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Monthly Premium
You must continue to pay your Medicare Part B premium. If you have a late enrollment penalty, it will still apply.
$0*
Max out of pocket
$8,850
Deductible
$0**
Copays (PCP/Specialist)
You do not pay anything for services listed, as long as you are eligible for cost-sharing assistance under Medicaid.
$0**
Over-the-counter (OTC) benefit
$200 allowance/quarter and can rollover. Must use NationsOTC.
Vision
$0 routine exam. $300 yearly allowance for eyeglasses or contact lenses. 20% discount over $300 base allowance for frames, lenses, lens options. 40% discount applies on the purchase of any additional eyeglasses. Must obtain eyewear from an EyeMed provider.
Hearing / Hearing Aids
$0 routine exam. $1,000 allowance; 2 hearing aids/calendar year. Member must obtain hearing aids from a NationsHearing provider.
Inpatient Hospital
You do not pay anything for services listed, as long as you are eligible for cost-sharing assistance under Medicaid.
$0**
Preventive Care
No copay for services considered preventive.
Outpatient Diagnostics Labs, Procedures, Tests
You do not pay anything for services listed, as long as you are eligible for cost-sharing assistance under Medicaid.
$0**
Emergency Room / Urgent Care
You do not pay anything for services listed, as long as you are eligible for cost-sharing assistance under Medicaid.
$0** no limit; worldwide coverage
Physical, Occupational and Speech Therapy
You do not pay anything for services listed, as long as you are eligible for cost-sharing assistance under Medicaid.
$0**
Flex Card
$1300/yr benefit for dental, pest control, utilities, healthy food, home modifications
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Plan Documents