Plan Benefits

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 What’s this? $3,900 Per Year
Annual Medical Deductible $0 Per Year
Preventive Care/Screenings $0 Copay
Primary Care Doctor Visits $5 Copay
Specialty Care Doctor Visits $45 Copay
Urgent Care $45 Copay
Emergency Room Care $90 Copay
Lab Services $5 Copay
Home Health Care 100% Coverage
Chiropractic Services $20 Copay
Inpatient Hospital Care $295 copay per day for days 1-6,
$0 Per Day 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 coinsurance that you will pay in each tier. A drug formulary provides a list of drugs that are covered by our plan.

Cox Healthcare MedicarePlus (HMO)
Annual Part D Deductible $0 Copay
Tier 1 – Preferred Generics $3 Copay for 30-day supply,
$0 Copay for 90-day mail order supply
Tier 2 – Generics $6 Copay for 30-day supply,
$0 Copay for 90-day mail order supply
Tier 3 – Preferred Brands $47 Copay for 30-day supply,
$117.50 Copay for 90-day mail order supply
Tier 4 – Non-Preferred Brands $100 Copay for 30-day supply,
$250 Copay for 90-day mail order supply
Tier 5 – Specialty Drugs 33% Co-insurance,
no coverage for 90-day mail order supply
Initial Coverage Limit $3,820 Per Year

Part D drug benefit expenses are not covered under the maximum out-of-pocket limit. 

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.

Cox Healthcare MedicarePlus (HMO)
Routine Eye Exam $35 Copay
Eye Glasses or Contacts* $35 Copay
Preventive Dental Benefits $35 Copay
Over-the-Counter (OTC) Items $45 Per Quarter
SilverSneakers® Fitness BenefitsWhat’s this? 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 per year.

Important Plan Documents

Download: Summary of Benefits Download: Evidence of Coverage
Download: Provider Directory Download: Drug Formulary
Download: Formulary Change Notice Download: Annual Notice of Change
Extra Help: Low Income Subsidy Information Download: CMS Star rating for this plan
Download: Multi-Language Interpreter Services Sheet