Monthly premium: $0
Up to $100 Part B premium reduction
| Travel coverage | Coverage when you are outside of Minnesota for up to 12 months |
| Dental | In-Network: $30 copay/Medicare-covered dental services Out-of-Network: 40% coinsurance/Medicare-covered dental Preventive: $0 copay/2 cleanings, 2 oral exams, 1 x-ray, 2 periodontal cleanings, 2 fluoride treatments Comprehensive: 20% coinsurance/restorative, 20% coinsurance/endodontics, periodontics (not including cleaning), extractions, prosthodontics, other oral/maxillofacial surgery Maximum Dental Plan Benefit: $2,500 |
| Vision | In-Network: $0 copay/1 routine eye exam, 1 annual glaucoma screening for people at risk, diabetic retinopathy exams, eyewear after cataract, $0 copay/Medicare-covered exams to diagnose and treat diseases and conditions of the eye, $250 allowance/non-Medicare-covered eyewear Out-of-Network: 40% coinsurance/Medicare-covered services |
| Hearing | In-Network: $0 copay/each Medicare-covered diagnostic hearing exam, $0 copay/2 routine hearing exams per year, $599 copay/Advanced hearing aids, $899 copay/Premium hearing aids, you must see a TruHearing provider to use this benefit Out-of-Network: 40% coinsurance/Medicare-covered visit |
| Medicare Part D coverage | No, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan |
| Discounts & programs | The SilverSneakers exercise, e-visits, 24-hour nurse advice line, $100 quarterly/over-the-counter drugs and supplies, 2 medically tailored meals per day for 14 days at no extra cost following an authorized inpatient or skilled nursing facility discharge |
Blue Cross Medicare Advantage Core
H5959-012
PPO
Monthly premium: $39
| Travel coverage | Coverage when you are outside of Minnesota for up to 12 months |
| Dental | In-Network: $50 copay/Medicare-covered dental services Out-of-Network: 45% coinsurance/Medicare-covered dental Preventive: $0 copay/2 cleanings, 2 oral exams, 1 x-ray, 2 periodontal cleanings, 2 fluoride treatments Maximum Dental Plan Benefit: $2,000 |
| Vision | In-Network: $0 copay/2 routine eye exams, 1 annual glaucoma screening for people at risk, diabetic retinopathy exams, eyewear after cataract, $0 copay/Medicare-covered exams to diagnose and treat diseases and conditions of the eye, $125 allowance/non-Medicare-covered eyewear Out-of-Network: 45% coinsurance/Medicare-covered services |
| Hearing | In-Network: $0 copay/each Medicare-covered diagnostic hearing exam, $0 copay/2 routine hearing exams per year, $699 copay/Advanced hearing aids, $999 copay/Premium hearing aids, you must see a TruHearing provider to use this benefit Out-of-Network: 45% coinsurance/Medicare-covered visit |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $350/tiers 3-5 |
| Discounts & programs | SilverSneakers exercise, e-visits, 24-hour nurse advice line, $50 quarterly/over-the-counter drugs and supplies, 2 medically tailored meals per day for 14 days at no extra cost following an authorized inpatient or skilled nursing facility discharge |
Blue Cross Medicare Advantage Comfort
H5959-015
PPO
Monthly premium: $48
| Travel coverage | Coverage when you are outside of Minnesota for up to 12 months |
| Dental | In-Network: $30 copay/Medicare-covered dental services Out-of-Network: 40% coinsurance/Medicare-covered dental Preventive: $0 copay/2 cleanings, 2 oral exams, 1 x-ray, 2 periodontal cleanings, 2 fluoride treatments Comprehensive: 30% coinsurance/restorative, 50% coinsurance/endodontics, periodontics (not including cleaning), extractions, prosthodontics, other oral/maxillofacial surgery Maximum Dental Plan Benefit: $2,000 |
| Vision | In-Network: $0 copay/2 routine eye exams, 1 annual glaucoma screening for people at risk, diabetic retinopathy exams, eyewear after cataract, $0 copay/Medicare-covered exams to diagnose and treat diseases and conditions of the eye, $125 allowance/non-Medicare-covered eyewear Out-of-Network: 40% coinsurance/Medicare-covered services |
| Hearing | In-Network: $0 copay/each Medicare-covered diagnostic hearing exam, $0 copay/2 routine hearing exams per year, $599 copay/Advanced hearing aids, $899 copay/Premium hearing aids, you must see a TruHearing provider to use this benefit Out-of-Network: 40% coinsurance/Medicare-covered visit |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $300/tiers 3-5 |
| Discounts & programs | The SilverSneakers exercise, E-visits, 24-hour nurse advice line, $60 quarterly/over-the-counter drugs and supplies, 2 medically tailored meals per day for 14 days at no extra cost following an authorized inpatient or skilled nursing facility discharge |
Blue Cross Medicare Advantage Comfort
H5959-016
PPO
Monthly premium: $59
| Travel coverage | Coverage when you are outside of Minnesota for up to 12 months |
| Dental | In-Network: $30 copay/Medicare-covered dental services Out-of-Network: 40% coinsurance/Medicare-covered dental Preventive: $0 copay/2 cleanings, 2 oral exams, 1 x-ray, 2 periodontal cleanings, 2 fluoride treatments Comprehensive: 30% coinsurance/restorative, 50% coinsurance/endodontics, periodontics (not including cleaning), extractions, prosthodontics, other oral/maxillofacial surgery Maximum Dental Plan Benefit: $1,500 |
| Vision | In-Network: $0 copay/2 routine eye exams, 1 annual glaucoma screening for people at risk, diabetic retinopathy exams, eyewear after cataract, $0 copay/Medicare-covered exams to diagnose and treat diseases and conditions of the eye, $125 allowance/non-Medicare-covered eyewear Out-of-Network: 40% coinsurance/Medicare-covered services |
| Hearing | In-Network: $0 copay/each Medicare-covered diagnostic hearing exam, $0 copay/2 routine hearing exams per year, $599 copay/Advanced hearing aids, $899 copay/Premium hearing aids, you must see a TruHearing provider to use this benefit Out-of-Network: 40% coinsurance/Medicare-covered visit |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $275/tiers 3-5 |
| Discounts & programs | The SilverSneakers exercise, E-visits, 24-hour nurse advice line, $50 quarterly/over-the-counter drugs and supplies, 2 medically tailored meals per day for 14 days at no extra cost following an authorized inpatient or skilled nursing facility discharge |
Blue Cross Medicare Advantage Choice
H5959-014-1
PPO
Monthly premium: $96
| Travel coverage | Coverage when you are outside of Minnesota for up to 12 months |
| Dental | In-Network: $30 copay/Medicare-covered dental services Out-of-Network: 40% coinsurance/Medicare-covered dental Preventive: $0 copay/2 cleanings, 2 oral exams, 1 x-ray, 2 periodontal cleanings, 2 fluoride treatments Comprehensive: 30% coinsurance/restorative, 50% coinsurance/endodontics, periodontics (not including cleaning), extractions, prosthodontics, other oral/maxillofacial surgery Maximum Dental Plan Benefit: $2,000 |
| Vision | In-Network: $0 copay/2 routine eye exams, 1 annual glaucoma screening for people at risk, diabetic retinopathy exams, eyewear after cataract, $0 copay/Medicare-covered exams to diagnose and treat diseases and conditions of the eye, $200 allowance/non-Medicare-covered eyewear Out-of-Network: 40% coinsurance/Medicare-covered services |
| Hearing | In-Network: $0 copay/each Medicare-covered diagnostic hearing exam, $0 copay/2 routine hearing exams per year, $599 copay/Advanced hearing aids, $899 copay/Premium hearing aids, you must see a TruHearing provider to use this benefit Out-of-Network: 40% coinsurance/Medicare-covered visit |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0 |
| Discounts & programs | The SilverSneakers exercise, E-visits, 24-hour nurse advice line, $50 quarterly/over-the-counter drugs and supplies, 2 medically tailored meals per day for 14 days at no extra cost following an authorized inpatient or skilled nursing facility discharge |
Blue Cross Medicare Advantage Choice
H5959-014-2
PPO
Monthly premium: $105
| Travel coverage | Coverage when you are outside of Minnesota for up to 12 months |
| Dental | In-Network: $30 copay/Medicare-covered dental services Out-of-Network: 40% coinsurance/Medicare-covered dental Preventive: $0 copay/2 cleanings, 2 oral exams, 1 x-ray, 2 periodontal cleanings, 2 fluoride treatments Comprehensive: 30% coinsurance/restorative, 50% coinsurance/endodontics, periodontics (not including cleaning), extractions, prosthodontics, other oral/maxillofacial surgery Maximum Dental Plan Benefit: $1,500 |
| Vision | In-Network: $0 copay/2 routine eye exams, 1 annual glaucoma screening for people at risk, diabetic retinopathy exams, eyewear after cataract, $0 copay/Medicare-covered exams to diagnose and treat diseases and conditions of the eye, $150 allowance/non-Medicare-covered eyewear Out-of-Network: 40% coinsurance/Medicare-covered services |
| Hearing | In-Network: $0 copay/each Medicare-covered diagnostic hearing exam, $0 copay/2 routine hearing exams per year, $599 copay/Advanced hearing aids, $899 copay/Premium hearing aids, you must see a TruHearing provider to use this benefit Out-of-Network: 40% coinsurance/Medicare-covered visit |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0 |
| Discounts & programs | The SilverSneakers exercise, E-visits, 24-hour nurse advice line, $50 quarterly/over-the-counter drugs and supplies, 2 medically tailored meals per day for 14 days at no extra cost following an authorized inpatient or skilled nursing facility discharge |
Blue Cross Medicare Advantage Choice
H5959-009
PPO
Monthly premium: $144
| Travel coverage | Coverage when you are outside of Minnesota for up to 12 months |
| Dental | In-Network: $30 copay/Medicare-covered dental services Out-of-Network: 45% coinsurance/Medicare-covered dental Preventive: $0 copay/2 cleanings, 2 oral exams, 1 x-ray, 2 periodontal cleanings, 2 fluoride treatments Comprehensive: 30% coinsurance/restorative, 50% coinsurance/endodontics, periodontics (not including cleaning), extractions, prosthodontics, other oral/maxillofacial surgery Maximum Dental Plan Benefit: $2,000 |
| Vision | In-Network: $0 copay/2 routine eye exams, 1 annual glaucoma screening for people at risk, diabetic retinopathy exams, eyewear after cataract, $0 copay/Medicare-covered exams to diagnose and treat diseases and conditions of the eye, $125 allowance/non-Medicare-covered eyewear Out-of-Network: 45% coinsurance/Medicare-covered services |
| Hearing | In-Network: $0 copay/each Medicare-covered diagnostic hearing exam, $0 copay/2 routine hearing exams per year, $599 copay/Advanced hearing aids, $899 copay/Premium hearing aids, you must see a TruHearing provider to use this benefit Out-of-Network: 45% coinsurance/Medicare-covered visit |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0 |
| Discounts & programs | The SilverSneakers exercise, E-visits, 24-hour nurse advice line, $50 quarterly/over-the-counter drugs and supplies, 2 medically tailored meals per day for 14 days at no extra cost following an authorized inpatient or skilled nursing facility discharge |
Blue Cross Medicare Advantage Complete
H5959-010-1
PPO
Monthly premium: $187
| Travel coverage | Coverage when you are outside of Minnesota for up to 12 months |
| Dental | In-Network: $20 copay/Medicare-covered dental services Out-of-Network: 40% coinsurance/Medicare-covered dental Preventive: $0 copay/2 cleanings/2 oral exams/1 x-ray, 2 periodontal cleanings, 2 fluoride treatments Comprehensive: 30% coinsurance/restorative, 50% coinsurance/endodontics, periodontics (not including cleaning), extractions, prosthodontics, other oral/maxillofacial surgery Maximum Dental Plan Benefit: $2,000 |
| Vision | In-Network: $0 copay/2 routine eye exams, 1 annual glaucoma screening for people at risk, diabetic retinopathy exams, eyewear after cataract, $0 copay/Medicare-covered exams to diagnose and treat diseases and conditions of the eye, $225 allowance/non-Medicare-covered eyewear Out-of-Network: 40% coinsurance/Medicare-covered services |
| Hearing | In-Network: $0 copay/each Medicare-covered diagnostic hearing exam, $0 copay/2 routine hearing exams per year, $499 copay/Advanced hearing aids, $799 copay/Premium hearing aids, you must see a TruHearing provider to use this benefit Out-of-Network: 40% coinsurance/Medicare-covered visit |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0 |
| Discounts & programs | The SilverSneakers exercise, E-visits, 24-hour nurse advice line, $50 quarterly/over-the-counter drugs and supplies, 2 medically tailored meals per day for 14 days at no extra cost following an authorized inpatient or skilled nursing facility discharge |
Blue Cross Medicare Advantage Complete
H5959-010-2
PPO
Monthly premium: $228
| Travel coverage | Coverage when you are outside of Minnesota for up to 12 months |
| Dental | In-Network: $20 copay/Medicare-covered dental services Out-of-Network: 40% coinsurance/Medicare-covered dental Preventive: $0 copay/2 cleanings/2 oral exams/1 x-ray, 2 periodontal cleanings, 2 fluoride treatments Comprehensive: 30% coinsurance/restorative, 50% coinsurance/endodontics, periodontics (not including cleaning), extractions, prosthodontics, other oral/maxillofacial surgery Maximum Dental Plan Benefit: $2,000 |
| Vision | In-Network: $0 copay/2 routine eye exams, 1 annual glaucoma screening for people at risk, diabetic retinopathy exams, eyewear after cataract, $0 copay/Medicare-covered exams to diagnose and treat diseases and conditions of the eye, $200 allowance/non-Medicare-covered eyewear Out-of-Network: 40% coinsurance/Medicare-covered services |
| Hearing | In-Network: $0 copay/each Medicare-covered diagnostic hearing exam, $0 copay/2 routine hearing exams per year, $499 copay/Advanced hearing aids, $799 copay/Premium hearing aids, you must see a TruHearing provider to use this benefit Out-of-Network: 40% coinsurance/Medicare-covered visit |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0 |
| Discounts & programs | The SilverSneakers exercise, E-visits, 24-hour nurse advice line, $50 quarterly/over-the-counter drugs and supplies, 2 medically tailored meals per day for 14 days at no extra cost following an authorized inpatient or skilled nursing facility discharge |
Blue Cross Medicare Advantage Complete
H5959-011
PPO
Monthly premium: $228
| Travel coverage | Coverage when you are outside of Minnesota for up to 12 months |
| Dental | In-Network: $20 copay/Medicare-covered dental services Out-of-Network: 45% coinsurance/Medicare-covered dental Preventive: $0 copay/2 cleanings, 2 oral exams, 1 x-ray, 2 periodontal cleanings, 2 fluoride treatments Comprehensive: 30% coinsurance/restorative, 50% coinsurance/endodontics, periodontics (not including cleaning), extractions, prosthodontics, other oral/maxillofacial surgery Maximum Dental Plan Benefit: $2,000 |
| Vision | In-Network: $0 copay/2 routine eye exams, 1 annual glaucoma screening for people at risk, diabetic retinopathy exams, eyewear after cataract, $0 copay/Medicare-covered exams to diagnose and treat diseases and conditions of the eye, $200 allowance/non-Medicare-covered eyewear Out-of-Network: 45% coinsurance/Medicare-covered services |
| Hearing | In-Network: $0 copay/each Medicare-covered diagnostic hearing exam, $0 copay/2 routine hearing exams per year, $499 copay/Advanced hearing aids, $799 copay/Premium hearing aids, you must see a TruHearing provider to use this benefit Out-of-Network: 45% coinsurance/Medicare-covered visit |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0 |
| Discounts & programs | The SilverSneakers exercise, E-visits, 24-hour nurse advice line, $50 quarterly/over-the-counter drugs and supplies, 2 medically tailored meals per day for 14 days at no extra cost following an authorized inpatient or skilled nursing facility discharge |
EssentiaCare Essentia Health + UCare
New member enrollment: 855-432-7027
Customer service: 855-432-7025
TTY: 800-688-2534
Website: UCare.org
EssentiaCare Access
H8783-003
PPO
Monthly premium: $0
$11 Part B premium reduction
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered visit in the U.S. Out-of-Network: 40% coinsurance/most non-emergency Medicare-covered services at a provider who accepts Medicare in the U.S. |
| Dental | $600 flexible benefit allowance to use on one or a combination of eligible dental, hearing aids and prescription eyewear. Network does not apply to eligible dental services. |
| Vision | In-Network: $0 copay/annual routine eye exam; $35 copay/diagnostic eye exams Out-of-Network: 40% coinsurance/annual routine eye exam; diagnostic eye exams. $600 flexible benefit allowance to use on one or a combination of eligible dental, hearing aids and prescription eyewear. Network does not apply for the purchase of prescription eyewear. |
| Hearing | In-Network: $0 copay/routine hearing exam; $50 copay diagnostic hearing exam Out-of-Network: 40% coinsurance/routine hearing exam and diagnostic hearing exam. $600 flexible benefit allowance to use on one or a combination of eligible dental, hearing aids and prescription eyewear. Network does not apply for the purchase of hearing aids. |
| Medicare Part D coverage | Yes, if you enroll in a stand-alone Medicare Part D plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tier 1, $125/tiers 2-5 |
| Discounts & programs | One Pass fitness program or health club savings program, 24/7 nurse line, 20% discounts on skin care products and services, eyewear, and new hearing aids through Essentia Health; $50 allowance every month/over-the-counter benefit, e-visits through Essentia MyChart |
EssentiaCare Secure
H8783-001
PPO
Monthly premium: $8
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered visit in the U.S. Out-of-Network: 40% coinsurance/most non-emergency Medicare-covered services at a provider who accepts Medicare in the U.S. |
| Dental | In-Network: 1 oral exam, 1 routine teeth cleaning/year; 1 set of bitewing x-rays per year, fluoride treatments, 1 periodontal maintenance cleaning, optional restorative dental for $29/month, up to $2,000 annual plan maximum on routine coverage. Additional $2,000 plan maximum with optional coverage. Out-of-Network: includes covered services from a licensed provider, you must submit for reimbursement and pay the difference |
| Vision | In-Network: $0 copay/annual routine eye exam, $45 copay/diagnostic eye exams, $100 allowance on eyewear Out-of-Network: 40% coinsurance/annual routine eye exam; diagnostic eye exams |
| Hearing | In-Network: $0 copay/routine hearing exam; $45 copay diagnostic hearing exam Out-of-Network: 40% coinsurance/routine hearing exam and diagnostic hearing exam |
| Medicare Part D coverage | Yes, if you enroll in a stand-alone Medicare Part D plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $95/tiers 3-5 |
| Discounts & programs | One Pass fitness program or health club savings program; 24/7 nurse line; 20% discount on skin care products and services, eyewear, and new hearing aids through Essentia Health; $50 allowance every month/over-the-counter benefit, e-visits through Essentia MyChart |
EssentiaCare Grand
H8783-002
PPO
Monthly premium: $62
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered visit in the U.S. Out-of-Network: 40% coinsurance/most non-emergency Medicare-covered services at a provider who accepts Medicare in the U.S. |
| Dental | In-Network: 1 oral exam, 1 routine teeth cleaning/year, 1 set of bitewing x-rays per year, fluoride treatments, 1 periodontal maintenance cleaning, optional restorative dental for $29/month, up to $2,000 annual plan maximum on routine coverage. Additional $2,000 plan maximum with optional coverage. Out-of-Network: includes covered services from a licensed provider, you must submit for reimbursement and pay the difference |
| Vision | In-Network: $0 copay/annual routine eye exam, $35 copay/diagnostic eye exam, $200 allowance on eyewear Out-of-Network: 40% coinsurance/annual routine eye exam; diagnostic eye exams |
| Hearing | In-Network: $0 copay/routine hearing exam; $35 copay diagnostic hearing exam, $500 annual hearing aid allowance Out-of-Network: 40% coinsurance/routine hearing exam and diagnostic hearing exam, hearing aid allowance, 50% coinsurance/up to a maximum of $500 |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1-5 |
| Discounts & programs | One Pass fitness program or health club savings program, 24/7 nurse line; 20% discounts on skin care products and services, eyewear, and new hearing aids through Essentia Health; $50 allowance every month/over-the-counter benefit, e-visits through Essentia MyChart |
HealthPartners
New member enrollment: 844-363-8979
Customer service: 866-233-8734
TTY: 711
Website: healthpartners.com/medicare
HealthPartners Journey Pace
H4882-009-001
PPO
Monthly premium: $0
| Travel coverage | In-Network: $0 copay/individual medical health risk and safety counseling specific to travel. Out-of-Network: 30% coinsurance/ individual medical health risk and safety counseling specific to travel. Note: Plan coverage and in-network cost sharing when using Medicare providers while traveling outside Minnesota for at least 1 month (no more than 9 consecutive months). You must use Medicare providers and contact Member Services to activate this benefit. |
| Dental | In-Network: $0 copay/Medicare-covered benefits, optional comprehensive dental available for an additional monthly premium Out-of-Network: 30% coinsurance/Medicare covered benefits 50% coinsurance/preventive dental services. Combined In- and Out-of-Network: $2,000 allowance/year for preventive dental services |
| Vision | In-Network: $0 copay/routine eye exam per year, $40 copay/diagnostic eye exam Out-of-Network: 30% coinsurance/routine eye exam per year, diagnostic eye exam Combined In-Network and Out-of-Network: Up to $750/year on the HealthPartners Choice Card may be used toward the purchase of non-Medicare covered prescription eyewear |
| Hearing | In-Network: $0 copay/routine hearing exam, $40 copay/diagnostic hearing exam, $499, $699 or $999 copay/hearing aid from a TruHearing® provider (up to 1 per ear, 2 per year) Out-of-network: 30% coinsurance/routine hearing exam per year, diagnostic hearing exam Combined In-Network and Out-of-Network: Up to $750/year on the HealthPartners Choice Card may be used toward the purchase of hearing aids through TruHearing |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $300/tiers 3-5 |
| Discounts & programs | SilverSneakers®, Medication Therapy Management, Assist America® worldwide emergency travel logistics, CareLine® Service registered nurse line, Virtuwell® 24/7 online clinic care, $120/quarter for OTC items/supplies through NationsOTC, up to $750/year with the HealthPartners Choice Card to use on non-Medicare covered prescription eyewear, chiropractic services, hearing aids through TruHearing, and home-delivered meals through Mom’s Meals® following an inpatient hospital or skilled nursing facility (SNF) stay. May be used for one item/service or a combination. |
HealthPartners Journey Pace
H4882-009-002
PPO
Monthly premium: $0
| Travel coverage | In-Network: $0 copay/individual medical health risk and safety counseling specific to travel. Out-of-Network: 30% coinsurance/ individual medical health risk and safety counseling specific to travel. Note: Plan coverage and in-network cost sharing when using Medicare providers while traveling outside Minnesota for at least 1 month (no more than 9 consecutive months). You must use Medicare providers and contact Member Services to activate this benefit. |
| Dental | In-Network: $0 copay/Medicare-covered benefits, optional comprehensive dental available for an additional monthly premium Out-of-Network: 30% coinsurance/Medicare covered benefits 50% coinsurance/preventive dental services. Combined In- and Out-of-Network: $2,000 allowance/year for preventive dental services |
| Vision | In-Network: $0 copay/routine eye exam per year, $40 copay/diagnostic eye exam Out-of-Network: 30% coinsurance/routine eye exam per year, diagnostic eye exam Combined In-Network and Out-of-Network: Up to $575 /year on the HealthPartners Choice Card may be used toward the purchase of non-Medicare covered prescription eyewear |
| Hearing | In-Network: $0 copay/routine hearing exam, $40 copay/diagnostic hearing exam, $499, $699 or $999 copay/hearing aid from a TruHearing® provider (up to 1 per ear, 2 per year) Out-of-network: 30% coinsurance/routine hearing exam per year, diagnostic hearing exam Combined In-Network and Out-of-Network: Up to $575/year on the HealthPartners Choice Card may be used toward the purchase of hearing aids through TruHearing |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $300/tiers 3-5 |
| Discounts & programs | SilverSneakers®, Medication Therapy Management, Assist America® worldwide emergency travel logistics, CareLine® Service registered nurse line, Virtuwell® 24/7 online clinic care, $50 quarterly allowance/OTC medications and health related items, up to $575/year with the HealthPartners Choice Card to use on non-Medicare covered prescription eyewear, chiropractic services, hearing aids through TruHearing, and home-delivered meals through Mom’s Meals® following an inpatient hospital or skilled nursing facility (SNF) stay. May be used for one item/service or a combination. |
HealthPartners Journey Smart
H4882-013
PPO
Monthly premium: $0
Part B premium reduction: $80 a month
| Travel coverage | In-Network: $0 copay/individual medical health risk and safety counseling specific to travel. Out-of-Network: 30% coinsurance/ individual medical health risk and safety counseling specific to travel. Note: Plan coverage and in-network cost sharing when using Medicare providers while traveling outside Minnesota for at least 1 month (no more than 9 consecutive months). You must use Medicare providers and contact Member Services to activate this benefit. |
| Dental | In-Network: $0 copay/Medicare-covered benefits, optional comprehensive dental available for an additional monthly premium Out-of-Network: 30% coinsurance/Medicare covered benefits 50% coinsurance/preventive dental services. Combined In- and Out-of-Network: $2,000 allowance/year for preventive dental services |
| Vision | In-Network: $0 copay/routine eye exam per year, $50 copay/diagnostic eye exam Out-of-Network: 30% coinsurance/routine eye exam per year, diagnostic eye exam Combined In-Network and Out-of-Network: $350 allowance/year for non-Medicare covered prescription eyewear |
| Hearing | In-Network: $0 copay/routine hearing exam, $50 copay/diagnostic hearing exam, $499, $699 or $999 copay/hearing aid from a TruHearing® provider (up to 1 per ear, 2 per year) Out-of-network: 30% coinsurance/routine hearing exam per year, diagnostic hearing exam |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $400/tiers 3-5 |
| Discounts & programs | SilverSneakers®, Medication Therapy Management, Assist America® worldwide emergency travel logistics, CareLine® Service registered nurse line, Virtuwell® 24/7 online clinic care |
HealthPartners Journey Stride
H4882-011-001
PPO
Monthly premium: $41
| Travel coverage | In-Network: $0 copay/individual medical health risk and safety counseling specific to travel. Out-of-Network: $60 copay/ individual medical health risk and safety counseling specific to travel. Note: Plan coverage and in-network cost sharing when using Medicare providers while traveling outside Minnesota for at least 1 month (no more than 9 consecutive months). You must use Medicare providers and contact Member Services to activate this benefit. |
| Dental | In-Network: $0 copay/Medicare covered benefits, preventive dental services, optional comprehensive dental available for an additional monthly premium Out-of-Network: 20% coinsurance/Medicare covered benefits, 50% coinsurance/preventive dental services Combined In- and Out-of-Network: $2,000 allowance/year for preventive dental services |
| Vision | In-Network: $0 copay/routine eye exam per year, $40 copay/diagnostic eye exam Out-of-Network: 20% coinsurance/routine eye exam per year, diagnostic eye exam Combined In-Network and Out-of-Network: Up to $475/year on the HealthPartners Choice Card may be used toward the purchase of r non-Medicare covered prescription eyewear |
| Hearing | In-Network: $0 copay/routine hearing exam, $40 copay/diagnostic hearing exam, $499, $699 or $999 copay/hearing aid from a TruHearing® provider (up to 1 per ear, 2 per year) Out-of-network: 20% coinsurance/routine hearing exam per year, diagnostic hearing exam Combined In-Network and Out-of-Network: Up to $475/year on the HealthPartners Choice Card may be used toward the purchase of hearing aids from TruHearing. |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $300/tiers 3-5 |
| Discounts & programs | SilverSneakers®, Medication Therapy Management, Assist America® worldwide emergency travel logistics, CareLine® Service registered nurse line, Virtuwell® 24/7 online clinic care, $50 quarterly allowance/OTC medications and health related items, up to $475/year with the HealthPartners Choice Card to use on non-Medicare covered prescription eyewear, chiropractic services, hearing aids through TruHearing, and home-delivered meals through Mom’s Meals® following an inpatient hospital or skilled nursing facility (SNF) stay. May be used for one item/service or a combination. |
HealthPartners Journey Stride
H4882-011-002
PPO
Monthly premium: $51
| Travel coverage | In-Network: $0 copay/individual medical health risk and safety counseling specific to travel. Out-of-Network: $60 copay/ individual medical health risk and safety counseling specific to travel. Note: Plan coverage and in-network cost sharing when using Medicare providers while traveling outside Minnesota for at least 1 month (no more than 9 consecutive months). You must use Medicare providers and contact Member Services to activate this benefit. |
| Dental | In-Network: $0 copay/Medicare covered benefits, preventive dental services, optional comprehensive dental available for an additional monthly premium Out-of-Network: 20% coinsurance/Medicare covered benefits, 50% coinsurance/preventive dental services Combined In- and Out-of-Network: $2,000 allowance/year for preventive dental services |
| Vision | In-Network: $0 copay/routine eye exam per year, $45 copay/diagnostic eye exam Out-of-Network: 20% coinsurance/routine eye exam per year, diagnostic eye exam Combined In-Network and Out-of-Network: Up to $300 /year on the HealthPartners Choice Card may be used toward the purchase of non-Medicare covered prescription eyewear |
| Hearing | In-Network: $0 copay/routine hearing exam, $45 copay/diagnostic hearing exam, $499, $699 or $999 copay/hearing aid from a TruHearing® provider (up to 1 per ear, 2 per year) Out-of-network: 20% coinsurance/routine hearing exam per year, diagnostic hearing exam Combined In-Network and Out-of-Network: up to $300/year may be used toward the purchase of hearing aids through TruHearing. |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $300/tiers 3-5 |
| Discounts & programs | SilverSneakers®, Medication Therapy Management, Assist America® worldwide emergency travel logistics, CareLine® Service registered nurse line, Virtuwell® 24/7 online clinic care, $40 quarterly allowance/OTC medications and health related items, up to $300/year with the HealthPartners Choice Card to use on non-Medicare covered prescription eyewear, chiropractic services, hearing aids through TruHearing, and home-delivered meals through Mom’s Meals® following an inpatient hospital or skilled nursing facility (SNF) stay. May be used for one item/service or a combination. |
HealthPartners Journey Dash
H4882-010-001
PPO
Monthly premium: $93
| Travel coverage | In-Network: $0 copay/individual medical health risk and safety counseling specific to travel. Out-of-Network: $50 copay/ individual medical health risk and safety counseling specific to travel. Note: Plan coverage and in-network cost sharing when using Medicare providers while traveling outside Minnesota for at least 1 month (no more than 9 consecutive months). You must use Medicare providers and contact Member Services to activate this benefit. |
| Dental | In-Network: $0 copay/Medicare covered benefits Out-of-Network: 20% coinsurance/Medicare covered benefits, 50% coinsurance/preventive dental services Combined In- and Out-of-Network: $2,000 allowance/year for dental services |
| Vision | In-Network: $0 copay/routine eye exam per year, $30 copay/diagnostic eye exam Out-of-Network: 20% coinsurance/routine eye exam per year, diagnostic eye exam Combined In-Network and Out-of-Network: Up to $400/year on the HealthPartners Choice Card may be used toward the purchase non-Medicare covered prescription eyewear |
| Hearing | In-Network: $0 copay/routine hearing exam, $30 copay/diagnostic hearing exam, $399, $599 or $899 copay/hearing aid from a TruHearing® provider (up to 1 per ear, 2 per year) Out-of-network: 20% coinsurance/routine hearing exam and diagnostic hearing exam Combined In-Network and Out-of-Network: Up to $400/year on the HealthPartners Choice Card may be used toward the purchase of hearing aids from TruHearing. |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1-2 , $250/tiers 3-5 |
| Discounts & programs | SilverSneakers®, Medication Therapy Management, Assist America® worldwide emergency travel logistics, CareLine® Service registered nurse line, Virtuwell® 24/7 online clinic care, $50 quarterly allowance/OTC medications and health related items, up to $400/year with the HealthPartners Choice Card to use on non-Medicare covered prescription eyewear, chiropractic services, hearing aids through TruHearing, and home-delivered meals through Mom’s Meals® following an inpatient hospital or skilled nursing facility (SNF) stay. May be used for one item/service or a combination. |
HealthPartners Journey Dash
H4882-010-002
PPO
Monthly premium: $117
| Travel coverage | In-Network: $0 copay/individual medical health risk and safety counseling specific to travel. Out-of-Network: $50 copay/ individual medical health risk and safety counseling specific to travel. Note: Plan coverage and in-network cost sharing when using Medicare providers while traveling outside Minnesota for at least 1 month (no more than 9 consecutive months). You must use Medicare providers and contact Member Services to activate this benefit. |
| Dental | In-Network: $0 copay/Medicare covered benefits, optional comprehensive dental available for an additional monthly premium. Out-of-Network: 20% coinsurance/Medicare covered benefits, 50% coinsurance/preventive dental services Combined In- and Out-of-Network: $2,000 allowance/year for dental services |
| Vision | In-Network: $0 copay/routine eye exam per year, $30 copay/diagnostic eye exam Out-of-Network: 20% coinsurance/routine eye exam per year, diagnostic eye exam Combined In-Network and Out-of-Network: Up to $175/year on the HealthPartners Choice Card may be used toward the purchase of non-Medicare covered prescription eyewear |
| Hearing | In-Network: $0 copay/routine hearing exam, $30 copay/diagnostic hearing exam, $399, $599 or $899 copay/hearing aid from a TruHearing® provider (up to 1 per ear, 2 per year) Out-of-network: 20% coinsurance/routine hearing exam and diagnostic hearing exam Combined In-Network and Out-of-Network: Up to $175/year on the HealthPartners Choice Card may be used toward the purchase of hearing aids from TruHearing. |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1-2 , $250/tiers 3-5 |
| Discounts & programs | SilverSneakers®, Medication Therapy Management, Assist America® worldwide emergency travel logistics, CareLine® Service registered nurse line, Virtuwell® 24/7 online clinic care, $50 quarterly allowance/OTC medications and health related items, up to $175/year with the HealthPartners Choice Card to use on non-Medicare covered prescription eyewear, chiropractic services, hearing aids through TruHearing, and home-delivered meals through Mom’s Meals® following an inpatient hospital or skilled nursing facility (SNF) stay. May be used for one item/service or a combination. |
HealthPartners Journey Steady
H4882-003
PPO
Monthly premium: $146
| Travel coverage | In-Network: $0 copay/individual medical health risk and safety counseling specific to travel. Out-of-Network: $40 copay/ individual medical health risk and safety counseling specific to travel. Note: Plan coverage and in-network cost sharing when using Medicare providers while traveling outside Minnesota for at least 1 month (no more than 9 consecutive months). You must use Medicare providers and contact Member Services to activate this benefit. |
| Dental | In-Network: $0 copay/Medicare covered benefits, preventive dental services (1 oral exam and cleaning per year and 1 bitewing x-ray every 2 years); optional comprehensive dental available for an additional monthly premium Out-of-Network: 20% coinsurance/Medicare covered benefits, 40% coinsurance/preventive dental services Combined In- and Out-of-Network: $1,000 allowance/year for preventive dental services |
| Vision | In-Network: $0 copay/1 routine eye exam per year, $25 copay/diagnostic eye exam Out-of-Network: 20% coinsurance/1 routine eye exam per year, diagnostic eye exam Combined In-Network and Out-of-Network: $250 allowance/year for non-Medicare covered prescription eyewear |
| Hearing | In-Network: $0 copay/routine hearing exam, $25 copay/diagnostic hearing exam, $399, $599 or $899 copay/hearing aid from a TruHearing® provider (up to 1 per ear, 2 per year) Out-of-Network: 20% coinsurance/routine hearing exam per year, diagnostic hearing exam |
| Medicare Part D coverage | Yes, if you enroll in a separate Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $300/tiers 3-5 |
| Discounts & programs | SilverSneakers®, Medication Therapy Management, Assist America® worldwide emergency travel logistics, CareLine® Service registered nurse line, Virtuwell® 24/7 online clinic care |
Humana
New member enrollment: 800-833-2364
Customer service: 800-457-4708
TTY: 711
Website: www.humana.com/medicare
Humana Gold Plus
H6622-073
HMO-POS
Monthly premium: $0
| Travel coverage | $110 copay/Medicare-covered visit, worldwide coverage, copay waived if admitted within 24 hours |
| Dental | In-Network: $45 copay/Medicare-covered benefits Routine Dental: $0 copayment for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. $0 copayment for comprehensive oral evaluation or periodontal exam, occlusal adjustment, scaling for moderate inflammation up to 1every 3 years. $0 copayment for bridge recementation, crown recementation, panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for root canal, root canal retreatment up to 1 per tooth per lifetime. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for adjustments to dentures, denture rebase, denture reline, denture repair, emergency diagnostic exam, tissue conditioning up to 1 per year. $0 copayment for emergency treatment for pain, oral surgery, periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for amalgam and/or composite filling, necessary anesthesia with covered service, simple or surgical extraction up to unlimited per year. 30% coinsurance for bridgespontic, complete dentures, partial dentures up to 1 every 5 years. 30% coinsurance for other restorative services - core buildup and prefabricated post and core up to 1 per tooth per lifetime. 30%-40% coinsurance for crown up to 1 every 5 years. 30%-40% coinsurance for bridgescrown up to 2 every 5 years. $3,000 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions. |
| Vision | In-Network: $45 copay/Medicare-covered vision services, $0 copay/diabetic eye exam, glaucoma screening, post-cataract eyewear Routine vision: $0 copay/routine exam up to 1 per year, $50 maximum benefit coverage amount per year for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames, $100 maximum benefit coverage amount per year at PLUS Provider for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames, Eyeglass lens options may be available with the maximum benefit coverage amount up to 1 pair per year. Maximum benefit coverage amount is limited to one time use per year. |
| Hearing | In-Network: $45 copay/Medicare-covered hearing services Routine hearing: $0 copay/routine hearing exams up to 1 per year, $0 copay/follow-up provider visits up to unlimited per year, $499 copay/each Advanced level hearing aid up to 1 per ear per year, $799 copay/each Premium level hearing aid up to 1 per ear per year Note: Includes 80 batteries per aid and 3 year warranty, Unlimited follow-up provider visits during first year following TruHearing hearing aid purchase |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $575/tiers 3-5 |
| Discounts & programs | Go365 by Humana Rewards, SilverSneakers program, meal benefit |
HumanaChoice
H5216-275
PPO
Monthly premium: $0
| Travel coverage | $125 copay/Medicare-covered visit, worldwide coverage, copay waived if admitted within 24 hours |
| Dental | In-Network: $65 copay/Medicare-covered dental services Out-of-Network: 50% coinsurance/Medicare-covered services Routine Dental: $0 copayment for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. $0 copayment for comprehensive oral evaluation or periodontal exam, occlusal adjustment, scaling for moderate inflammation up to 1 every 3 years. $0 copayment for bridge recementation, crown recementation, panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for crown, other restorative services - core buildup and prefabricated post and core, root canal, root canal retreatment up to 1 per tooth per lifetime. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for adjustments to dentures, denture rebase, denture reline, denture repair, emergency diagnostic exam, tissue conditioning up to 1 per year. $0 copayment for emergency treatment for pain, oral surgery, periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for amalgam and/or composite filling, necessary anesthesia with covered service, simple or surgical extraction up to unlimited per year. 30% coinsurance for bridgespontic, complete dentures, partial dentures up to 1 every 5 years. 30% coinsurance for bridgescrown up to 2 every 5 years. $3,000 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits. |
| Vision | In-Network: $65 copay/Medicare-covered vision services, $0 copay/diabetic eye exam, glaucoma screening, post-cataract eyewear Out-of-Network: 50% coinsurance/Medicare-covered vision services, 50% coinsurance/diabetic eye exam, glaucoma screening, post-cataract eyewear Routine Vision: $0 copay/routine eye exam up to 1 per year, $40 max benefit coverage/year for routine exam, $250 max benefit coverage/year for contact lenses or eyeglasses - lenses and frames, $300 max benefit coverage/year at PLUS Provider for contact lenses or eyeglasses - lenses and frames, fitting for eyeglasses - lenses and frames. Maximum benefit coverage amount is limited to 1 time use/year. |
| Hearing | In-Network: $65 copay/Medicare-covered hearing services Out-of-Network: 50% coinsurance/Medicare-covered services Routine Hearing: $0 copayment/routine hearing exams up to 1 per year, follow-up provider visits up to unlimited per year; $699 copayment/each Advanced level hearing aid up to 1 per ear per year; $999 copayment/each Premium level hearing aid up to 1 per ear per year. Note: Includes 80 batteries per aid and 3 year warranty. Unlimited follow-up provider visits during first year following TruHearing hearing aid purchase. TruHearing provider must be used for in- and out-of-network hearing aid benefit. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $590/tiers 3-5 |
| Discounts & programs | Go365 by Humana Rewards, SilverSneakers program, meal benefit, over the counter drugs and supplies ($50 max quarterly) |
Humana USAA Honor Giveback
H5216-278-001
PPO
Monthly premium: $0
Up to $70 Part B premium reduction
| Travel coverage | $125 copay/Medicare-covered visit, worldwide coverage, copay waived if admitted to the hospital within 24 hours for the same condition |
| Dental | In-Network: $65 copay/Medicare-covered services Out-of-Network: 50% coinsurance/Medicare-covered services Routine Dental: Plan covers up to $4000 allowance every year for non-Medicare covered preventive and comprehensive dental services. You are responsible for any amount above the dental coverage limit. Any amount unused at the end of the year will expire. Your benefit can be used for most dental treatments such as: Preventive dental services, such as exams, routine cleanings, etc. Basic dental services, such as fillings, extractions, etc. Major dental services, such as periodontal scaling, crowns, dentures, root canals, bridges etc. 30% coinsurance applies to dentures. 30% - 40% coinsurance applies to bridges and crowns. Frequency limits may apply. Note: The allowance cannot be used on fluoride, cosmetic services and implants. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions. |
| Vision | In-Network: $65 copay/Medicare-covered vision benefits, $0 copay/diabetic eye exam, glaucoma screening, post-cataract eyewear Out-of-Network: 50% coinsurance/Medicare-covered vision benefits, 50% coinsurance/diabetic eye exam, glaucoma screening, post-cataract eyewear Routine Vision: $0 copay/routine exam up to 1 per year, $75 combined maximum benefit coverage amount per year for routine exam. $150 combined maximum benefit coverage amount per year for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses lenses and frames. Eyeglass lens options may be available with the maximum benefit coverage amount up to 1 pair per year. Maximum benefit coverage amount is limited to one time use per year. |
| Hearing | In-Network: $65 copay/Medicare-covered hearing benefits Out-of-Network: 50% coinsurance/Medicare-covered hearing services Routine Hearing: $0 copayment/fitting, routine hearing exams up to 1 per year, $699 copayment/Advanced level hearing aid up to 1 per ear per year, $999 copayment/Premium level hearing aid up to 1 per ear per year. $0 copay/follow-up provider visits. Note: includes 80 batteries per aid and 3 year warranty, fitting and adjustments covered for 1 year after TruHearing hearing aid purchase |
| Medicare Part D coverage | No, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan |
| Discounts & programs | Go365 by Humana Rewards, SilverSneakers program, over-the-counter drugs and supplies ($125 quarterly), meal benefit |
Humana USAA Honor Giveback
H5216-354
PPO
Monthly premium: $0
Up to $100 Part B premium reduction
| Travel coverage | $125 copay/Medicare-covered visit, worldwide coverage, copay waived if admitted to the hospital within 24 hours for the same condition |
| Dental | In-Network: $45 copay/Medicare-covered services Out-of-Network: 50% coinsurance/Medicare-covered services. Plan covers up to $1000 allowance every year for non-Medicare covered preventive and comprehensive dental services. You are responsible for any amount above the dental coverage limit. Any amount unused at the end of the year will expire. Your benefit can be used for most dental treatments such as: Preventive dental services, such as exams, routine cleanings, etc. Basic dental services, such as fillings, extractions, etc. Major dental services, such as periodontal scaling, crowns, dentures, root canals, bridges etc. 30% coinsurance applies to dentures. 30% - 40% coinsurance applies to bridges and crowns. Frequency limits may apply. Note: The allowance cannot be used on fluoride, cosmetic services and implants. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions. |
| Vision | In-Network: $45 copay/Medicare-covered vision benefits, $0 copay/diabetic eye exam, glaucoma screening, post-cataract eyewear Out-of-Network: 50% coinsurance/Medicare-covered vision benefits, 50% coinsurance/diabetic eye exam, glaucoma screening, post-cataract eyewear Routine Vision: $0 copay/routine exam up to 1 per year, $75 combined maximum benefit coverage amount per year for routine exam. $150 combined maximum benefit coverage amount per year for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses lenses and frames. $200 maximum benefit coverage amount per year at PLUS Provider for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames. Eyeglass lens options may be available with the maximum benefit coverage amount up to 1 pair per year. Maximum benefit coverage amount is limited to one time use per year. |
| Hearing | In-Network: $45 copay/Medicare-covered hearing benefits Out-of-Network: 50% coinsurance/Medicare-covered hearing services Routine Hearing: $0 copayment/fitting, routine hearing exams up to 1 per year, $699 copayment/Advanced level hearing aid up to 1 per ear per year, $999 copayment/Premium level hearing aid up to 1 per ear per year. $0 copay/follow-up provider visits. Note: includes 80 batteries per aid and 3 year warranty, fitting and adjustments covered for 1 year after TruHearing hearing aid purchase |
| Medicare Part D coverage | No, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan |
| Discounts & programs | Go365 by Humana Rewards, SilverSneakers program, over-the-counter drugs and supplies ($50 quarterly), meal benefit |
HumanaChoice
H5216-359
PPO
Monthly premium: $11
| Travel coverage | $125 copay/Medicare-covered visit, worldwide coverage, copay waived if admitted to the hospital within 24 hours for the same condition |
| Dental | In-Network: $45 copay/Medicare-covered dental benefits Out-of-Network: 50% coinsurance/Medicare-covered dental services Routine Dental: $0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years. $0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for emergency diagnostic exam up to 1 per year. $0 copayment for periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for necessary anesthesia with covered service up to unlimited per year. $25 copayment per tooth for amalgam and/or composite filling up to 2 per year. $1,000 combined maximum benefit coverage amount per year for preventive and comprehensive benefits. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions |
| Vision | In-Network: $45 copay/Medicare-covered vision benefits, $0 copay/diabetic eye exam, glaucoma screening, post-cataract eyewear Out-of-Network: 50% coinsurance/Medicare-covered vision benefits, diabetic eye exam, glaucoma screening, post-cataract eyewear Routine Vision: $0 copay/routine exam up to 1 per year, $75 combined maximum benefit coverage amount per year for routine exam, $50 combined maximum benefit coverage amount per year for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames, $100 maximum benefit coverage amount per year at PLUS Provider for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames, eyeglass lens options may be available with the maximum benefit coverage amount up to 1 pair per year, maximum benefit coverage amount is limited to one time use per year. |
| Hearing | In-Network: $45 copay/Medicare-covered hearing benefits Out-of-Network: 50% coinsurance/Medicare-covered hearing services Routine Hearing: $0 copay/routine hearing exams up to 1 per year, $0 copay/for follow-up provider visits up to unlimited per year, $699 copay/each Advanced level hearing aid up to 1 per ear per year, $999 copay/each Premium level hearing aid up to 1 per ear per year. Note: Includes 80 batteries per aid and 3 year warranty, unlimited follow-up provider visits during first year following TruHearing hearing aid purchase. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $590 |
| Discounts & programs | Go365 by Humana Rewards for completing preventive health screenings and activities, SilverSneakers, meal benefit |
Humana Value Plus
H5216-176
PPO
Monthly premium: $27.60
| Travel coverage | $110 copay/covered ER visit worldwide with copay waived if admitted to the hospital within 24 hours |
| Dental | In-Network: 20% coinsurance/Medicare-covered benefits Out-of-Network: 50% coinsurance/Medicare-covered benefits Routine Dental: $0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years. $0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for emergency diagnostic exam up to 1 per year. $0 copayment for periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for necessary anesthesia with covered service up to unlimited per year. $1,000 combined maximum benefit coverage amount per year for all preventive and comprehensive benefits. |
| Vision | In-Network: 20% coinsurance/covered vision benefits, $0 copay/diabetic eye exam, glaucoma screening, post-cataract eyewear Out-of-Network: 50% coinsurance/covered vision benefits, diabetic eye exam, glaucoma screening, post-cataract eyewear Routine Vision: $0 copay/routine exam, up to 1/year, $75 max benefit coverage amount/year for routine exam, $50 max benefit amount/year for eyeglasses/contact lenses. $100 maximum benefit coverage amount per year at PLUS Provider for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames. |
| Hearing | In-Network: 20% coinsurance/Medicare-covered hearing benefits Out-of-Network: 50% coinsurance/Medicare-covered hearing services Routine Hearing: $0 copay/routine hearing exams up to 1 per year, $0 copay/follow-up provider visits up to unlimited per year, $699 copay/each Advanced level hearing aid up to 1 per ear per year, $999 copay/each Premium level hearing aid up to 1 per ear per year Note: Includes 80 batteries per aid and 3 year warranty, unlimited follow-up provider visits during first year following TruHearing hearing aid purchase. |
| Medicare Part D coverage | Yes, if you enroll in a stand-alone Part D plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $590 |
| Discounts & programs | Go365 by Humana Rewards, SilverSneakers, meal benefit, enhanced nutrition therapy |
Humana Gold Choice
H8145-006
PFFS
Monthly premium: $38
| Travel coverage | $110 for worldwide, waived if admitted within 24 hours |
| Dental | $55 copay/Medicare-covered dental benefits, limits apply. Plan covers up to $3000 allowance every year for non-Medicare covered preventive and comprehensive dental services. You are responsible for any amount above the dental coverage limit. Any amount unused at the end of the year will expire. Your benefit can be used for most dental treatments such as: Preventive dental services, such as exams, routine cleanings, etc. Basic dental services, such as fillings, extractions, etc. Major dental services, such as periodontal scaling, crowns, dentures, root canals, bridges etc. 30% coinsurance applies to dentures. 30% - 40% coinsurance applies to bridges and crowns. Frequency limits may apply. Note: The allowance cannot be used on fluoride, cosmetic services and implants. |
| Vision | $55 copay/Medicare-covered vision benefits Note: $0 copay/routine exam up to 1 per year, $75 combined maximum benefit coverage amount per year for routine exam, $50 combined maximum benefit coverage amount per year for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames, $100 maximum benefit coverage amount per year at PLUS Provider for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames, eyeglass lens options may be available with the maximum benefit coverage amount up to 1 pair per year |
| Hearing | $55 copay/Medicare-covered hearing benefits, $0 copay/routine hearing exams up to 1 per year, $0 copay/follow-up provider visits up to unlimited per year, $699 copay/each Advanced level hearing aid up to 1 per ear per year, $999 copay/each Premium level hearing aid up to 1 per ear per year, Note: Includes 80 batteries per aid and 3 year warranty, unlimited follow-up provider visits during first year following TruHearing hearing aid purchase. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $590/tiers 3, 4 & 5 |
| Discounts & programs | Go365 by Humana Rewards for completing preventive health screenings and activities, SilverSneakers, over-the-counter drugs and supplies, meal benefit |
HumanaChoice
H5216-092
PPO
Monthly premium: $48
| Travel coverage | $110 copay/Medicare-covered visit, worldwide coverage, copay waived if admitted to the hospital within 24 hours for the same condition |
| Dental | In-Network: $50 copay/Medicare-covered dental benefits Out-of-Network: 50% coinsurance/Medicare-covered dental services Note: $0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years. $0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for emergency diagnostic exam up to 1 per year. $0 copayment for periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for necessary anesthesia with covered service up to unlimited per year. |
| Vision | In-Network: $50 copay/Medicare-covered vision benefits Out-of-Network: 50% coinsurance/Medicare-covered vision services Note: $0 copay/routine exam up to 1 per year, $75 combined maximum benefit coverage amount per year for routine exam, $50 combined maximum benefit coverage amount per year for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames, $100 maximum benefit coverage amount per year at PLUS Provider for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames, eyeglass lens options may be available with the maximum benefit coverage amount up to 1 pair per year |
| Hearing | In-Network: $50 copay/Medicare-covered hearing benefits Out-of-Network: 50% coinsurance/Medicare-covered hearing services. $0 copay/routine hearing exams up to 1 per year, $0 copay/follow-up provider visits up to unlimited per year, $699 copay/each Advanced level hearing aid up to 1 per ear per year, $999 copay/each Premium level hearing aid up to 1 per ear per year, Note: Includes 80 batteries per aid and 3 year warranty, unlimited follow-up provider visits during first year following TruHearing hearing aid purchase. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $590/tiers 3, 4 & 5 |
| Discounts & programs | Go365 by Humana Rewards for completing preventive health screenings and activities, SilverSneakers |
HumanaChoice
H5216-397
PPO
Monthly premium: $56
| Travel coverage | $140 Worldwide coverage, copay waived if admitted within 24 hours |
| Dental | In-Network: $35 copay/Medicare-covered dental benefits Out-of-Network: 50% coinsurance/Medicare-covered dental services Note: $0 copayment for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. $0 copayment for comprehensive oral evaluation or periodontal exam, occlusal adjustment, scaling for moderate inflammation up to 1 every 3 years. $0 copayment for crown recementation, panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for root canal, root canal retreatment up to 1 per tooth per lifetime. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for adjustments to dentures, denture rebase, denture reline, denture repair, emergency diagnostic exam, tissue conditioning up to 1 per year. $0 copayment for emergency treatment for pain, oral surgery, periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for amalgam and/or composite filling, necessary anesthesia with covered service, simple or surgical extraction up to unlimited per year. 30% coinsurance for complete dentures, partial dentures up to 1 every 5 years. 30% coinsurance for other restorative services - core buildup and prefabricated post and core up to 1 per tooth per lifetime. 30%-40% coinsurance for crown up to 1 every 5 years. $2,500 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits. |
| Vision | In-Network: $35 copay/Medicare-covered vision benefits Out-of-Network: 50% coinsurance/Medicare-covered vision services Note: $0 copay/routine exam up to 1 per year, $75 combined maximum benefit coverage amount per year for routine exam, $50 combined maximum benefit coverage amount per year for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames, $100 maximum benefit coverage amount per year at PLUS Provider for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames, eyeglass lens options may be available with the maximum benefit coverage amount up to 1 pair per year |
| Hearing | In-Network: $35 copay/Medicare-covered hearing benefits Out-of-Network: 50% coinsurance/Medicare-covered hearing services. $0 copay/routine hearing exams up to 1 per year, $0 copay/follow-up provider visits up to unlimited per year, $699 copay/each Advanced level hearing aid up to 1 per ear per year, $999 copay/each Premium level hearing aid up to 1 per ear per year, Note: Includes 80 batteries per aid and 3 year warranty, unlimited follow-up provider visits during first year following TruHearing hearing aid purchase. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $250/tiers 3-5 |
| Discounts & programs | Go365 by Humana Rewards for completing preventive health screenings and activities, SilverSneakers, meal benefit |
HumanaChoice
H5216-063
PPO
Monthly premium: $102
| Travel coverage | $140 copay/Medicare-covered visit, worldwide coverage, copay waived if admitted to the hospital within 24 hours for the same condition |
| Dental | In-Network: $35 copay/Medicare-covered dental benefits Out-of-Network: 50% coinsurance/Medicare-covered dental services Routine Dental: $0 copayment for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. $0 copayment for comprehensive oral evaluation or periodontal exam, occlusal adjustment, scaling for moderate inflammation up to 1 every 3 years. $0 copayment for crown recementation, panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for root canal, root canal retreatment up to 1 per tooth per lifetime. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for adjustments to dentures, denture rebase, denture reline, denture repair, emergency diagnostic exam, tissue conditioning up to 1 per year. $0 copayment for emergency treatment for pain, oral surgery, periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for amalgam and/or composite filling, necessary anesthesia with covered service, simple or surgical extraction up to unlimited per year. 30% coinsurance for complete dentures, partial dentures up to 1 every 5 years. 30% coinsurance for other restorative services - core buildup and prefabricated post and core up to 1 per tooth per lifetime. 30%-40% coinsurance for crown up to 1 every 5 years. $2,500 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits. |
| Vision | In-Network: $35 copay/Medicare-covered vision benefits, $0 copay/diabetic eye exam, glaucoma screening, post-cataract eyewear Out-of-Network: 50% coinsurance/Medicare-covered vision benefits, 50% coinsurance/diabetic eye exam, glaucoma screening, post-cataract eyewear Routine vision: $0 copayment for routine exam up to 1 per year. $75 combined maximum benefit coverage amount per year for routine exam. $50 maximum benefit coverage amount per year for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames, eyeglass lens options may be available with the maximum benefit coverage amount up to 1 pair per year, maximum benefit coverage amount is limited to one time use per year, benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions. |
| Hearing | In-Network: $35 copay/Medicare-covered hearing benefits Out-of-Network: 50% coinsurance/Medicare-covered hearing services Routine Hearing: $0 copay/routine hearing exams up to 1 per year, $0 copay/follow-up provider visits up to unlimited per year, $699 copay/each Advanced level hearing aid up to 1 per ear per year, $999 copay/each Premium level hearing aid up to 1 per ear per year. Note: Includes 80 batteries per aid and 3 year warranty, unlimited follow-up provider visits during first year following TruHearing hearing aid purchase. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $250/tiers 3-5 |
| Discounts & programs | Go365 by Humana Rewards, SilverSneakers program, meal benefit |
Medica
New member enrollment: 800-918-2416
Customer service: 866-269-6804
TTY/TDD: 711
Website: https://www.medica.com/shop/medicare/plan-materials-forms/medica-medicare-advantage-solution-plan-materials
Medica Advantage Solution
H6154-001
HMO-POS
Monthly premium: $0
| Travel coverage | Receive all plan covered services at in-network cost sharing while traveling outside the state for no more than 6 consecutive months. Members call to activate benefit. Emergency Care Worldwide: 20% coinsurance/emergency care services and emergency ground transportation. Out-of-Network Services: 40%/most Medicare-covered services through the POS benefit in the U.S. and its territories at any provider who accepts Medicare. |
| Dental | 20% coinsurance/Medicare-covered dental benefits, up to a $400 allowance for non-Medicare-covered dental services each year from a licensed dentist by using Health+ by Medica card at time of payment. |
| Vision | $0 copay/1 routine eye exam plus 1 refraction per year, $150 annual allowance for non-Medicare-covered prescription eyewear by using Health+ by Medica card at time of payment, $50 copay Medicare covered diagnostic eye exam, $0 copay for Medicare-covered glaucoma and diabetic retinopathy screenings, $0 copay for 1 refraction associated with a Medicare-covered eye service, $0 copay Medicare-covered eyewear following cataract surgery. |
| Hearing | $0 copay/1 routine hearing test per year; $0 copay/fitting-evaluations for hearing aids; $549,$799 or $1299 copay/hearing aid when using the EPIC Hearing network, $40 copay/Medicare-covered diagnostic hearing and balance evaluations. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $590/tiers 3-5 |
| Discounts & programs | One Pass™ Fitness program includes CogniFit memory training, $65 semi-annual over-the-counter allowance can be used for health and wellness products by using Health+ by Medica card at participating retailers, online and over the phone, 24/7 HealthAdvocate nurseline, $0 copay/e-visit from virtuwell, Health+ by Medica Card. |
Medica Advantage Solution
H8889-009
PPO
Monthly premium: $0
$85 Part B premium reduction
| Travel coverage | Receive all plan covered services at in-network cost sharing while traveling outside the state for no more than 6 consecutive months. Members call to activate benefit. Emergency Care Worldwide: 20% coinsurance/emergency care services and emergency ground transportation. |
| Dental | In-Network: $0-$35 copay/Medicare-covered dental benefits, up to a $1,000 allowance for non-Medicare-covered dental services each year from a licensed dentist by using Health+ by Medica card at time of payment Out-of-Network: $0-$50 copay/Medicare-covered dental benefits. |
| Vision | In-Network: $0 copay/1 routine eye exam plus 1 refraction per year. $200 annual allowance for non-Medicare-covered prescription eyewear/year by using Health+ by Medica card at time of payment, $35 copay/Medicare-covered diagnostic eye exam, $0 copay for Medicare-covered glaucoma and diabetic retinopathy screenings, $0 copay/1 refraction associated with a Medicare-covered eye service, $0 copay Medicare-covered eyewear following cataract surgery. Out-of-Network: $0 copay/1 routine eye exam per year, Medicare-covered diabetic retinopathy exam and glaucoma screening, and Medicare-covered eyewear, $50 copay/Medicare-covered diagnostic exams. |
| Hearing | In-Network: $0 copay/1 routine hearing test per year; $0 copay/fitting-evaluations for hearing aids; $549, $799 or $1299 copay/hearing aid when using EPIC Hearing network, $0-$25 copay/Medicare-covered diagnostic hearing and balance evaluations Out-of-Network: $0-$40 copay/Medicare-covered diagnostic hearing and balance evaluations. |
| Medicare Part D coverage | No, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan |
| Discounts & programs | One Pass™ Fitness program includes CogniFit memory training, $75 semi-annualover-the-counter allowance can be used for health and wellness products by using Health+ by Medica card at participating retailers, online and over the phone, 24/7 HealthAdvocate Nurseline, Health+ by Medica Card. |
Medica Advantage Solution
H8889-005
PPO
Monthly premium: $0
| Travel coverage | Receive all plan covered services at in-network cost sharing while traveling outside the state for no more than 6 consecutive months. Members call to activate benefit. Emergency Care Worldwide: 20% coinsurance/emergency care services and emergency ground transportation. |
| Dental | In-Network: $0-$45 copay/Medicare-covered dental benefits, up to a $750 allowance for non-Medicare-covered dental services each year from a licensed dentist by using Health+ by Medica card at time of payment Out-of-Network: $20-$50 copay/Medicare-covered dental benefits. |
| Vision | In-Network: $0 copay/1 routine eye exam plus 1 refraction per year..$200 annual allowance for non-Medicare-covered prescription eyewear each year by using Health+ by Medica card at time of payment; $45 copay/Medicare-covered diagnostic eye exam, $0 copay for Medicare-covered glaucoma and diabetic retinopathy screenings, $0 copay/1 refraction associated with a Medicare-covered eye service, $0 copay Medicare-covered eyewear following cataract surgery. Out-of-Network: $0 copay/1 routine eye exam per year, Medicare-covered glaucoma screening, and Medicare-covered eyewear, $20/Medicare-covered diabetic retinopathy exam, $50 copay/Medicare-covered diagnostic exams. |
| Hearing | In-Network: $0 copay/1 routine hearing test per year; $0 copay/fitting-evaluations for hearing aids; $549,$799 or $1299 copay/hearing aid when using the EPIC Hearing network. $0-35 copay/ Medicare-covered diagnostic hearing and balance evaluations Out-of-Network: $20-$40 copay/Medicare-covered diagnostic hearing and balance evaluations. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $495/tiers 3-5 |
| Discounts & programs | One Pass™ Fitness program includes CogniFit memory training, $75 semi-annual/over-the-counter allowance can be used for health and wellness products by using Health+ by Medica card at participating retailers, online and over the phone, 24/7 HealthAdvocate Nurseline, $0 copay/e-visit from virtuwell, Health+ by Medica Card. |
Medica Advantage Solution
H8889-008
PPO
Monthly premium: $44
| Travel coverage | Receive all plan covered services at in-network cost sharing while traveling outside the state for no more than 6 consecutive months. Members call to activate benefit. Emergency Care Worldwide: 20% coinsurance/emergency care services and emergency ground transportation |
| Dental | In-Network: $0-$50 copay/Medicare-covered dental benefits, up to a $400 allowance for non-Medicare-covered dental services each year from a licensed dentist, by using Health+ by Medica card at time of payment Out-of-Network: $20-$55 copay/Medicare-covered dental benefits |
| Vision | In-Network: $0 copay/1 routine eye exam plus 1 refraction per year. $100 annual allowance for non-Medicare-covered prescription eyewear by using Health+ by Medica card at time of payment, $50 copay/Medicare-covered diagnostic eye exam, $0 copay for Medicare-covered glaucoma and diabetic retinopathy screenings, $0 copay/1 refraction associated with a Medicare-covered eye service, $0 copay Medicare-covered eyewear following cataract surgery. Out-of-Network: $0 copay/1 routine eye exam per year, Medicare-covered glaucoma screening, and Medicare-covered eyewear, $20 copay/Medicare-covered diabetic retinopathy exam, $55 copay/Medicare-covered diagnostic exams. |
| Hearing | In-Network: $0 copay/1 routine hearing test per year; $0 copay/fitting-evaluations for hearing aids; $549, $799 or $1299 copay/hearing aid when using EPIC Hearing network, $0-$35 copay/Medicare-covered diagnostic hearing and balance evaluations Out-of-Network: $20-$40 copay/Medicare-covered diagnostic hearing and balance evaluations |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $590/tiers 3-5 |
| Discounts & programs | One Pass™ Fitness program includes CogniFit memory training, $50 semi-annual/over-the-counter allowance can be used for health and wellness products by using Health+ by Medica card at participating retailers, online and over the phone, 24/7 HealthAdvocate Nurseline, $0 copay/e-visit from virtuwell, Health+ by Medica Card. |
Medica Advantage Solution
H8889-001
PPO
Monthly premium: $89
| Travel coverage | Receive all plan covered services at in-network cost sharing while traveling outside the state for no more than 6 consecutive months. Members call to activate benefit. Emergency Care Worldwide: 20% coinsurance/emergency care services and emergency ground transportation |
| Dental | In-Network: $0-$35 copay/Medicare-covered dental benefits, up to a $1,000 allowance for non-Medicare-covered dental services each year from a licensed dentist by using Health+ by Medica card at time of payment Out-of-Network: $0-$40 copay/Medicare-covered dental benefits |
| Vision | In-Network: $0 copay/1 routine eye exam plus 1 refraction per year, $300 annual allowance for non-Medicare-covered prescription eyewear by using Health+ by Medica card at time of payment, $35 copay/Medicare-covered diagnostic exam, $0 copay for Medicare-covered glaucoma and diabetic retinopathy screenings, $0 copay/1 refraction associated with a Medicare-covered eye service, $0 copay Medicare-covered eyewear following cataract surgery. Out-of-Network: $0 copay/1 routine eye exam per year, Medicare-covered diabetic retinopathy exam and glaucoma screening, and Medicare-covered eyewear, $40 copay/Medicare-covered diagnostic exams |
| Hearing | In-Network: $0 copay/1 routine hearing test per year, $0 copay/fitting-evaluations for hearing aids; $549, $799 or $1299 copay/hearing aid when using EPIC Hearing network, $0-$25 copay/Medicare-covered diagnostic hearing and balance evaluations from any provider Out-of-Network: $0-$40 copay/Medicare-covered diagnostic hearing and balance evaluations |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1-2, $295/tiers 3-5 |
| Discounts & programs | One Pass™ Fitness program includes CogniFit memory training, $75 semi-annualover-the-counter allowance can be used for health and wellness products by using Health+ by Medica card at participating retailers, online and over the phone, 24/7 HealthAdvocate Nurseline, $0 copay/e-visit from virtuwell , Health+ by Medica Card. |
Medica Advantage Solution
H8889-002
PPO
Monthly premium: $99
| Travel coverage | Receive all plan covered services at in-network cost sharing while traveling outside the state for no more than 6 consecutive months. Members call to activate benefit. Emergency Care Worldwide: 20% coinsurance/emergency care services and emergency ground transportation |
| Dental | In-Network: $0-$35 copay/Medicare-covered dental benefits, up to a $1,000 allowance for non-Medicare-covered dental services each year from a licensed dentist by using Health+ by Medica card at time of payment Out-of-Network: $0-$40 copay/Medicare-covered dental benefits |
| Vision | In-Network: $0 copay/1 routine eye exam plus 1 refraction per year, $300 annual allowance for non-Medicare-covered prescription eyewear by using Health+ by Medica card at time of payment, $35 copay/Medicare-covered diagnostic exam, $0 copay for Medicare-covered glaucoma and diabetic retinopathy screenings, $0 copay/1 refraction associated with a Medicare-covered eye service, $0 copay Medicare-covered eyewear following cataract surgery. Out-of-Network: $0 copay/1 routine eye exam per year, Medicare-covered diabetic retinopathy exam and glaucoma screening, and Medicare-covered eyewear, $40 copay/Medicare-covered diagnostic exams |
| Hearing | In-Network: $0 copay/1 routine hearing test per year; $0/fitting-evaluations for hearing aids; $549, $799 or $1299 copay/hearing aid when using the EPIC Hearing network, $0-$25 copay/Medicare-covered diagnostic hearing and balance evaluations Out-of-Network: $0-$40 copay/Medicare-covered diagnostic hearing and balance evaluations |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1-2, $295/tiers 3-5 |
| Discounts & programs | One Pass™ Fitness program includes CogniFit memory training, $75 semi-annualover-the-counter allowance can be used for health and wellness products by using Health+ by Medica card at participating retailers, online and over the phone, 24/7 HealthAdvocate Nurseline, $0 copay/e-visit from virtuwell, Health+ by Medica Card. |
Medica Advantage Solution
H8889-004
PPO
Monthly premium: $149
| Travel coverage | Receive all plan covered services at in-network cost sharing while traveling outside the state for no more than 6 consecutive months. Members call to activate benefit. Emergency Care Worldwide: 20% coinsurance/emergency care services and emergency ground transportation |
| Dental | In-Network: $0-$45 copay/Medicare-covered dental benefits, up to a $500 allowance for non-Medicare-covered dental services each year from a licensed dentist by using Health+ by Medica card at time of payment Out-of-Network: $20-$50 copay/Medicare-covered dental benefits |
| Vision | In-Network: $0 copay/1 routine eye exam plus 1 refraction per year, $100 annual allowance by using Health+ by Medica card at time of payment for non-Medicare-covered prescription eyewear, $45 copay/Medicare-covered diagnostic exam, $0 copay for Medicare-covered glaucoma and diabetic retinopathy screenings, $0 copay/1 refraction associated with a Medicare-covered eye service, $0 copay Medicare-covered eyewear following cataract surgery. Out-of-Network: $0 copay/1 routine eye exam per year, Medicare-covered glaucoma screening, and Medicare-covered eyewear, $20/Medicare-covered diabetic retinopathy exam, $50 copay/Medicare-covered diagnostic exams. |
| Hearing | In-Network: $0 copay/1 routine hearing test per year, $0 copay/fitting-evaluations for hearing aids, $549, $799 or $1299 copay/hearing aid when using the EPIC Hearing network, $0-$25 copay/Medicare-covered diagnostic hearing and balance evaluations Out-of-Network: $20-$40 copay/Medicare-covered diagnostic hearing and balance evaluations |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $395/tiers 3-5 |
| Discounts & programs | One Pass™ Fitness program includes CogniFit memory training, $50 semi-annualover-the-counter allowance can be used for health and wellness products by using Health+ by Medica card at participating retailers, online and over the phone, 24/7 HealthAdvocate Nurseline, $0 copay/e-visit from virtuwell, Health+ by Medica Card. |
Medica Advantage Solution
H8889-003
PPO
Monthly premium: $203
| Travel coverage | Receive all plan covered services at in-network cost sharing while traveling outside the state for no more than 6 consecutive months. Members call to activate benefit. Emergency Care Worldwide: 20% coinsurance/emergency care services and emergency ground transportation |
| Dental | In-Network: $0-$10 copay/Medicare-covered dental benefits, up to a $1,000 allowance for non-Medicare-covered dental services each year from a licensed dentist by using Health+ by Medica card at time of payment Out-of-Network: $0-$25 copay/Medicare-covered dental benefits |
| Vision | In-Network: $0 copay/1 routine eye exam plus 1 refraction per year; $300 annual allowance for non-Medicare-covered prescription eyewear by using Health+ by Medica card at time of payment; $10 copay/Medicare-covered diagnostic exam, $0 copay for Medicare-covered glaucoma and diabetic retinopathy screenings, $0 copay/1 refraction associated with a Medicare-covered eye service, $0 copay Medicare-covered eyewear following cataract surgery. Out-of-Network: $0 copay/1 routine eye exam per year, Medicare-covered diabetic retinopathy exam and glaucoma screening, and Medicare-covered eyewear, $25 copay/Medicare-covered diagnostic exams |
| Hearing | In-Network: $0 copay/1 routine hearing test per year; $0 copay/fitting-evaluations for hearing aids; $549 or $799 copay/hearing aid when using EPIC Hearing network, $0-$10 copay/Medicare-covered diagnostic hearing and balance evaluations Out-of-Network: $0-$25 copay/Medicare-covered diagnostic hearing and balance evaluations |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1-5 |
| Discounts & programs | One Pass™ Fitness program includes CogniFit memory training, $75 semi-annualover-the-counter allowance can be used for health and wellness products by using Health+ by Medica card at participating retailers, online and over the phone, 24/7 HealthAdvocate Nurseline, $0 copay/e-visit from virtuwell, Health+ by Medica Card. |
Quartz
New member enrollment: 888-346-0886
Customer service: 800-394-5566
TTY: 711
Website: QuartzBenefits.com/MedicareAdvantage
Gundersen MN Quartz Medicare Advantage Core D
H9834-006
HMO
Monthly premium: $0
| Travel coverage | You may receive all plan covered services at in-network cost for up to 6 months when you travel domestically outside of Wisconsin, Illinois, Minnesota, or Iowa. |
| Dental | $50 copay/Medicare-covered dental exam, $350 limit/reimbursement for combined preventive and comprehensive dental services Note: May purchase an additional $1,000 of dental coverage for $44/month. |
| Vision | $0-$25 copay/exam to diagnose and treat diseases and conditions of the eye, $0 copay/initial routine eye exam annually, $600 provided through the Quartz CashCard toward the purchase of vision hardware |
| Hearing | $10 copay/annual routine hearing exam, $1,000 provided for 2 hearing aids every 2 years |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1-2&6, $225/tiers 3-5 |
| Discounts & programs | Over-the-counter benefit program for eligible over-the-counter medications, health and wellness items, first-aid supplies, and other qualifying items, purchase in-store or online, $15 is automatically reloaded to card every three months; Memory Fitness; Help with certain chronic conditions: Members with chronic conditions (such as diabetes, high blood pressure, congestive heart failure, and obesity), and who are enrolled in a care management program, may be eligible for extra benefits, such as continuous glucose monitors, blood pressure cuffs, scales, keytone readers, etc. |
Gundersen MN Quartz Medicare Advantage Value
H9834-004
HMO
Monthly premium: $0
| Travel coverage | You may receive all plan covered services at in-network cost for up to 6 months when you travel domestically outside of Wisconsin, Illinois, Minnesota, or Iowa. |
| Dental | $40 copay/Medicare-covered dental exam, $350 limit/reimbursement for combined preventive and comprehensive dental services Note: May purchase an additional $1,000 of dental coverage for $44/month |
| Vision | $0-$25 copay/exam to diagnose and treat diseases and conditions of the eye, $0 copay/initial routine eye exam annually, $200 provided through the Quartz CashCard toward the purchase of vision hardware |
| Hearing | $0 copay/annual routine hearing exam, $1,250 provided for 2 hearing aids every 2 years. |
| Medicare Part D coverage | No, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this plan. |
| Discounts & programs | Over-the-counter benefit program for eligible over-the-counter medications, health and wellness items, first-aid supplies, and other qualifying items, purchase in-store or online, $20 is automatically reloaded to card every three months; Memory Fitness; Help with certain chronic conditions: Members with chronic conditions (such as diabetes, high blood pressure, congestive heart failure, and obesity), and who are enrolled in a care management program, may be eligible for extra benefits, such as continuous glucose monitors, blood pressure cuffs, scales, keytone readers, etc. |
Gundersen MN Quartz Medicare Advantage Value D
H9834-003
HMO
Monthly premium: $48
| Travel coverage | You may receive all plan covered services at in-network cost for up to 6 months when you travel domestically outside of Wisconsin, Illinois, Minnesota, or Iowa. |
| Dental | $40 copay/Medicare-covered dental exam, $350 limit/reimbursement for combined preventive and comprehensive dental services Note: May purchase an additional $1,000 of dental coverage for $44/month |
| Vision | $0-$25 copay/exam to diagnose and treat diseases and conditions of the eye, $0 copay/initial routine eye exam annually, $200 provided through the Quartz CashCard toward the purchase of vision hardware |
| Hearing | $0 copay/annual routine hearing exam, $1,250 provided for 2 hearing aids every 2 years. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1-2&6, $225/tiers 3-5 |
| Discounts & programs | Over-the-counter benefit program for eligible over-the-counter medications, health and wellness items, first-aid supplies, and other qualifying items, purchase in-store or online, $15 is automatically reloaded to card every three months; Memory Fitness; Help with certain chronic conditions: Members with chronic conditions (such as diabetes, high blood pressure, congestive heart failure, and obesity), and who are enrolled in a care management program, may be eligible for extra benefits, such as continuous glucose monitors, blood pressure cuffs, scales, keytone readers, etc. |
Gundersen MN Quartz Medicare Advantage Elite
H9834-005
HMO
Monthly premium: $120
| Travel coverage | You may receive all plan covered services at in-network cost for up to 6 months when you travel domestically outside of Wisconsin, Illinois, Minnesota, or Iowa. |
| Dental | $30 copay/Medicare-covered dental exam, $550 limit/reimbursement for combined preventive and comprehensive dental services Note: May purchase an additional $1,000 of dental coverage for $44/month |
| Vision | $0-$10 copay/exam to diagnose and treat diseases and conditions of the eye, $0 copay/initial routine eye exam annually, $250 provided through the Quartz CashCard toward the purchase of vision hardware |
| Hearing | $0 copay/annual routine hearing exam, $1,500 provided for 2 hearing aids every 2 years. |
| Medicare Part D coverage | No, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this plan. |
| Discounts & programs | Over-the-counter benefit program for eligible over-the-counter medications, health and wellness items, first-aid supplies, and other qualifying items, purchase in-store or online, $20 is automatically reloaded to card every three months; Memory Fitness; Help with certain chronic conditions: Members with chronic conditions (such as diabetes, high blood pressure, congestive heart failure, and obesity), and who are enrolled in a care management program, may be eligible for extra benefits, such as continuous glucose monitors, blood pressure cuffs, scales, keytone readers, etc. |
Gundersen MN Quartz Medicare Advantage Elite D
H9834-001
HMO
Monthly premium: $157
| Travel coverage | You may receive all plan covered services at in-network cost for up to 6 months when you travel domestically outside of Wisconsin, Illinois, Minnesota, or Iowa. |
| Dental | $30 copay/Medicare-covered dental exam, $550 limit/reimbursement for combined preventive and comprehensive dental services Note: May purchase an additional $1,000 of dental coverage for $44/month |
| Vision | $0-$10 copay/exam to diagnose and treat diseases and conditions of the eye, $0 copay/initial routine eye exam annually, $250 provided through the Quartz CashCard toward the purchase of vision hardware |
| Hearing | $0 copay/annual routine hearing exam, $1,500 provided for 2 hearing aids every 2 years. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1-2&6, $200/tiers 3-5 |
| Discounts & programs | Over-the-counter benefit program for eligible over-the-counter medications, health and wellness items, first-aid supplies, and other qualifying items, purchase in-store or online, $15 is automatically reloaded to card every three months; Memory Fitness; Help with certain chronic conditions: Members with chronic conditions (such as diabetes, high blood pressure, congestive heart failure, and obesity), and who are enrolled in a care management program, may be eligible for extra benefits, such as continuous glucose monitors, blood pressure cuffs, scales, keytone readers, etc. |
UCare
New member enrollment: 877-523-1518
Customer service: 877-523-1515
TTY: 800-688-2534
Website: ucare.org
UCare Your Choice
H8070-001
PPO
Monthly premium: $0
$24 Part B premium reduction
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered visit in the U.S. PPO Benefit: many out-of-network benefits covered at in-network rates nationwide. |
| Dental | $1,200 annual flexible benefit allowance to use on one or a combination of eligible dental, hearing aids, and prescription eyewear. Network does not apply to eligible dental services |
| Vision | $0 copay/annual routine eye exam; $40 copay/diagnostic eye exam Note: copayment is the same both in-network and out-of-network, $1,200 annual flexible benefit allowance to use on one or a combination of eligible dental, hearing aids, and prescription eyewear. Network does not apply for the purchase of prescription eyewear. |
| Hearing | $0 copay/routine hearing exam; $40 copay/diagnostic hearing exam Note: copayment is the same both in-network and out-of-network, $1,200 annual flexible benefit allowance to use on one or a combination of eligible dental, hearing aids, and prescription eyewear. Network does not apply for the purchase of hearing aids. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/all tiers |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $75 allowance twice a year for over-the-counter benefit |
UCare Value Plus
H2459-030
HMO-POS
Monthly premium: $0
$75 Part B premium reduction
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered services at urgent care centers in U.S. Point-of-Service Benefit: In-network copay for primary and specialist visits when seeing providers who accept Medicare, 20% coinsurance/many other services throughout U.S. |
| Dental | 1 oral exam, 1 routine teeth cleaning, 1 set of bitewing x-rays per year and fluoride application included, 1 periodontal maintenance cleaning, up to $2,000 annual plan maximum on routine coverage. Optional Choice Dental $29/month, additional $2,000 plan maximum with optional coverage. |
| Vision | $0 copay/annual routine eye exam, $45 copay/diagnostic eye exams, $100 annual eyewear allowance |
| Hearing | TruHearing aids are available in both Advanced ($699 copay/aid) and Premium ($999 copay/aid) models |
| Medicare Part D coverage | No, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $45 annual allowance for community education classes nationwide, $75 allowance twice a year for over-the-counter benefit |
UCare Aware
H2459-029
HMO-POS
Monthly premium: $6.90
$20 Part B premium reduction
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered services at urgent care centers in U.S. Point-of-Service Benefit: In-network copay for primary and specialist visits when seeing providers who accept Medicare, 20% coinsurance/many other services throughout U.S. |
| Dental | $600 annual dental allowance |
| Vision | $0 copay/annual routine eye exam; $45 copay/diagnostic eye exams; $150 annual eyewear allowance |
| Hearing | TruHearing aids are available in both Advanced ($699 copay/aid) and Premium ($999 copay/aid) models |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tier 1, $295/tiers 2 -5. |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $45 annual allowance for community education classes nationwide, $75 allowance twice a year for over-the-counter benefit |
UCare Value
H2459-001
HMO-POS
Monthly premium: $19
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered services at urgent care centers in U.S. Point-of-Service Benefit: In-network copays for primary and specialist visits when seeing providers who accept Medicare, plus 20% coinsurance for many other services, throughout U.S. |
| Dental | Routine and restorative dental included at no additional cost, up to $2,000 annual plan maximum. $0 copay/preventive services including 2 oral exams, 2 routine cleanings, 1 set of bitewing x-rays/year, full mouth x-rays every 5 years, fluoride applications included. 30% coinsurance/basic restorative services. 60% coinsurance/major restorative procedures. |
| Vision | $0 copay/annual routine eye exam, $35 copay/diagnostic eye exams, $150 annual eyewear allowance |
| Hearing | TruHearing aids are available in both Advanced ($599 copay/aid) and Premium ($899 copay/aid) models |
| Medicare Part D coverage | No, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $45 annual allowance for community education classes nationwide, $75 allowance twice a year for over-the-counter benefit. |
UCare Essentials Rx
H2459-023-1
HMO-POS
Monthly premium: $20
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits; $45 copay/Medicare-covered services at urgent care centers in U.S. Point-of-Service Benefit: In-network copays for primary and specialist visits when seeing providers who accept Medicare, plus 20% coinsurance for many other services, throughout U.S. |
| Dental | 1 oral exam, 1 routine teeth cleaning, 1 set of bitewing x-rays per year and fluoride application included, 1 periodontal maintenance cleaning, up to $2,000 annual plan maximum on routine coverage. Optional Choice Dental/$29 per month, additional $2,000 plan maximum with optional coverage. |
| Vision | $0 copay/annual routine eye exam, $45 copay/diagnostic eye exams; $150 annual eyewear allowance |
| Hearing | TruHearing aids are available in both Advanced ($699 copay/aid) and Premium ($999 copay/aid) models |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $295/tiers 3-5. |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $45 annual allowance for community education classes nationwide, $75 allowance twice a year for over-the-counter benefit |
UCare Essentials Rx
H2459-023-2
HMO-POS
Monthly premium: $38
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits; $45 copay/Medicare-covered services at urgent care centers in U.S. Point-of-Service Benefit: In-network copays for primary and specialist visits when seeing providers who accept Medicare, plus 20% coinsurance for many other services, throughout U.S. |
| Dental | 1 oral exam, 1 routine teeth cleaning, 1 set of bitewing x-rays per year and fluoride application included, 1 periodontal maintenance cleaning, up to $2,000 annual plan maximum on routine coverage. Optional Choice Dental/$29 per month, additional $2,000 plan maximum with optional coverage. |
| Vision | $0 copay/annual routine eye exam, $45 copay/diagnostic eye exams; $150 annual eyewear allowance |
| Hearing | TruHearing aids are available in both Advanced ($699 copay/aid) and Premium ($999 copay/aid) models |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $295/tiers 3-5. |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $45 annual allowance for community education classes nationwide, $75 allowance twice a year for over-the-counter benefit |
UCare Standard
H2459-024
HMO-POS
Monthly premium: $38
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $40 copay/Medicare-covered services at urgent care centers in U.S. Point-of-Service Benefit: In-network copays for primary and specialist visits when seeing providers who accept Medicare, plus 20% coinsurance for many other services, throughout U.S. |
| Dental | 1 oral exam, 1 routine teeth cleaning, 1 set of bitewing x-rays per year and fluoride application included, 1 periodontal maintenance cleaning, up to $2,000 annual plan maximum on routine coverage. Optional Choice Dental/$29 per month, additional $2,000 plan maximum with optional coverage. |
| Vision | $0 copay/annual routine eye exam, $40 copay/diagnostic eye exams; $100 annual eyewear allowance |
| Hearing | TruHearing aids are available in both Advanced ($699 copay/aid) and Premium ($999 copay/aid) models |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tier 1, $480/tiers 2-5 |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $45 annual allowance for community education classes nationwide, $75 allowance twice a year for over-the-counter benefit |
UCare Your Choice Plus
H8070-002
PPO
Monthly premium: $51
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered visit in the U.S. PPO Benefit: many out-of-network benefits covered at in-network rates nationwide. |
| Dental | $1,600 annual flexible benefit allowance to use on one or a combination of eligible dental, hearing aids, and prescription eyewear. Network does not apply to eligible dental services |
| Vision | $0 copay/annual routine eye exam; $30 copay/diagnostic eye exam Note: copayment is the same both in-network and out-of-network, $1,600 annual flexible benefit allowance to use on one or a combination of eligible dental, hearing aids, and prescription eyewear. Network does not apply for the purchase of prescription eyewear. |
| Hearing | $0 copay/routine hearing exam; $30 copay/diagnostic hearing exam Note: copayment is the same both in-network and out-of-network, $1,600 annual flexible benefit allowance to use on one or a combination of eligible dental, hearing aids, and prescription eyewear. Network does not apply for the purchase of hearing aids. |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/all tiers |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $75 allowance twice a year for over-the-counter benefit |
UCare Complete
H2459-026-1
HMO-POS
Monthly premium: $93
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered services at urgent care centers in U.S. Point-of-Service Benefit: In-network copays for primary and specialist visits when seeing providers who accept Medicare, plus 20% coinsurance for many other services, throughout U.S. |
| Dental | Routine and restorative dental included at no additional cost, up to $2,000 annual plan maximum. $0 copay/preventive services including 2 oral exams, 2 routine cleanings, 1 set of bitewing x-rays/year, full mouth x-rays every 5 years, fluoride applications included. 50% coinsurance/basic restorative services. 70% coinsurance/major restorative procedures. |
| Vision | $0 copay/annual routine eye exam, $30 copay/diagnostic eye exams, $200 annual eyewear benefit |
| Hearing | TruHearing aids are available in both Advanced ($599 copay/aid) and Premium ($899 copay/aid) models |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $235/tiers 3 – 5. |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $45 annual allowance for community education classes nationwide, $45 allowance every month for over-the-counter benefit |
UCare Complete
H2459-026-3
HMO-POS
Monthly premium: $98
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered services at urgent care centers in U.S. Point-of-Service Benefit: In-network copays for primary and specialist visits when seeing providers who accept Medicare, plus 20% coinsurance for many other services, throughout U.S. |
| Dental | Routine and restorative dental included at no additional cost, up to $2,000 annual plan maximum. $0 copay/preventive services including 2 oral exams, 2 routine cleanings, 1 set of bitewing x-rays/year, full mouth x-rays every 5 years, fluoride applications included. 50% coinsurance/basic restorative services. 70% coinsurance/major restorative procedures. |
| Vision | $0 copay/annual routine eye exam, $30 copay/diagnostic eye exams, $200 annual eyewear benefit |
| Hearing | TruHearing aids are available in both Advanced ($599 copay/aid) and Premium ($899 copay/aid) models |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $235/tiers 3 – 5. |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $45 annual allowance for community education classes nationwide, $45 allowance every month for over-the-counter benefit |
UCare Complete
H2459-026-4
HMO-POS
Monthly premium: $142
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered services at urgent care centers in U.S. Point-of-Service Benefit: In-network copays for primary and specialist visits when seeing providers who accept Medicare, plus 20% coinsurance for many other services, throughout U.S. |
| Dental | Routine and restorative dental included at no additional cost, up to $2,000 annual plan maximum. $0 copay/preventive services including 2 oral exams, 2 routine cleanings, 1 set of bitewing x-rays/year, full mouth x-rays every 5 years, fluoride applications included. 50% coinsurance/basic restorative services. 70% coinsurance/major restorative procedures. |
| Vision | $0 copay/annual routine eye exam, $30 copay/diagnostic eye exams, $200 annual eyewear benefit |
| Hearing | TruHearing aids are available in both Advanced ($599 copay/aid) and Premium ($899 copay/aid) models |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/tiers 1&2, $235/tiers 3 – 5. |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $45 annual allowance for community education classes nationwide, $45 allowance every month for over-the-counter benefit |
UCare Classic
H2459-021-1
HMO-POS
Monthly premium: $156
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered services at urgent care centers in U.S. Point-of-Service Benefit: In-network copays for primary and specialist visits when seeing providers who accept Medicare, plus 20% coinsurance for many other services, throughout U.S. |
| Dental | $0 copay/preventive services including 2 oral exams, 3 routine teeth or periomaintenance cleanings, 1 set of bitewing x-rays/year, full mouth x-rays every 5 years, fluoride applications included, up to $2,500 annual plan maximum on routine coverage. Optional Classic Choice Dental/$29 per month, additional $2,500 plan maximum with optional coverage. |
| Vision | $0 copay/annual routine eye exam, $20 copay/diagnostic eye exams, $200 annual eyewear benefit |
| Hearing | TruHearing aids are available in both Advanced ($499 copay/aid) and Premium ($799 copay/aid) models |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/all tiers |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $45 annual allowance for community education classes nationwide, $50 allowance every month for over-the-counter benefit, medication reconciliation post-discharge, Mom's Meals provides 28 home delivered meals for 14 days for members with CHF, post-discharge |
UCare Classic
H2459-021-2
HMO-POS
Monthly premium: $214
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered services at urgent care centers in U.S. Point-of-Service Benefit: In-network copays for primary and specialist visits when seeing providers who accept Medicare, plus 20% coinsurance for many other services, throughout U.S. |
| Dental | $0 copay/preventive services including 2 oral exams, 3 routine teeth or periomaintenance cleanings, 1 set of bitewing x-rays/year, full mouth x-rays every 5 years, fluoride applications included, up to $2,500 annual plan maximum on routine coverage. Optional Classic Choice Dental/$29 per month, additional $2,500 plan maximum with optional coverage. |
| Vision | $0 copay/annual routine eye exam, $20 copay/diagnostic eye exams, $200 annual eyewear benefit |
| Hearing | TruHearing aids are available in both Advanced ($499 copay/aid) and Premium ($799 copay/aid) models |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/all tiers |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $45 annual allowance for community education classes nationwide, $70 allowance every month for over-the-counter benefit, medication reconciliation post-discharge, Mom's Meals provides 28 home delivered meals for 14 days for members with CHF, post-discharge |
UCare Classic
H2459-021-3
HMO-POS
Monthly premium: $212
| Travel coverage | Worldwide Emergency Care: $100 copay/emergency and urgent care visits Worldwide Urgent Care: $100 copay/emergency and urgent care visits, $45 copay/Medicare-covered services at urgent care centers in U.S. Point-of-Service Benefit: In-network copays for primary and specialist visits when seeing providers who accept Medicare, plus 20% coinsurance for many other services, throughout U.S. |
| Dental | $0 copay/preventive services including 2 oral exams, 3 routine teeth or periomaintenance cleanings, 1 set of bitewing x-rays/year, full mouth x-rays every 5 years, fluoride applications included, up to $2,500 annual plan maximum on routine coverage. Optional Classic Choice Dental/$29 per month, additional $2,500 plan maximum with optional coverage. |
| Vision | $0 copay/annual routine eye exam, $20 copay/diagnostic eye exams, $200 annual eyewear benefit |
| Hearing | TruHearing aids are available in both Advanced ($499 copay/aid) and Premium ($799 copay/aid) models |
| Medicare Part D coverage | Yes, if you enroll in a separate Medicare Part D stand-alone plan, you will be disenrolled from this health plan. |
| Medicare Part D deductible | $0/all tiers |
| Discounts & programs | One Pass fitness benefit, UCare 24/7 nurse line, $45 annual allowance for community education classes nationwide, $50 allowance every month for over-the-counter benefit, medication reconciliation post-discharge, Mom's Meals provides 28 home delivered meals for 14 days for members with CHF, post-discharge |