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Gold Freedom

2022 Benefits Summary

This is a summary of what our plan covers and what you pay. It does not list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, please refer to the Evidence of Coverage, this legal member contract is the primary source of the coverage information and supersedes all other information.

Download the Summary of Benefits

Plan Summaries

  • Medical Coverage
  • Prescription Drug Coverage
  • Comprehensive Dental
  • Over-the-Counter Allowance
  • COVID-19 Coverage
  • Wellness Benefit Allowance
  • Hearing & Vision Allowances
  • $0 Tier 1 and Tier 2 Medications
  • No Referrals for Out-of-Network Services
  • And more

You Must:

  1. Be eligible for Medicare Part A and enrolled in Part B,
  2. Continue to pay Part B premiums,
  3. Live in the plan service area

How Much Does it Cost

The monthly plan premium to enroll in the Gold Freedom plan is $0. Additionally, you must maintain your Medicare Part B coverage to be a member of any Medicare Advantage plan. Most people will pay the standard Part B premium amount. Please call Social Security at 1-800-772-1213 for information about your Part B premium.

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