Benefits at a Glance:
We Have Got You Covered From Head to Toe
The following tables highlight just some of the many benefits available to you as a valued CoxHealth MedicarePlus member. For more details and a complete list of benefits, please review our Summary of Benefits or Evidence of Coverage which can be downloaded by clicking the links below.
Hospital & Medical Coverage
Your CoxHealth MedicarePlus plan provides comprehensive medical and hospital coverage with no annual deductible and low copayments.
CoxHealth MedicarePlus (HMO) | |
---|---|
Monthly Premium | $0 |
Maximum Out-of-Pocket Limit | $3,200 Per Year |
Annual Medical Deductible | $0 Per Year |
Preventive Care/Screenings | $0 Copay |
Primary Care Doctor Visits | $0 Copay |
Specialty Care Doctor Visits | $35 Copay |
Urgent Care | $45 Copay |
Emergency Room Care | $120 Copay |
Lab Services | $5 Copay |
Home Health Care | 100% Coverage |
Chiropractic Services | $20 Copay |
Inpatient Hospital Care | $295 Copay Per Day, Per Stay for Days 1-6, $0 Per Day, Per Stay for Days 7 and Beyond |
Outpatient Surgery at a Hospital | $220 Copay |
Outpatient Surgery at an Ambulatory Surgical Center | $220 Copay |
Part D Drug Coverage
This table shows the drug tiers associated with your plan and the copayments or co-insurance that you will pay in each tier. A drug formulary provides a list of drugs that are covered by our plan.
CoxHealth MedicarePlus (HMO) | ||
---|---|---|
Preferred Pharmacies | Other Pharmacies | |
Annual Part D Deductible | $0 | |
Tier 1 – Preferred Generics | $0 Copay* | $5 Copay* |
Tier 2 – Generics | $5 Copay* | $10 Copay* |
Tier 3 – Preferred Brands | $42 Copay* | $47 Copay* |
Tier 4 – Non-Preferred Brands | $95 Copay* | $100 Copay* |
Tier 5 – Specialty Drugs | 33% Co-insurance | |
Tier 6 – Insulins | $0 Copay* | |
Initial Coverage Limit | $4,430 Per Year |
*30 day supply
Extra Benefits
Your CoxHealth MedicarePlus plan offers many valuable extras not offered by Original Medicare or Medicare supplement plans – at no additional cost to you.
CoxHealth MedicarePlus (HMO) | |
---|---|
Routine Eye Exam | $0 Copay when using an EyeQuest Provider |
Eyeglasses* | $0 Copay $200 allowance frames/contacts every two calendar years |
Dental Benefits | $0 Copay $0 Copay for preventive dental, such as cleanings, exams, X-rays and more $1,250 Annual allowance for dental services, such as fillings, extractions, deep cleanings and more. Allowance applies to combined comprehensive and preventive services. $35 Copay for Medicare-covered comprehensive dental |
Diabetic Benefits | $0 copays for insulin (See our Prescription Drug Formulary for details on brands covered) $0 copays for most diabetic supplies $0 copays for diabetic eye exams $0 copays for diabetes self-management training |
Hearing | $1000 allowance every 2 calendar years (both ears combined) |
Over-the-Counter (OTC) Items | $93 Per Quarter |
SilverSneakers® Fitness Benefits | Included at no additional cost |
Travel Benefits | Emergency or urgent care coverage if you are making a trip out of state or country |
Extra benefit expenses are not covered under the maximum out-of-pocket limit.
*Our eyewear benefit is limited to one pair of eyeglass lenses and frames every 2 calendar years.
Important Plan Documents to Download
Summary of Benefits (Updated: 10/1/2021) | Evidence of Coverage (Updated: 09/24/2021) |
Provider Directory (Updated: 04/04/2022) | Drug Formulary (Updated: 03/30/2022) |
CMS Star Rating (Updated: 10/26/2021) | Annual Notice of Change (Updated: 09/17/2021) |
Low-Income Subsidy Information (Updated: 09/30/2021) |