Check out available plan benefits below to determine if a CoxHealth MedicarePlus (HMO) plan is right for YOU.

Maximum Out-of-Pocket Limit

Maximum Out-of-Pocket Limit

Annual Medical Deductible

Annual Medical Deductible

Preventive Care/Screenings

Preventive Care/Screenings

Primary Care Doctor Visits

Primary Care Doctor Visits

Specialty Care Doctor Visits

Specialty Care Doctor Visits

Urgent Care

Urgent Care

Emergency Room Care

Emergency Room Care

Lab Services

Lab Services

Home Health Care

Home Health Care

Chiropractic Services

Chiropractic Services

Inpatient Hospital Care

Inpatient Hospital Care

Outpatient Surgery at a Hospital

Outpatient Surgery at a Hospital

Outpatient Surgery at an Ambulatory Surgical Center

Outpatient Surgery at an Ambulatory Surgical Center

Annual Part D Deductible

Annual Part D Deductible

Tier 1 – Preferred Generics

Tier 1 – Preferred Generics

Tier 2 – Generics

Tier 2 – Generics

Tier 3 – Preferred Brands

Tier 3 – Preferred Brands

Tier 4 – Non-Preferred Brands

Tier 4 – Non-Preferred Brands

Tier 5 – Specialty Drugs

Tier 5 – Specialty Drugs

Tier 6 – Insulins

Tier 6 – Insulins

Initial Coverage Limit

Initial Coverage Limit

Routine Eye Exam

Routine Eye Exam

Eye Glasses

Eye Glasses

Preventive Dental Benefits

Preventive Dental Benefits

Hearing

Hearing

Over-the-Counter (OTC) Items

Over-the-Counter (OTC) Items

SilverSneakers® Fitness Benefits

SilverSneakers® Fitness Benefits

Travel Benefits

Travel Benefits

CoxHealth MedicarePlus (HMO)
Maximum Out-of-Pocket Limit

$3,200 Per Year

Annual Medical Deductible

$0 Per Year

Preventive Care/Screenings

$0 Copay

Primary Care Doctor Visits

$5 Copay

Specialty Care Doctor Visits

$35 Copay

Urgent Care

$45 Copay

Emergency Room Care

$120 Copay

Lab Services

$5 Copay

Home Health Care

100% Coverage

Chiropractic Services

$20 Copay

Inpatient Hospital Care

$295 Copay Per Day, Per Stay for Days 1-6,
$0 Per Day, Per Stay for Day 7 and Beyond

Outpatient Surgery at a Hospital

$220 Copay

Outpatient Surgery at an Ambulatory Surgical Center

$220 Copay

Annual Part D Deductible

$0 Copay

Tier 1 – Preferred Generics

$3 Copay for 30-day supply
$0 Copay for 90-day mail order supply

Tier 2 – Generics

$6 Copay for 30-day supply
$0 Copay for 90-day mail order supply

Tier 3 – Preferred Brands

$47 Copay for 30-day supply
$117.50 Copay for 90-day mail order supply

Tier 4 – Non-Preferred Brands

$100 Copay for 30-day supply
$250 Copay for 90-day mail order supply

Tier 5 – Specialty Drugs

33% Co-insurance
for a 30-day mail order supply

Tier 6 – Insulins

$0 Copay for 30-day supply
$0 Copay for 90-day mail order supply

Initial Coverage Limit

$4,130 Per Year

Routine Eye Exam

$0 Copay when using an EyeQuest Provider

Eye Glasses

$0 Copay

Preventive Dental Benefits

$0 Copay

Hearing

$1000 allowance for up to 2 hearing aids every 2 calendar years (both ears combined)

Over-the-Counter (OTC) Items

$100 Per Quarter

SilverSneakers® Fitness Benefits

Included at no additional cost

Travel Benefits

Emergency or urgent care coverage if you are making a trip out of state or country

Ready to learn more about the CoxHealth MedicarePlus(HMO) plan?

Get the nitty-gritty details about the all-in-one CoxHealth MedicarePlus(HMO) plan available to Southwest, MO residents

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