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? $3,200 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 What’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 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)