Premium
Part B Reduction
Out-of-Pocket Max.
(Includes member expense only. Does not include Part D drugs)
Prescription Coverage
PCP Office Visit
Specialist Office Visit
Emergency Care
Over-the-Counter Benefit
Out-of-Network Coverage for PCP and Specialist Office Visits
Visitor/Travel Benefit
Vision
Vision Allowance
Hearing
Hearing Allowance
Dental
Dental Allowance
Smoking Cessation
Included Gym Membership
Acupuncture
Weight Loss Program
Rewards
(HMO)
MA-PD
$0
Up to $35.50
$6,700
Yes
$15
$35
$65
NA
NA
NA
$35 for Medicare- covered exams, $0 for glaucoma screening exams, $0 for retinal exams
NA
$35 for Medicare-covered exams no coverage for routine exam
NA
$20 for Medicare-covered dental benefits
NA
$0
YES
NA
NA
Value
(HMO)
MA-PD
$0
NA
$6,000
YES
$10
$30
$60
NA
NA
NA
$30 for Medicare-covered exams, $0 for glaucoma screening exams, $0 for retinal exam, routine/comprehensive exam is not covered
NA
$30 Medicare-covered exams, no coverage for routine exam
NA
$0 for Medicare-covered dental benefits
NA
$0
YES
NA
NA
Secure
(HMO)
MA only
$30
NA
$3,400
NA
$10
$25
$50
NA
NA
NA
$0 for routine exams, $15 for Medicare-covered exams
Up to $100
$15 for Medicare-covered exams and $15 for routine
Up to $250
$0 for Medicare-covered dental benefits
Up to $100
$0
YES
NA
NA
Classic
(HMO-POS)
MA-PD
$91
NA
$5,000 in-network
$10,000 out-of-network
YES
$10
$25
$50
NA
20% co-insurance
NA
$0 for routine exams, $15 for Medicare-covered exams, $0 for glaucoma screening exams, $0 for retinal exam
Up to $100
$15 for Medicare-covered exams and $15 for routine exams
Up to $250
$0 for Medicare-covered dental benefits, Delta Dental coverage for preventive services
NA
$0
YES
NA
NA
New Platinum
(HMO)
MA-PD
$155
NA
$3,400
YES
$5
$15
$50
Up to $20 a month
NA
YES
$0 for routine exams, $15 for Medicare-covered exams, $0 for glaucoma screening exams, $0 for retinal exam
Up to $250
$15 for Medicare-covered exams and $0 for routine exams
Up to $500
$0 for Medicare-covered dental benefits
Up to $300
$0
YES
$150 allowance or 2 visits a year
Up to $35 a month



