Find a 2024 BayCarePlus^® (HMO) Plan in Your Area

All of the BayCarePlus (HMO) plans bundle your hospital, medical and prescription drug benefits into one plan and include money-saving extra benefits like dental and vision coverage and free health club memberships. Below is an overview of the 2024 benefits for each of BayCarePlus plans, so you can quickly and easily compare your options.

Medicare Plans to Fit Your Needs

BayCarePlus offers several plan options so you can choose the plan that best meets your personal needs. All plans include medical and hospital coverage as well as prescription drugs, dental, vision, hearing and fitness benefits, plus more. View our 2024 plan comparison below to see highlights and and download the Summary of Benefits below for more details.

Enroll for 2024 Benefits

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Feature	BayCarePlus Rewards (HMO) H2235-002	BayCarePlus Value (HMO) H2235-005	BayCarePlus Complete (HMO) H2235-001	BayCarePlus Premier (HMO) H2235-003	BayCarePlus Freedom (HMO-POS) H2235-006
Medical and Hospital

Monthly Premium	$0	$0	$0	$42 You may be able to lower your premium, if you get Extra Help from Medicare	$0
Part B Premium Monthly Saving	$134 per month	$113 per month	Not Covered
Maximum Out-Of-Pocket Limit	$4,500 per calendar year	$4,500 per calendar year	$3,100 per calendar year	$2,500 per calendar year	In Network $3,850 per calendar year Out of Network $8,950 per calendar year
Annual Deductible	$0
Primary Care Physician Visits	$0 copay	$0 copay	$0 copay	$0 copay	In Network $0 copay Out of Network $50 copay
Specialist Visits	$40 copay	$40 copay	$15 copay	$15 copay	In Network $35 copay Out of Network $70 copay
Inpatient Hospital Care	$250 copay per day, per stay: days 1–5 $0 copay per day, per stay: days 6 and beyond	$250 copay per day, per stay: days 1–5 $0 copay per day, per stay: days 6 and beyond	$200 copay per day, per stay: days 1–5 $0 copay per day, per stay: days 6 and beyond	$175 copay per day, per stay: days 1–5 $0 copay per day, per stay: days 6 and beyond	In Network $250 copay per day, per stay: days 1–5 $0 copay per day, per stay: days 6 and beyond Out of Network 45% coinsurance
Urgent Care	$35 copay	$35 copay	$35 copay	$30 copay	$40 copay
Emergency Care	$100 copay	$100 copay	$90 copay	$120 copay	$135 copay
Lab Services	$0 copay	$0 copay	$0 copay	$0 copay	In Network $0 copay Out of Network 45% coinsurance
Part D Prescription Drug Coverage
Annual Deductible	$0
Tier 1 Preferred Generic	$0 copay
Tier 2 Generic	$10 copay	$10 copay	$3 copay	$0 copay	$3 copay
Tier 3 Preferred Brand	$47 copay	$47 copay	$35 copay	$30 copay	$35 copay
Tier 4 Non-Preferred Brand	$100 copay	$100 copay	$85 copay	$85 copay	$85 copay
Tier 5 Specialty Drug	33% coinsurance
Mail Order 90-Day Supply (Tiers 1-4)	$0/ $0/ $125/ $275	$0/ $0/ $125/ $275	$0/ $0/ $95/ $245	$0/ $0/ $80/ $245	$0/ $0/ $95/ $245
Diabetic Insulin 30-Day Supply (Tiers 1-5)	NA/$10/$35/NA/NA	NA/$10/$35/NA/NA	NA/$3/$35/NA/NA	NA/$0/$30/NA/NA	NA/$3/$35/NA/NA
Initial Coverage Limit	$5,030
Extra Benefit Highlights
Dental (Base Option)	$0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $2,000 for comprehensive dental
Optional Comprehensive Dental ($49 per month)	See any dentist you want!* $0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $4,000 for comprehensive dental
Vision	$0 copay for routine eye exam $0 copay or a pair of eyeglasses (lenses and frames) or contacts $150 max benefit (non-Medicare-covered eyewear) per calendar year	$0 copay for routine eye exam $0 copay for a pair of eyeglasses (lenses and frames) or contacts $300 max benefit (non-Medicare-covered eyewear) per calendar year for eyeglass (lenses and frames) or $350 max benefit per year for contacts
Hearing Aids (Up to two hearing aids every calendar year [one per ear])	$599 or $899 copay per hearing aid		$699 or $999 copay per hearing aid	$599 or $899 copay per hearing aid	$699 or $999 copay per hearing aid
Over-the-Counter (OTC) Items	Not covered	$50 per quarter	$107 per quarter +$25 per quarter for members with diabetes	$135 per quarter +$50 per quarter for members with diabetes	$25 per quarter
Transportation Assistance	Not covered		$0 copay for 16 one-way trips to approved locations per calendar year	$0 copay for 24 one-way trips to approved locations per calendar year	Not covered
Meals	Not covered		56 home-delivered, post-discharge meals per calendar year		Not covered
Grocery Allowance	Not covered	$50 per quarter (Must meet health condition requirements to qualify. See Evidence of Coverage.)			Not covered
Travel Benefits	Emergency or urgent care coverage if you’re making a trip out of state or country.
Important Documents (All Plans)	Provider Directory Drug Formulary Star Ratings Formulary Change Notice Summary of Benefits
Documentos Importantes (Todos los planes)	Directorio d Proveedores Formulario de Medicamentos Recetados Calificaciones por Estrellas Resumen de Beneficios (Disponible próximamente)
Important Documents (Plan Specific)	Evidence of Coverage Annual Notice of Change	Evidence of Coverage	Evidence of Coverage Annual Notice of Change	Evidence of Coverage Annual Notice of Change	Evidence of Coverage
Documentos Importantes (Específico del Plan)	Evidencial de Cobertura Aviso Anual de Cambio	Evidencial de Cobertura	Evidencial de Cobertura Aviso Anual de Cambio	Evidencial de Cobertura Aviso Anual de Cambio	Evidence of Coverage

Medical and Hospital

Feature	BayCarePlus Rewards (HMO) H2235-002

Monthly Premium	$0
Part B Premium Monthly Saving	$134 per month
Maximum Out-Of-Pocket Limit	$4,500 per calendar year
Annual Deductible	$0
Primary Care Physician Visits	$0 copay
Specialist Visits	$40 copay
Inpatient Hospital Care	$250 copay per day, per stay: days 1–5 $0 copay per day, per stay: days 6 and beyond
Urgent Care	$35 copay
Emergency Care	$100 copay
Lab Services	$0 copay

Feature	BayCarePlus Value (HMO) H2235-005

Monthly Premium	$0
Part B Premium Monthly Saving	$113 per month
Maximum Out-Of-Pocket Limit	$4,500 per calendar year
Annual Deductible	$0
Primary Care Physician Visits	$0 copay
Specialist Visits	$40 copay
Inpatient Hospital Care	$250 copay per day, per stay: days 1–5 $0 copay per day, per stay: days 6 and beyond
Urgent Care	$35 copay
Emergency Care	$100 copay
Lab Services	$0 copay

Feature	BayCarePlus Complete (HMO) H2235-001

Monthly Premium	$0
Part B Premium Monthly Saving	Not Covered
Maximum Out-Of-Pocket Limit	$3,100 per calendar year
Annual Deductible	$0
Primary Care Physician Visits	$0 copay
Specialist Visits	$15 copay
Inpatient Hospital Care	$200 copay per day, per stay: days 1–5 $0 copay per day, per stay: days 6 and beyond
Urgent Care	$35 copay
Emergency Care	$90 copay
Lab Services	$0 copay

Feature	BayCarePlus Premier (HMO) H2235-003

Monthly Premium	$42 You may be able to lower your premium, if you get Extra Help from Medicare
Part B Premium Monthly Saving	Not Covered
Maximum Out-Of-Pocket Limit	$2,500 per calendar year
Annual Deductible	$0
Primary Care Physician Visits	$0 copay
Specialist Visits	$15 copay
Inpatient Hospital Care	$175 copay per day, per stay: days 1–5 $0 copay per day, per stay: days 6 and beyond
Urgent Care	$30 copay
Emergency Care	$120 copay
Lab Services	$0 copay

Feature	BayCarePlus Freedom (HMO-POS) H2235-006

Monthly Premium	$0
Part B Premium Monthly Saving	Not Covered
Maximum Out-Of-Pocket Limit	In Network $3,850 per calendar year Out of Network $8,950 per calendar year
Annual Deductible	$0
Primary Care Physician Visits	In Network $0 copay Out of Network $50 copay
Specialist Visits	In Network $35 copay Out of Network $70 copay
Inpatient Hospital Care	In Network $250 copay per day, per stay: days 1–5 $0 copay per day, per stay: days 6 and beyond Out of Network 45% coinsurance
Urgent Care	$40 copay
Emergency Care	$135 copay
Lab Services	In Network $0 copay Out of Network 45% coinsurance

Feature	Test 7 columns

Monthly Premium	$0
Part B Premium Monthly Saving	Not Covered
Maximum Out-Of-Pocket Limit	In Network $3,850 per calendar year Out of Network $8,950 per calendar year
Annual Deductible	$0
Primary Care Physician Visits	In Network $0 copay Out of Network $50 copay
Specialist Visits	In Network $35 copay Out of Network $70 copay
Inpatient Hospital Care	In Network $250 copay per day, per stay: days 1–5 $0 copay per day, per stay: days 6 and beyond Out of Network 45% coinsurance
Urgent Care	$40 copay
Emergency Care	$135 copay
Lab Services	In Network $0 copay Out of Network 45% coinsurance

Part D Prescription Drug Coverage

Feature	BayCarePlus Rewards (HMO) H2235-002
Annual Deductible	$0
Tier 1 Preferred Generic	$0 copay
Tier 2 Generic	$10 copay
Tier 3 Preferred Brand	$47 copay
Tier 4 Non-Preferred Brand	$100 copay
Tier 5 Specialty Drug	33% coinsurance
Mail Order 90-Day Supply (Tiers 1-4)	$0/ $0/ $125/ $275
Diabetic Insulin 30-Day Supply (Tiers 1-5)	NA/$10/$35/NA/NA
Initial Coverage Limit	$5,030

Feature	BayCarePlus Value (HMO) H2235-005
Annual Deductible	$0
Tier 1 Preferred Generic	$0 copay
Tier 2 Generic	$10 copay
Tier 3 Preferred Brand	$47 copay
Tier 4 Non-Preferred Brand	$100 copay
Tier 5 Specialty Drug	33% coinsurance
Mail Order 90-Day Supply (Tiers 1-4)	$0/ $0/ $125/ $275
Diabetic Insulin 30-Day Supply (Tiers 1-5)	NA/$10/$35/NA/NA
Initial Coverage Limit	$5,030

Feature	BayCarePlus Complete (HMO) H2235-001
Annual Deductible	$0
Tier 1 Preferred Generic	$0 copay
Tier 2 Generic	$3 copay
Tier 3 Preferred Brand	$35 copay
Tier 4 Non-Preferred Brand	$85 copay
Tier 5 Specialty Drug	33% coinsurance
Mail Order 90-Day Supply (Tiers 1-4)	$0/ $0/ $95/ $245
Diabetic Insulin 30-Day Supply (Tiers 1-5)	NA/$3/$35/NA/NA
Initial Coverage Limit	$5,030

Feature	BayCarePlus Premier (HMO) H2235-003
Annual Deductible	$0
Tier 1 Preferred Generic	$0 copay
Tier 2 Generic	$0 copay
Tier 3 Preferred Brand	$30 copay
Tier 4 Non-Preferred Brand	$85 copay
Tier 5 Specialty Drug	33% coinsurance
Mail Order 90-Day Supply (Tiers 1-4)	$0/ $0/ $80/ $245
Diabetic Insulin 30-Day Supply (Tiers 1-5)	NA/$0/$30/NA/NA
Initial Coverage Limit	$5,030

Feature	BayCarePlus Freedom (HMO-POS) H2235-006
Annual Deductible	$0
Tier 1 Preferred Generic	$0 copay
Tier 2 Generic	$3 copay
Tier 3 Preferred Brand	$35 copay
Tier 4 Non-Preferred Brand	$85 copay
Tier 5 Specialty Drug	33% coinsurance
Mail Order 90-Day Supply (Tiers 1-4)	$0/ $0/ $95/ $245
Diabetic Insulin 30-Day Supply (Tiers 1-5)	NA/$3/$35/NA/NA
Initial Coverage Limit	$5,030

Feature	Test 7 columns
Annual Deductible	$0
Tier 1 Preferred Generic	$0 copay
Tier 2 Generic	$3 copay
Tier 3 Preferred Brand	$35 copay
Tier 4 Non-Preferred Brand	$85 copay
Tier 5 Specialty Drug	33% coinsurance
Mail Order 90-Day Supply (Tiers 1-4)	$0/ $0/ $95/ $245
Diabetic Insulin 30-Day Supply (Tiers 1-5)	NA/$3/$35/NA/NA
Initial Coverage Limit	$5,030

Extra Benefit Highlights

Feature	BayCarePlus Rewards (HMO) H2235-002
Dental (Base Option)	$0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $2,000 for comprehensive dental
Optional Comprehensive Dental ($49 per month)	See any dentist you want!* $0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $4,000 for comprehensive dental
Vision	$0 copay for routine eye exam $0 copay or a pair of eyeglasses (lenses and frames) or contacts $150 max benefit (non-Medicare-covered eyewear) per calendar year
Hearing Aids (Up to two hearing aids every calendar year [one per ear])	$599 or $899 copay per hearing aid
Over-the-Counter (OTC) Items	Not covered
Transportation Assistance	Not covered
Meals	Not covered
Grocery Allowance	Not covered
Travel Benefits	Emergency or urgent care coverage if you’re making a trip out of state or country.
Important Documents (All Plans)	Provider Directory Drug Formulary Star Ratings Formulary Change Notice Summary of Benefits
Documentos Importantes (Todos los planes)	Directorio d Proveedores Formulario de Medicamentos Recetados Calificaciones por Estrellas Resumen de Beneficios (Disponible próximamente)
Important Documents (Plan Specific)	Evidence of Coverage Annual Notice of Change
Documentos Importantes (Específico del Plan)	Evidencial de Cobertura Aviso Anual de Cambio

Feature	BayCarePlus Value (HMO) H2235-005
Dental (Base Option)	$0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $2,000 for comprehensive dental
Optional Comprehensive Dental ($49 per month)	See any dentist you want!* $0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $4,000 for comprehensive dental
Vision	$0 copay for routine eye exam $0 copay for a pair of eyeglasses (lenses and frames) or contacts $300 max benefit (non-Medicare-covered eyewear) per calendar year for eyeglass (lenses and frames) or $350 max benefit per year for contacts
Hearing Aids (Up to two hearing aids every calendar year [one per ear])	$699 or $999 copay per hearing aid
Over-the-Counter (OTC) Items	$50 per quarter
Transportation Assistance	$0 copay for 16 one-way trips to approved locations per calendar year
Meals	56 home-delivered, post-discharge meals per calendar year
Grocery Allowance	$50 per quarter (Must meet health condition requirements to qualify. See Evidence of Coverage.)
Travel Benefits	Emergency or urgent care coverage if you’re making a trip out of state or country.
Important Documents (All Plans)	Provider Directory Drug Formulary Star Ratings Formulary Change Notice Summary of Benefits
Documentos Importantes (Todos los planes)	Directorio d Proveedores Formulario de Medicamentos Recetados Calificaciones por Estrellas Resumen de Beneficios (Disponible próximamente)
Important Documents (Plan Specific)	Evidence of Coverage
Documentos Importantes (Específico del Plan)	Evidencial de Cobertura

Feature	BayCarePlus Complete (HMO) H2235-001
Dental (Base Option)	$0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $2,000 for comprehensive dental
Optional Comprehensive Dental ($49 per month)	See any dentist you want!* $0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $4,000 for comprehensive dental
Vision	$0 copay for routine eye exam $0 copay for a pair of eyeglasses (lenses and frames) or contacts $300 max benefit (non-Medicare-covered eyewear) per calendar year for eyeglass (lenses and frames) or $350 max benefit per year for contacts
Hearing Aids (Up to two hearing aids every calendar year [one per ear])	$599 or $899 copay per hearing aid
Over-the-Counter (OTC) Items	$107 per quarter +$25 per quarter for members with diabetes
Transportation Assistance	$0 copay for 24 one-way trips to approved locations per calendar year
Meals	Not covered
Grocery Allowance	Not covered
Travel Benefits	Emergency or urgent care coverage if you’re making a trip out of state or country.
Important Documents (All Plans)	Provider Directory Drug Formulary Star Ratings Formulary Change Notice Summary of Benefits
Documentos Importantes (Todos los planes)	Directorio d Proveedores Formulario de Medicamentos Recetados Calificaciones por Estrellas Resumen de Beneficios (Disponible próximamente)
Important Documents (Plan Specific)	Evidence of Coverage Annual Notice of Change
Documentos Importantes (Específico del Plan)	Evidencial de Cobertura Aviso Anual de Cambio

Feature	BayCarePlus Premier (HMO) H2235-003
Dental (Base Option)	$0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $2,000 for comprehensive dental
Optional Comprehensive Dental ($49 per month)	See any dentist you want!* $0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $4,000 for comprehensive dental
Vision	$0 copay for routine eye exam $0 copay for a pair of eyeglasses (lenses and frames) or contacts $300 max benefit (non-Medicare-covered eyewear) per calendar year for eyeglass (lenses and frames) or $350 max benefit per year for contacts
Hearing Aids (Up to two hearing aids every calendar year [one per ear])	$699 or $999 copay per hearing aid
Over-the-Counter (OTC) Items	$135 per quarter +$50 per quarter for members with diabetes
Transportation Assistance	Not covered
Meals	Not covered
Grocery Allowance	Not covered
Travel Benefits	Emergency or urgent care coverage if you’re making a trip out of state or country.
Important Documents (All Plans)	Provider Directory Drug Formulary Star Ratings Formulary Change Notice Summary of Benefits
Documentos Importantes (Todos los planes)	Directorio d Proveedores Formulario de Medicamentos Recetados Calificaciones por Estrellas Resumen de Beneficios (Disponible próximamente)
Important Documents (Plan Specific)	Evidence of Coverage Annual Notice of Change
Documentos Importantes (Específico del Plan)	Evidencial de Cobertura Aviso Anual de Cambio

Feature	BayCarePlus Freedom (HMO-POS) H2235-006
Dental (Base Option)	$0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $2,000 for comprehensive dental
Optional Comprehensive Dental ($49 per month)	See any dentist you want!* $0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $4,000 for comprehensive dental
Vision	$0 copay for routine eye exam $0 copay for a pair of eyeglasses (lenses and frames) or contacts $300 max benefit (non-Medicare-covered eyewear) per calendar year for eyeglass (lenses and frames) or $350 max benefit per year for contacts
Hearing Aids (Up to two hearing aids every calendar year [one per ear])	$699 or $999 copay per hearing aid
Over-the-Counter (OTC) Items	$25 per quarter
Transportation Assistance	Not covered
Meals	Not covered
Grocery Allowance	Not covered
Travel Benefits	Emergency or urgent care coverage if you’re making a trip out of state or country.
Important Documents (All Plans)	Provider Directory Drug Formulary Star Ratings Formulary Change Notice Summary of Benefits
Documentos Importantes (Todos los planes)	Directorio d Proveedores Formulario de Medicamentos Recetados Calificaciones por Estrellas Resumen de Beneficios (Disponible próximamente)
Important Documents (Plan Specific)	Evidence of Coverage
Documentos Importantes (Específico del Plan)	Evidence of Coverage

Feature	Test 7 columns
Dental (Base Option)	$0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $2,000 for comprehensive dental
Optional Comprehensive Dental ($49 per month)	See any dentist you want!* $0 copay for preventive dental services including oral exams, X-rays and cleanings $0 copay for comprehensive dental services Annual maximum of $4,000 for comprehensive dental
Vision	$0 copay for routine eye exam $0 copay for a pair of eyeglasses (lenses and frames) or contacts $300 max benefit (non-Medicare-covered eyewear) per calendar year for eyeglass (lenses and frames) or $350 max benefit per year for contacts
Hearing Aids (Up to two hearing aids every calendar year [one per ear])	$699 or $999 copay per hearing aid
Over-the-Counter (OTC) Items	$25 per quarter
Transportation Assistance	Not covered
Meals	Not covered
Grocery Allowance	Not covered
Travel Benefits	Emergency or urgent care coverage if you’re making a trip out of state or country.
Important Documents (All Plans)	Provider Directory Drug Formulary Star Ratings Formulary Change Notice Summary of Benefits
Documentos Importantes (Todos los planes)	Directorio d Proveedores Formulario de Medicamentos Recetados Calificaciones por Estrellas Resumen de Beneficios (Disponible próximamente)
Important Documents (Plan Specific)	Evidence of Coverage
Documentos Importantes (Específico del Plan)	Evidence of Coverage

* The Delta Dental plan will pay benefits for covered services provided by a non-participating provider. However, a non-participating provider may charge you more than the Maximum Plan Allowance payable under this Medicare Advantage plan and you’ll be responsible for all cost-sharing charges. See the Evidence of Coverage for full details.

Important Disclaimers

For accommodations of persons with special needs at meetings call (877) 549-1741 (TTY: 711).

BayCare Select Health Plans is an HMO plan with a Medicare contract. Enrollment in BayCare Select Health Plans depends on contract renewal. All BayCare Select Health Plans include Part D drug coverage.

To enroll, you must have both Medicare Parts A and B and reside in the plan service area.

You must continue to pay your Medicare Part B premium. Enrollment in a BayCare Select Health Plan may be limited to specific times of the year.

Members must use plan providers except in emergency or urgent care situations. If a member obtains care from an out-of-network provider without prior approval from BayCare Select Health Plans, neither Medicare nor BayCare Select Health Plans will be responsible for the costs.

Information on our utilization management processes, including prior authorization, concurrent review, post service review and appeals, can be found online at Member.BayCarePlus.org.

BayCare Select Health Plans complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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Monthly Premium

Part B Premium Monthly Saving

Maximum Out-Of-Pocket Limit

Annual Deductible

Primary Care Physician Visits

Specialist Visits

Inpatient Hospital Care

Urgent Care

Emergency Care

Lab Services

Annual Deductible

Tier 1 Preferred Generic

Tier 2 Generic

Tier 3 Preferred Brand

Tier 4 Non-Preferred Brand

Tier 5 Specialty Drug

Mail Order 90-Day Supply (Tiers 1-4)

Diabetic Insulin 30-Day Supply (Tiers 1-5)

Initial Coverage Limit

Dental (Base Option)

Optional Comprehensive Dental ($49 per month)

Vision

Hearing Aids (Up to two hearing aids every calendar year [one per ear])

Over-the-Counter (OTC) Items

Transportation Assistance

Meals

Grocery Allowance

Travel Benefits

Important Documents (All Plans)

Documentos Importantes (Todos los planes)

Important Documents (Plan Specific)

Documentos Importantes (Específico del Plan)

Monthly Premium

Part B Premium Monthly Saving

Maximum Out-Of-Pocket Limit

Annual Deductible

Primary Care Physician Visits

Specialist Visits

Inpatient Hospital Care

Urgent Care

Emergency Care

Lab Services

Monthly Premium

Part B Premium Monthly Saving

Maximum Out-Of-Pocket Limit

Annual Deductible

Primary Care Physician Visits

Specialist Visits

Inpatient Hospital Care

Urgent Care

Emergency Care

Lab Services

Monthly Premium

Part B Premium Monthly Saving

Maximum Out-Of-Pocket Limit

Annual Deductible

Primary Care Physician Visits

Specialist Visits

Inpatient Hospital Care

Urgent Care

Emergency Care

Lab Services

Monthly Premium

Part B Premium Monthly Saving

Maximum Out-Of-Pocket Limit

Annual Deductible

Primary Care Physician Visits

Specialist Visits

Inpatient Hospital Care

Urgent Care

Emergency Care

Lab Services

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Hearing Aids
(Up to two hearing aids every calendar year [one per ear])