MedicareCommons™

Neutral. Transparent. Retrieval-first.

🩺 Doctor’s Office Visits
Service 2026 2025
PrimaryComing soonNot Covered
Referral Required
SpecialistComing soon$15.00 Copay
Prior Authorization Required, Referral Required
🏥 Emergency, Urgent, and Inpatient Hospital Coverage
Service 2026 2025
Emergency room careComing soon$0.00 - $300.00 Copay
Prior Authorization Required, Referral Required
Urgent careComing soon$35.00 Copay
Referral Required
Ground ambulanceComing soon$250.00 Copay
Prior Authorization Required, Referral Required
Inpatient hospital careComing soon$275.00 (days 1–7), $0.00 (days 8–90)
Prior Authorization Required, Referral Required
Skilled Nursing FacilityComing soon$0.00 (days 1–20), $214.00 (days 21–100)
Prior Authorization Required, Referral Required
🦶 Foot Care
Service 2026 2025
Foot Exams and Treatments (Medicare-covered)Coming soon20% Coinsurance
Prior Authorization Required, Referral Required
Routine Foot CareComing soon0% - 20% Coinsurance
Prior Authorization Required, Referral Required
💆 Chiropractic Care
Service 2026 2025
Medicare-covered chiropracticComing soon20% Coinsurance
Prior Authorization Required, Referral Required
Routine chiropracticComing soon20% Coinsurance
Prior Authorization Required, Referral Required
🧠 Mental Health Services
Service 2026 2025
Outpatient individual therapyComing soon$15.00 Copay
Referral Required
Outpatient group therapyComing soon$15.00 Copay
Prior Authorization Required, Referral Required
Inpatient psychiatric hospital careComing soon$275.00 (days 1–7), $0.00 (days 8–90)
Prior Authorization Required, Referral Required
🏋️ Rehabilitation Services
Service 2026 2025
Physical therapy and speech/language therapyComing soon$35.00 Copay
Prior Authorization Required, Referral Required
Occupational therapyComing soonNot Covered
Prior Authorization Required, Referral Required
🧰 Medical Equipment and Supplies
Service 2026 2025
Diabetes suppliesComing soonNot Covered
Prior Authorization Required, Referral Required
Durable medical equipmentComing soon$35.00 Copay
Referral Required
ProstheticsComing soon$0.00 - $35.00 Copay
Prior Authorization Required, Referral Required
🔬 Diagnostics, Lab Services, and Imaging
Service 2026 2025
Diagnostic radiology servicesComing soonNot Covered
Prior Authorization Required, Referral Required
Lab servicesComing soon$35.00 Copay
Referral Required
Outpatient x-raysComing soon$0.00 Copay
Referral Required
Diagnostic tests and proceduresComing soon$35.00 Copay
Prior Authorization Required, Referral Required
💉 Medicare Part B Drugs
Service 2026 2025
ChemotherapyComing soonNot Covered
Prior Authorization Required, Referral Required
Other Part B drugs (Medicare-covered)Coming soon20% Coinsurance
Prior Authorization Required, Referral Required

Supplemental Benefits

🦷 Dental Services
Service 2026 2025
Medicare Covered Preventive DentalComing soon$1,000.00 max
$1,000.00 max
Referral Required
Oral examComing soon% - % Coinsurance
Referral Required
Dental x-raysComing soon% - % Coinsurance
Referral Required
CleaningComing soon% - % Coinsurance
Referral Required
PeriodonticsComing soon% - % Coinsurance
Referral Required
EndodonticsComing soon% - % Coinsurance
Referral Required
Restorative ServicesComing soon% - % Coinsurance
Referral Required
Dental MaximumComing soon$1000.00 max
👂 Hearing Aids and Services
Service 2026 2025
Fitting/evaluationComing soonNot Covered
Referral Required
Hearing aidsComing soonNot Covered
Referral Required
Hearing examComing soonNot Covered
Referral Required
Hearing MaximumComing soonNot Covered
👓 Vision Services
Service 2026 2025
Medicare-covered eye examComing soonNot Covered
Referral Required
Routine eye examComing soon% - % Coinsurance
Referral Required
Eyewear benefitsComing soon% - % Coinsurance
Referral Required
Vision Eyewear MaximumComing soon$250.00/yr eyewear
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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.

{name} Prescription Drug Plan Premium Details
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.

{name} Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic30-day: —
90-day: —		30-day: —
90-day: —
Tier 230-day: —
90-day: —		30-day: —
90-day: —
Tier 330-day: —
90-day: —		30-day: —
90-day: —
Tier 430-day: —
90-day: —		30-day: —
90-day: —
Tier 530-day: —
90-day: —		30-day: —
90-day: —
*Deductible does not apply.