|Benefit||Original Medicare||2021 PHP|
|Acupuncture||Not covered.||$0 copay for up to 2 acupuncture visits per month.|
|Dental Services||Preventive dental services (such as cleaning) not covered.||
$0 copay for preventive dental services such as oral exams, cleanings, fluoride treatments and dental x-rays, and other dental services.
In addition to the preventive services above, plan covers up to $700 a year for comprehensive dental services such as non-routine, diagnostic, and restorative services; endontics, periodontics, and extractions; and prosthodontics, oral and maxillofacial surgery, etc.
|Health and Wellness||Supplemental health and wellness programs not covered.||$0 copay for choice of gym membership at 24 Hour Fitness OR up to $200 in over-the-counter pharmacy merchandise, such as vitamins, fiber supplements, first aid supplies, sunscreen, tooth brushes and pastes, cold medication, antacids, etc.
$0 copay for access to 24 hour nurse hotline.
|Hearing Services||Supplemental routine hearing exams and hearing aids not covered.||$0 copay for a routine hearing exam every year.
$0 copay for up to 2 hearing aids every year including a fitting evaluation.
Plan covers up to $400 a year for hearing aids.
|In-Home Support Services (IHSS)||Not covered.||$0 copay for up to 16 hours a week of IHSS for up to 2 weeks. IHSS include personal care and domestic services. IHSS are available to members after discharge from an acute hospital or skilled nursing facility.|
|Meal Benefit||Not covered.||$0 copay for up to 2 meals per day for up to 28 days. (56 meal limit per year.) Meal benefit is available to members after discharge from an acute hospital or skilled nursing facility.|
|Non-Emergency Transportation||Not covered.||$0 copay for unlimited round trips to plan-approved locations every year.|
|Therapeutic Massage||Not covered.||$0 copay for up to 2 therapeutic massages per month for members diagnosed with AIDS-related neuropathy.|
|Transportation to Cancer Treatment Visits||Not covered.||Not covered. This benefit has been superseded by the non-emergency transportation benefit above.|
|Transportation to Dialysis Visits||Not covered.||Not covered. This benefit has been superseded by the non-emergency transportation benefit above.|
|Vision Services||Supplemental routine eye exams and glasses not covered.||$0 copay for one routine eye exam every year.
$0 copay for glasses, lenses or contacts.
Plan covers up to $150 a year for eye wear.
More information about the additional benefits is in the 2021 Summary of Benefits.
If all of this looks good to you and you’d like to enroll, we make it easy and convenient.