🩺 Doctor’s Office Visits
Service | 2026 | 2025 |
---|---|---|
Primary | Coming soon | $0.00 Copay Referral Required |
Specialist | Coming soon | $10.00 Copay Prior Authorization Required, Referral Required |
🏥 Emergency, Urgent, and Inpatient Hospital Coverage
Service | 2026 | 2025 |
---|---|---|
Emergency room care | Coming soon | $0.00 - $200.00 Copay Prior Authorization Required, Referral Required |
Urgent care | Coming soon | $10.00 Copay Prior Authorization Required, Referral Required |
Ground ambulance | Coming soon | $225.00 Copay Prior Authorization Required, Referral Required |
Inpatient hospital care | Coming soon | $275.00 (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), $214.00 (days 21–40), $0.00 (days 41–100) Prior Authorization Required, Referral Required |
🦶 Foot Care
Service | 2026 | 2025 |
---|---|---|
Foot Exams and Treatments (Medicare-covered) | Coming soon | 20% Coinsurance 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 | 20% Coinsurance 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 | $20.00 Copay Referral Required |
Outpatient group therapy | Coming soon | $20.00 Copay 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 | $10.00 Copay Prior Authorization Required, Referral Required |
Occupational therapy | Coming soon | $0.00 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 | $10.00 Copay Prior Authorization Required, Referral Required |
Prosthetics | Coming soon | $0.00 - $10.00 Copay Prior Authorization Required, Referral Required |
🔬 Diagnostics, Lab Services, and Imaging
Service | 2026 | 2025 |
---|---|---|
Diagnostic radiology services | Coming soon | $0.00 Copay Prior Authorization Required, Referral Required |
Lab services | Coming soon | $10.00 Copay Prior Authorization Required, Referral Required |
Outpatient x-rays | Coming soon | $0.00 - $25.00 Copay Prior Authorization Required, Referral Required |
Diagnostic tests and procedures | Coming soon | $10.00 Copay 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 | 20% Coinsurance Prior Authorization Required, Referral Required |
Supplemental Benefits
🦷 Dental Services
Service | 2026 | 2025 |
---|---|---|
Medicare Covered Preventive Dental | Coming soon | $0.00 max $0.00 max Referral Required |
Oral exam | Coming soon | $0.00 Copay Referral Required |
Dental x-rays | Coming soon | $0.00 Copay Referral Required |
Cleaning | Coming soon | $0.00 Copay Referral Required |
Periodontics | Coming soon | $0.00 Copay Referral Required |
Endodontics | Coming soon | $0.00 Copay Referral Required |
Restorative Services | Coming soon | $0.00 Copay Referral Required |
Dental Maximum | Coming soon | Not Covered |
👂 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 | $300.00/yr eyewear |