Wellness programs (e.g., fitness, nursing hotline) Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline): Some coverage.Enhanced Disease Management: Not covered.
Additional Sessions of Smoking and Tobacco Cessation Counseling: Not covered. Support for Caregivers of Enrollees: Not covered. Home-Based Palliative Care: Not covered. Nutritional/Dietary Benefit: Some coverage. Weight Management Programs: Not covered. Wigs for Hair Loss Related to Chemotherapy: Not covered. Post discharge In-Home Medication Reconciliation: Not covered. 
Medical Nutrition Therapy (MNT): Not covered. Personal Emergency Response System (PERS): Not covered. WorldWide emergency urgent care: Some coverage. WorldWide emergency coverage: Some coverage. WorldWide emergency transportation: Some coverage. Meals for short duration: Some coverage. Over-the-counter drug benefits: Some coverage. Medically-approved non-opioid pain management services Eyeglass lenses: $0 copay (limits apply). Eyeglass frames: $0 copay (limits apply). Eyeglasses (frames and lenses): $0 copay (limits apply). Contact lenses: $0 copay (limits apply). Routine eye exam: $0 copay (referral required). Prosthodontics, other oral/maxillofacial surgery, other services: Not covered. Extractions: $0 copay (authorization and referral required). Periodontics: $0 copay (limits apply, authorization and referral required). Diagnostic services: $0 copay (limits apply, authorization and referral required). Dental x-ray(s): $0 copay (limits apply, referral required). Cleaning: $0 copay (limits apply, referral required). Oral exam: $0 copay (limits apply, referral required). Fitting/evaluation: $0 copay (referral required). Hearing exam: $10 copay (referral required). Diabetes supplies: $0 copay (authorization required). Prosthetics (e.g., braces, artificial limbs): 20% coinsurance per item (authorization required). Durable medical equipment (e.g., wheelchairs, oxygen): 0-20% coinsurance per item (authorization required). Outpatient individual therapy visit: $0 copay. Outpatient group therapy visit: $0 copay. Outpatient individual therapy visit with a psychiatrist: $0 copay. Outpatient group therapy visit with a psychiatrist: $0 copay. $0 per day for days 91 and beyond (referral required) Inpatient hospital - psychiatric: $170 per day for days 1 through 5. Physical therapy and speech and language therapy visit: $0-10 copay (referral required). Occupational therapy visit: $5-10 copay (referral required). $100 per day for days 21 through 100 (authorization and referral required) $0 per day for days 91 and beyond (authorization and referral required) Emergency: $110 copay per visit (always covered). 
Outpatient x-rays: $0 copay (referral required).Diagnostic radiology services (e.g., MRI): $0-195 copay (referral required).Lab services: $0 copay (referral required).Diagnostic tests and procedures: $0 copay (referral required).Specialist: $10 copay per visit (referral required)ĭiagnostic procedures/lab services/imaging.Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)Īdditional benefits and/or reduced cost-sharing for enrollees with certain health conditions? Drug plan deductible: No annual deductible.Other health plan deductibles: In-network: No.You must continue to pay your Part B premium.Total Monthly Premium with LIS (Parts C & D): Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ The Monthly Premium is Split as Follows: ❔ This plan qualifies for the 5-star rating Special Enrollment period. Number of Members enrolled in this plan in (H0524 - 039): Number of Members enrolled in this plan in Santa Clara, California: Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less.īIN: 011842 PCN: NCCMS See BIN/PCNs for all plans See cost-sharing for all pharmacies and tiers. Maximum Out-of-Pocket Limit for Parts A & B (MOOP):īrowse the Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) Formulary Or contact your local SHIP for assistanceĮmail a copy of the Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) benefit details Santa Clara, California Click to see other locations Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) Find a 2023 Medicare Advantage Plan by Drug Costs.2023 Medicare Advantage Plan Benefit Details.2023 Medicare Advantage Plans State Overview.IRMAA: Higher premiums for higher incomes.Understanding Your Explanation of Benefits.Medicare plan quality and CMS Star Ratings.Find Medicare plans covering your prescriptions.Q1Rx Drug-Finder: Compare Drug Cost Across all 2023 Medicare Plans.Browse Any 2023 Medicare Plan Formulary (or Drug List).
Find a 2023 Medicare Advantage Plan (Health and Health w/Rx Plans).
0 kommentar(er)
