Plan Benefits

Benefits at a Glance:
We Have Got You Covered From Head to Toe

The following tables highlight 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 downloadable Summary of Benefits or Evidence of Coverage 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
Annual Medical Deductible $0 Per Year
Preventative Care/Screenings $0 Copay
Primary Care Physician Visits $5 Copay
Specialty Care Physician Visits $45 Copay
Labs $5 Copay
Home Health Care 100% Coverage
Chiropractic Services $20 Copay
Urgent Care $45 Copay
Emergency Care $80 Copay
Inpatient Hospital Care $350 Copay Per Day for days 1-5,
$0 Per Day for Days 6-90,
$0 Copay for additional days
Outpatient Surgery at a Hospital $220 Copay or 20% Co-insurance
Outpatient Surgery at an Ambulatory Surgical Center $220 Copay
Maximum Out-of-Pocket Limit What’s This? $4,250 Per Year

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.

Cox Health MedicarePlus (HMO)
Annual Deductible $0 Copay
Preferred Generic $3 Copay
Generic $6 Copay
Preferred Brand $47 Copay
Non-Preferred Brand $100 Copay
Specialty Drugs 33% Co-insurance
Initial Coverage Limit $3,750 Per Year

Part D drug 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 Health MedicarePlus (HMO)
Routine Eye Exam $35 Copay
Eyeglass Frames or Contacts $35 Copay
Preventive Dental Visits $35 Copay
SilverSneakers® Fitness Benefits What’s This? Included at No Additional Cost
Travel Coverage Urgent and emergent care is available worldwide

Our eyewear benefit is limited to one pair of eyeglass lenses and frames per year. Extra benefit expenses are not covered under the maximum out-of-pocket limit.

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
View: CMS Star rating for this plan
View: Multi-Language Insert