| Benefits |
Medicare Advantage (HMO) |
Medicare Advantage Plus (HMO) |
| Monthly plan premium* |
$0 |
$82 |
| Annual out-of-pocket maximum |
$5,900 |
$4,000 |
| Primary care physician visit |
$10 copay |
$10 copay |
| Specialist visit |
$40 copay |
$35 copay |
| Inpatient hospital care |
$360/day copay for days 1-4;
$0 copay for days 5+ |
$220/day copay for days 1-6;
$0 copay for days 7+ |
| Outpatient services |
20% coinsurance |
$200 copay/visit |
| Emergency room |
$65 copay (waived if admitted) |
$65 copay (waived if admitted) |
| Ambulance |
$225 copay/trip |
$150 copay/trip |
| Preventive care |
$0 copay |
$0 copay |
| Routine chiropractic services |
not covered |
$20 copay (up to 12 visits) |
| Routine foot care |
$40 copay (up to 6 visits) |
$35 copay (up to 6 visits) |
| Annual routine vision and hearing exams |
not covered |
$35 copay |
| $0 Fitness Program |
Healthways SilverSneakers® Fitness Program |
Healthways SilverSneakers® Fitness Program |