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Below are plan options for 2025.
HMO-POS Select | |
---|---|
Monthly Premium | $0 |
Medical Deductible | $0 |
Out-of-Pocket Maximum | $5,800 |
Primary Care Visit (In-office and Telehealth) |
$0 copay |
Specialty Care Physician Office Visit | $30 copay |
Prescription Drug Benefits | |
Deductible | $0 |
Total Out-of-Pocket | $2,000 |
Supplemental Benefits | |
Hearing Aids (every three years) | $1,500 allowance |
Eyewear (annually; must use network provider) | $150 allowance |
Over-the-Counter Allowance | $50 per quarter |
HMO-POS Preferred | |
---|---|
Monthly Premium | $135 |
Medical Deductible | $0 |
Out-of-Pocket Maximum | $4,600 |
Primary Care Visit (In-office and Telehealth) |
$0 copay |
Specialty Care Physician Office Visit | $30 copay |
Prescription Drug Benefits | |
Deductible | $0 |
Total Out-of-Pocket | $2,000 |
Supplemental Benefits | |
Hearing Aids (every three years) | $1,100 allowance |
Eyewear (annually; must use network provider) | $150 allowance |
Over-the-Counter Allowance | $30 per quarter |
HMO-POS Premium | |
---|---|
Monthly Premium | $243 |
Medical Deductible | $0 |
Out-of-Pocket Maximum | $4,800 |
Primary Care Visit (In-office and Telehealth) |
$0 copay |
Specialty Care Physician Office Visit | $0 copay |
Prescription Drug Benefits | |
Deductible | $0 |
Total Out-of-Pocket | $2,000 |
Supplemental Benefits | |
Hearing Aids (every three years) | $1,000 allowance |
Eyewear (annually; must use network provider) | $125 allowance |
Over-the-Counter Allowance | $30 per quarter |
HMO-POS Select Rx Assist | |
---|---|
Monthly Premium | $0 |
Medical Deductible | $0 |
Out-of-Pocket Maximum | $5,800 |
Primary Care Visit (In-office and Telehealth) |
$0 copay |
Specialty Care Physician Office Visit | $25 copay |
Prescription Drug Benefits | |
Deductible | $0 (if you qualify for Extra Help) $18.30/month (without Extra Help) |
Total Out-of-Pocket | $2,000 |
Supplemental Benefits | |
Hearing Aids (every three years) | $1,500 allowance |
Eyewear (annually; must use network provider) | $170 allowance |
Over-the-Counter Allowance | $50 per quarter |
PPO Basic | |
---|---|
Monthly Premium | $0 |
Medical Deductible | $0 |
Out-of-Pocket Maximum | $6,750 |
Primary Care Visit (In-office and Telehealth) |
$0 copay |
Specialty Care Physician Office Visit | $35 copay |
Prescription Drug Benefits | |
Deductible | $250 (Applies to Tiers 3-5) |
Total Out-of-Pocket | $2,000 |
Supplemental Benefits | |
Hearing Aids (every three years) | $1,000 allowance |
Eyewear (annually; must use network provider) | $150 allowance |
Over-the-Counter Allowance | $30 per quarter |
PPO Platinum | |
---|---|
Monthly Premium | $129 |
Medical Deductible | $0 |
Out-of-Pocket Maximum | $4,600 |
Primary Care Visit (In-office and Telehealth) |
$0 copay |
Specialty Care Physician Office Visit | $20 copay |
Prescription Drug Benefits | |
Deductible | $50 (Applies to Tiers 3-5) |
Total Out-of-Pocket | $2,000 |
Supplemental Benefits | |
Hearing Aids (every three years) | $1,500 allowance |
Eyewear (annually; must use network provider) | $150 allowance |
Over-the-Counter Allowance | Not available |
Speak with a Medicare Advisor at 1.833.975.08411.833.975.0841 (TTY: 711).
Oct. 1 – March 31: 7 days a week, 8 AM to 8 PM. Closed on major holidays.
April 1 – Sept. 30: Monday-Friday, 8 AM to 5 PM. Closed on major holidays.
Para hablar con un representante en español, llame a 1.833.412.33201.833.412.3320