Freedom health medicare advantage plans12/2/2023 ![]() $0 copay for Renew Active, which includes a free gym membership, plus online fitness classes and brain health challenges. $175 copay - $1,225 copay for each hearing aid through UnitedHealthcare Hearing, up to 2 hearing aids every year.įitness Program through Renew Active® $0 copay for Renew Active, which includes a free gym membership, plus online fitness classes and brain health challenges. Includes hearing aids delivered directly to you with virtual follow-up care (select models). $175 copay - $1,225 copay for each hearing aid through UnitedHealthcare Hearing, up to 2 hearing aids every year. Hearing Aids 3 $175 copay - $1,225 copay for each hearing aid through UnitedHealthcare Hearing, up to 2 hearing aids every year. Hearing Exam 3 $0 copay 1 per year No Coverage Home delivered eyewear available nationwide only through UnitedHealthcare Vision (select products only). Standard single, bifocal, trifocal, or progressive lenses are covered in full. Plan pays up to $300 every year for frames or contact lenses. $20 copay per visit ($0 copay when outside of the United States)Įye Exam 3 $0 copay 1 per year No Coverage Urgent Care $20 copay per visit ($0 copay when outside of the United States) $20 copay per visit ($0 copay when outside of the United States) $0 copay per day: Days 29-100 No Coverage Skilled Nursing Facility $0 copay per day: Days 1-20 Preventive Services (such as covered screenings, vaccinations, etc.) 2 $0 copay for covered services All Part D covered vaccines: $0 copay Preventive Services (such as covered screenings, vaccinations, etc.) Outpatient Hospital Services (includes observation services) 2 $0 copay $500 copay Outpatient Hospital Services (includes observation services) Opioid Treatment Services $0 copay No Coverage Mental Health (outpatient) Group: $15 copay Inpatient Hospital Care $100 per stay No Coverage $90 copay per visit ($0 copay when outside of the United States)Īmbulance Services $65 copay for ground or air $65 copay for ground or air $0 copay for at least 3-month supply of Tier 1 medications with Preferred Mail Home Delivery from OptumRx.Īmbulatory Surgical Center 2 $0 copay $500 copayĭiabetes Monitoring Supplies 2 $0 copay No coverageĭiagnostic Radiology Services (such as MRIs/CT scans, etc.)ĭiagnostic Radiology Services (such as MRIs/CT scans, etc.) $0 copay $200 copayĭiagnostic Tests and Procedures, non-radiological (such as EKG/ECG tests, etc.)ĭiagnostic Tests and Procedures, non-radiological (such as EKG/ECG tests, etc.) $0 copay $40 copayĮmergency Care $90 copay per visit ($0 copay when outside of the United States) $90 copay per visit ($0 copay when outside of the United States) Preferred Mail Home Delivery through OptumRx The money you spend using your card counts toward your out-of-pocket costs.Īfter your total out-of-pocket costs reach $7,400, you will pay the greater of $4.15 copay for generic (including brand drugs treated as generic), and $10.35 copay for all other drugs, or 5% coinsurance. Always use your Medicare Advantage member ID card during the coverage gap to get the plan's discounted drug rates. You may pay less if your plan has additional coverage in the gap. x Close Popupĭuring the Coverage Gap Stage, you (or others on your behalf) will pay no more than 25% of the price for generic drugs or 25% of the price (plus the dispensing fee) for brand name drugs, for any drug tier until the total amount you (or others on your behalf) have paid reaches $7,400 in year-to-date out-of-pocket costs. ![]() For all other plans: You will pay a maximum of $35 for each 1-month supply of Part D covered insulin drug through all coverage stages. If your plan has an annual deductible, you (or others on your behalf) will pay your drug costs up to the amount of this deductible before moving into the Initial Coverage stage.įor Chronic Special Needs plans: You will pay a maximum of $25 for each 1-month supply of Part D select insulin drug through all coverage stages. ![]()
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