🩺 Doctor’s Office Visits
| Service | 2026 | 2025 |
|---|---|---|
| Primary | Coming soon | $0.00 Copay |
| Specialist | Coming soon | $15.00 Copay Prior Authorization Required |
🏥 Emergency, Urgent, and Inpatient Hospital Coverage
| Service | 2026 | 2025 |
|---|---|---|
| Emergency room care | Coming soon | $0.00 Copay Prior Authorization Required |
| Urgent care | Coming soon | $0.00 Copay Prior Authorization Required |
| Ground ambulance | Coming soon | $290.00 Copay Prior Authorization Required |
| Inpatient hospital care | Coming soon | $375.00 (days 1–5), $0.00 (days 6–90), $0.00 (days –) Prior Authorization Required |
| Skilled Nursing Facility | Coming soon | $0.00 (days 1–20), $203.00 (days 21–100), $0.00 (days –) Prior Authorization Required |
🦶 Foot Care
| Service | 2026 | 2025 |
|---|---|---|
| Foot Exams and Treatments (Medicare-covered) | Coming soon | $0.00 Copay Prior Authorization Required |
| Routine Foot Care | Coming soon | $0.00 Copay Prior Authorization Required |
💆 Chiropractic Care
| Service | 2026 | 2025 |
|---|---|---|
| Medicare-covered chiropractic | Coming soon | $0.00 Copay Prior Authorization Required |
| Routine chiropractic | Coming soon | $0.00 Copay Prior Authorization Required |
🧠 Mental Health Services
| Service | 2026 | 2025 |
|---|---|---|
| Outpatient individual therapy | Coming soon | $15.00 Copay Prior Authorization Required |
| Outpatient group therapy | Coming soon | $15.00 Copay Prior Authorization Required |
| Inpatient psychiatric hospital care | Coming soon | $375.00 (days 1–4), $0.00 (days 5–90), $0.00 (days –) Prior Authorization Required |
🏋️ Rehabilitation Services
| Service | 2026 | 2025 |
|---|---|---|
| Physical therapy and speech/language therapy | Coming soon | $0.00 Copay Prior Authorization Required |
| Occupational therapy | Coming soon | $0.00 Copay Prior Authorization Required |
🧰 Medical Equipment and Supplies
| Service | 2026 | 2025 |
|---|---|---|
| Diabetes supplies | Coming soon | $0.00 Copay Prior Authorization Required |
| Durable medical equipment | Coming soon | $30.00 Copay 6 visits/yr, Prior Authorization Required |
| Prosthetics | Coming soon | $0.00 Copay Prior Authorization Required |
🔬 Diagnostics, Lab Services, and Imaging
| Service | 2026 | 2025 |
|---|---|---|
| Diagnostic radiology services | Coming soon | $0.00 Copay Prior Authorization Required |
| Lab services | Coming soon | $0.00 Copay Prior Authorization Required |
| Outpatient x-rays | Coming soon | $0.00 Copay |
| Diagnostic tests and procedures | Coming soon | $0.00 Copay Prior Authorization Required |
💉 Medicare Part B Drugs
| Service | 2026 | 2025 |
|---|---|---|
| Chemotherapy | Coming soon | $0.00 Copay Prior Authorization Required |
| Other Part B drugs (Medicare-covered) | Coming soon | $0.00 Copay Prior Authorization Required |
Supplemental Benefits
🦷 Dental Services
| Service | 2026 | 2025 |
|---|---|---|
| Medicare Covered Preventive Dental | Coming soon | $0.00 max $0.00 max |
| Oral exam | Coming soon | $0.00 Copay |
| Dental x-rays | Coming soon | $0.00 Copay |
| Cleaning | Coming soon | Not Covered |
| Periodontics | Coming soon | Not Covered |
| Endodontics | Coming soon | Not Covered |
| Restorative Services | Coming soon | Not Covered |
| Dental Maximum | Coming soon | Not Covered |
👂 Hearing Aids and Services
| Service | 2026 | 2025 |
|---|---|---|
| Fitting/evaluation | Coming soon | $0.00 Copay |
| Hearing aids | Coming soon | $0.00 Copay |
| Hearing exam | Coming soon | $0.00 max $0.00 max Prior Authorization 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 |
| Routine eye exam | Coming soon | $0.00 Copay |
| Eyewear benefits | Coming soon | Not Covered |
| Vision Eyewear Maximum | Coming soon | $300.00/yr eyewear |