Doctor's Office Visits
Check your costs for primary care and specialist visits, plus what’s included for preventive care.
- Primary:$0.00 Copay
- Specialist:$20.00 Copay
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Emergency, Urgent, and Inpatient Hospital Coverage
See your costs for ER visits, urgent care, ambulance rides, hospital stays, and skilled nursing care.
- Emergency room care:$0.00 - $310.00 Copay
Prior Authorization Required - Urgent care:$0.00 - $30.00 Copay
Prior Authorization Required - Ground ambulance:$290.00 Copay
Prior Authorization Required - Inpatient hospital care:$310.00 (days 1–6), $0.00 (days 7–90)
Prior Authorization Required - Skilled Nursing Facility:$0.00 (days 1–20), $203.00 (days 21–100)
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Foot Care
Learn what’s covered for Medicare-approved foot exams and routine podiatry services.
- Foot Exams and Treatments (Medicare-covered):20% Coinsurance
Prior Authorization Required - Routine Foot Care:0% - 20% Coinsurance
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Chiropractic Care
Understand your costs for Medicare-approved chiropractic services and routine adjustments.
- Medicare-covered chiropractic:20% Coinsurance
Prior Authorization Required - Routine chiropractic:20% Coinsurance
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Mental Health Services
Find out the costs for outpatient therapy sessions and inpatient psychiatric care.
- Outpatient individual therapy:$15.00 Copay
Prior Authorization Required - Outpatient group therapy:$15.00 Copay
Prior Authorization Required - Inpatient psychiatric hospital care:$310.00 (days 1–6), $0.00 (days 7–90)
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Rehabilitation Services
See coverage details for physical, speech, and occupational therapy.
- Physical therapy and speech and language therapy:$0.00 - $35.00 Copay
Prior Authorization Required - Occupational therapy:$0.00 - $25.00 Copay
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Medical Equipment and Supplies
Check your share of costs for diabetes supplies, durable equipment, and prosthetics.
- Diabetes supplies:$0.00 Copay
Prior Authorization Required - Durable medical equipment:$35.00 Copay
6 visits/yr, Prior Authorization Required - Prosthetics:$0.00 - $35.00 Copay
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Diagnostics, Lab Services, and Imaging
Review your costs for lab work, imaging, x-rays, and diagnostic testing.
- Diagnostic radiology services:$0.00 - $25.00 Copay
Prior Authorization Required - Lab services:$0.00 - $30.00 Copay
Prior Authorization Required - Outpatient x-rays:$0.00 Copay
- Diagnostic tests and procedures:$0.00 Copay
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Medicare Part B Drugs
See what you’ll pay for chemotherapy and other Medicare-covered Part B drugs.
- Chemotherapy:$0.00 Copay
Prior Authorization Required - Other Part B drugs (Medicare-covered):20% Coinsurance
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Dental Services
Learn about preventive, diagnostic, and comprehensive dental benefits.
- Medicare Covered Preventive Dental:(function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'988683de0e56a3ae',t:'MTc1OTQzMjM4Ni4wMDAwMDA='};var a=document.createElement('script');a.nonce='';a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();