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.
Durable Medical Equipment (DME) and Related Supplies
Prosthetic Devices and Related Supplies
Medicare Part B Prescription Drugs
20% coinsurance (including chemotherapy)
Services to Treat Kidney Disease
Pulmonary Rehabilitation Services
Cardiac Rehabilitation Services
Home Health Agency Care
Inpatient Mental Health Care
$325 per stay
Medical Nutrition Therapy
Diabetes Self Management Training, Diabetic Services and Supplies
0% - 20%
$0 - $20 and $750 per ear towards the cost of hearing aid(s) every 3 years
$0 - $20 and $75 plan allowance per year
Optional Supplemental Buy-Up
Available for purchase
Healthy Living Rewards
Acute inpatient hospital copay waived with COVID-19 diagnosis. Post hospital discharge meal delivery included.
The monthly fee you pay the plan for your health care. The amount shown does not include the Part B premium you already pay to the government.
Hearing & Vision Allowances
No Referrals for Out-of-Network Services
Be eligible for Medicare Part A and enrolled in Part B,
Continue to pay Part B premiums,
Live in the plan service area.
How Much Does it Cost
The monthly plan premium to enroll in the Silver Community 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.