Prior Authorization Required, Referral Required" ["snf"]=> string(128) "$0.00 (days 1–20), $150.00 (days 21–100), $0.00 (days –)
Prior Authorization Required, Referral Required" ["pcp"]=> string(47) "$0.00 Copay
Referral Required" ["specialist"]=> string(78) "$15.00 Copay
Prior Authorization Required, Referral Required" ["urgent_care"]=> string(79) "% Coinsurance
Prior Authorization Required, Referral Required" ["er"]=> string(79) "% Coinsurance
Prior Authorization Required, Referral Required" ["ambulance_ground"]=> string(79) "% Coinsurance
Prior Authorization Required, Referral Required" ["ambulance_air"]=> string(81) "20% Coinsurance
Prior Authorization Required, Referral Required" ["dental"]=> string(81) "$1,000.00 max
$1,000.00 max
Referral Required" ["vision"]=> string(114) "$0.00 Copay
$400.00/yr eyewear
Prior Authorization Required, Referral Required" ["hearing"]=> string(47) "Not Covered
Referral Required" ["rx"]=> array(2) { ["deductible"]=> string(11) "Not Covered" ["tiers"]=> array(0) { } } ["data_status"]=> string(2) "ok" } Humana USAA Honor Giveback (HMO)H1036-290HumanaHMOCentral and North Florida6700Data missing
🩺 Doctor’s Office Visits
| Service | 2026 | 2025 | 
|---|---|---|
| Primary | Coming soon | $0.00 Copay Referral Required | 
| Specialist | Coming soon | $15.00 Copay Prior Authorization Required, Referral Required | 
🏥 Emergency, Urgent, and Inpatient Hospital Coverage
| Service | 2026 | 2025 | 
|---|---|---|
| Emergency room care | Coming soon | % Coinsurance Prior Authorization Required, Referral Required | 
| Urgent care | Coming soon | % Coinsurance Prior Authorization Required, Referral Required | 
| Ground ambulance | Coming soon | % Coinsurance Prior Authorization Required, Referral Required | 
| Inpatient hospital care | Coming soon | $225.00 (days 1–5), $0.00 (days 6–90), $0.00 (days –) Prior Authorization Required, Referral Required | 
| Skilled Nursing Facility | Coming soon | $0.00 (days 1–20), $150.00 (days 21–100), $0.00 (days –) Prior Authorization Required, Referral Required | 
🦶 Foot Care
| Service | 2026 | 2025 | 
|---|---|---|
| Foot Exams and Treatments (Medicare-covered) | Coming soon | 20% Coinsurance Prior Authorization Required, Referral Required | 
| Routine Foot Care | Coming soon | 0% - 20% Coinsurance Prior Authorization Required, Referral Required | 
💆 Chiropractic Care
| Service | 2026 | 2025 | 
|---|---|---|
| Medicare-covered chiropractic | Coming soon | $0.00 Copay Prior Authorization Required, Referral Required | 
| Routine chiropractic | Coming soon | 20% Coinsurance Prior Authorization Required, Referral Required | 
🧠 Mental Health Services
| Service | 2026 | 2025 | 
|---|---|---|
| Outpatient individual therapy | Coming soon | $15.00 Copay Prior Authorization Required, Referral Required | 
| Outpatient group therapy | Coming soon | $25.00 Copay Prior Authorization Required, Referral Required | 
| Inpatient psychiatric hospital care | Coming soon | $225.00 (days 1–5), $0.00 (days 6–90), $0.00 (days –) Prior Authorization Required, Referral Required | 
🏋️ Rehabilitation Services
| Service | 2026 | 2025 | 
|---|---|---|
| Physical therapy and speech/language therapy | Coming soon | $25.00 Copay Prior Authorization Required, Referral Required | 
| Occupational therapy | Coming soon | $25.00 Copay Prior Authorization Required, Referral Required | 
🧰 Medical Equipment and Supplies
| Service | 2026 | 2025 | 
|---|---|---|
| Diabetes supplies | Coming soon | $0.00 Copay Prior Authorization Required, Referral Required | 
| Durable medical equipment | Coming soon | $25.00 Copay Prior Authorization Required, Referral Required | 
| Prosthetics | Coming soon | % Coinsurance Prior Authorization Required, Referral Required | 
🔬 Diagnostics, Lab Services, and Imaging
| Service | 2026 | 2025 | 
|---|---|---|
| Diagnostic radiology services | Coming soon | $25.00 Copay Prior Authorization Required, Referral Required | 
| Lab services | Coming soon | % Coinsurance Prior Authorization Required, Referral Required | 
| Outpatient x-rays | Coming soon | % Coinsurance Referral Required | 
| Diagnostic tests and procedures | Coming soon | % Coinsurance Prior Authorization Required, Referral Required | 
💉 Medicare Part B Drugs
| Service | 2026 | 2025 | 
|---|---|---|
| Chemotherapy | Coming soon | $0.00 Copay Prior Authorization Required, Referral Required | 
| Other Part B drugs (Medicare-covered) | Coming soon | $10.00 Copay Prior Authorization Required, Referral Required | 
Supplemental Benefits
🦷 Dental Services
| Service | 2026 | 2025 | 
|---|---|---|
| Medicare Covered Preventive Dental | Coming soon | $1,000.00 max $1,000.00 max Referral Required | 
| Oral exam | Coming soon | 0% Coinsurance Referral Required | 
| Dental x-rays | Coming soon | 0% Coinsurance Referral Required | 
| Cleaning | Coming soon | 0% Coinsurance Referral Required | 
| Periodontics | Coming soon | $25.00 Copay Referral Required | 
| Endodontics | Coming soon | Not Covered Referral Required | 
| Restorative Services | Coming soon | Not Covered Referral Required | 
| Dental Maximum | Coming soon | $1000 max | 
👂 Hearing Aids and Services
| Service | 2026 | 2025 | 
|---|---|---|
| Fitting/evaluation | Coming soon | $0.00 Copay Referral Required | 
| Hearing aids | Coming soon | $0.00 Copay Referral Required | 
| Hearing exam | Coming soon | $0.00 max $0.00 max Prior Authorization Required, Referral Required | 
| Hearing Maximum | Coming soon | $0.00 max | 
👓 Vision Services
| Service | 2026 | 2025 | 
|---|---|---|
| Medicare-covered eye exam | Coming soon | $0.00 max $0.00 max Prior Authorization Required, Referral Required | 
| Routine eye exam | Coming soon | $0.00 Copay Referral Required | 
| Eyewear benefits | Coming soon | $0.00 Copay Referral Required | 
| Vision Eyewear Maximum | Coming soon | $400/yr eyewear | 
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | ${part_d_basic_premium} | 
|---|---|
| Supplemental Part D Premium: | ${part_d_supplemental_premium} | 
| Total Part D Premium: | ${part_d_total_premium} | 
| Low-Income Premium Subsidy: | ${part_d_lips_amount} | 
| Low-Income Premium Subsidy Paid by CMS: | ${part_d_lips_cms_pays} | 
| Low-Income Subsidy Premium: | ${part_d_lis_premium} | 
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a ${deductible} annual Part D deductible. You'll pay this deductible at the pharmacy before {carrier} starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, {name} may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order | 
|---|---|---|
| *Deductible does not apply. | ||