Plus Long-Term Care

Inpatient hospital stays, surgery, and emergency room visits.

Covered when medically necessary. Prior authorization is required.

Primary Care Provider (PCP) and Specialist visits

• Primary Care Provider: $0 copay, in-network only
• Specialist: $0 copay, in-network and out-of-network¹. No referral needed to see a specialist.

Annual wellness visits, cancer screenings (mammograms, colonoscopies), and vaccines (flu, COVID-19, shingles, RSV, and more).

$0 copay.

Medicare Part D prescription drugs

• $0 monthly Part D premium
• $700 Part D deductible. Depending on your Extra Help, you pay $0, $1.65, $5.80, or 25% of the cost.

Care Management, Home Health Care Services, Personal Care Services (PCS), Consumer-Directed Personal Assistance Services (CDPAS), Private-Duty Nursing, Adult Day Health Care, Social Day Care, Home-Delivered and Congregate Meals, Nutrition, Medical Social Services, Social and Environmental Supports, Personal Emergency Response Services (PERS), and a Routine Physical Exam.

$0 cost for Medicaid-covered benefits, coordinated by your Elderplan care team. Most services require prior authorization.

Community Rides

You get the freedom to travel to any location not related to your medical care, to visit friends and family, pharmacies, grocery stores, houses of worship,
fitness centers, banks, post offices and even your favorite senior center. Paid from your monthly OTC allowance for members who qualify through the Expanded OTC benefit ².

Preventive services (exams, cleanings, X-rays) and comprehensive services (fillings, crowns, root canals, dentures and more).

$0 copay for covred dentail sevices, in- and out-of-network¹. Some services may require prior authorization.

Routine exams and eyewear (frames and lenses, or contact lenses).

• $0 copay for your yearly routine eye exam.
• Up to $600 a year toward frames and lenses or contacts.

Routine hearing services, hearing aids (all types), and fitting and evaluation.

• $0 copay for the diagnostic hearing exam.
• Up to $2,000 for hearing aids, both ears combined, each year. Prior authorization required for hearing aids.

Acupuncture and related therapies — cupping/moxa, acupressure, Tui Na, Gua Sha, reflexology, and infrared therapy

$0 copay, up to 60 visits a year (in-network).

Over-the-counter allowance for eligible health items — pain relief, vitamins, oral care, cold and allergy medicine, first aid, and more. Members who qualify can access the Expanded OTC benefit ²

$290 per month. Your balance rolls over month to month but expires at the end of the calendar year

Additional allowance for out-of-pocket dental, vision, hearing, or fitness expenses.

$400 a year on a Visa-accepted prepaid card to use toward dental, vision, hearing, and fitness expenses.

Emergency care, urgent care, and emergency transportation anywhere in the world.

$0 copay, up to $50,000 a year. Travel assistance through Assist America® when more than 100 miles from home or outside the U.S., for stays under 90 consecutive days.