A non-government entity
Molina Healthcare, Inc.
Plan ID: H2533-1-0
Plan Summary PageMolina Dual Options (Medicare-Medicaid Plan)
2025 Molina Dual Options (Medicare-Medicaid Plan) H2533 — 001 — 0 is a Medicare Advantage plan with drug coverage. 0
Learn more about Molina Dual Options (Medicare-Medicaid Plan) H2533 - 001 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.
$0.00 /mo
Monthly premium
$0
Drug deductible
Enroll online
Call to enroll
OR
Get personalized help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week!
Plan Overview
2025 Molina Dual Options (Medicare-Medicaid Plan) H2533 — 001 — 0 is a Medicare-Medicaid Plan offered in South Carolina by Molina Healthcare, Inc.. It has a monthly premium of $0.00.
Premium Breakdown
Standard Part B Premium
$185.00
Part B premium reduction
- $0
Monthly Plan Premium
$0.00
Total Premium:
$185.00
Note:
The standard Medicare Part B premium for 2025 is $185.00. Your premium may differ based on factors like late enrollment, income (IRMAA), or disability status. Most people enrolled in Medicare Part B are required to pay this premium.
Special needs plan type
No
Out-of-pocket maximum (In-Network)
N/A
Out-of-pocket maximum (Out-of-Network)
N/A
Out-of-pocket maximum (Combined)
N/A
Plan Organization:
Molina Healthcare, Inc.
Plan Type:
Medicare-Medicaid Plan
Location:
South Carolina
Drugs Covered:
Yes
Drug Formulary:
Pharmacies:
Doctors Link:
Deductibles
The amount you must pay each year before your plan starts to pay for covered services or drugs.
Drug deductible
$0
Sign up for Molina Dual Options (Medicare-Medicaid Plan)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Molina Dual Options (Medicare-Medicaid Plan) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Benefit Type
Enhanced Alternative
Prescription drug deductible
$0
Part D Premium Reduction
This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.
Part D | LIS Full |
|---|---|
$0.00 | $0.00 |
Initial Coverage Phase
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2000.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Preferred Pharmacy | Standard Pharmacy | Preferred Mail | Standard Mail |
|---|---|---|---|---|
1. Preferred Generic | - | - | - | - |
2. Standard Generic | - | - | - | - |
3. Preferred Brand | - | - | - | - |
4. Non-Preferred Drug | - | - | - | - |
5. Specialty Tier | - | - | - | - |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
Molina Dual Options (Medicare-Medicaid Plan) also provides the following benefits.
Inpatient Hospital
Inpatient Hospital benefits are covered.
Inpatient Hospital-Acute
Inpatient Hospital-Acute benefits are covered. Prior Authorization is required.
More Details:
Periodicity
Original Medicare
Additional Days for Inpatient Hospital-Acute
Not covered.
Non-Medicare-covered Stay for Inpatient Hospital-Acute
Not covered.
Upgrades for Inpatient Hospital-Acute
Not covered.
Inpatient Hospital Psychiatric
Inpatient Hospital Psychiatric benefits are covered. Prior Authorization is required.
More Details:
Periodicity
Original Medicare
Additional Days for Inpatient Hospital Psychiatric
Not covered.
Non-Medicare-covered Stay for Inpatient Hospital Psychiatric
Not covered.
Outpatient Services
Outpatient Services benefits are covered.
All Outpatient Hospital Services
All Outpatient Hospital Services benefits are covered.
Outpatient Hospital Services
Outpatient Hospital Services benefits are covered. Prior Authorization is required.
Observation Services
Observation Services benefits are covered.
Ambulatory Surgical Center (ASC) Services
Ambulatory Surgical Center (ASC) Services benefits are covered. Prior Authorization is required.
Outpatient Substance Abuse Services
Outpatient Substance Abuse Services benefits are covered.
Individual Sessions for Outpatient Substance Abuse
Not covered.
Group Sessions for Outpatient Substance Abuse
Not covered.
Outpatient Blood Services
Outpatient Blood Services benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.
More Details:
Enhanced benefit
Three (3) Pint Deductible Waived
Partial Hospitalization
Partial Hospitalization benefits are covered. Prior Authorization is required.
Ambulance and Transportation Services
Ambulance and Transportation Services benefits are covered.
All Ambulance Services
All Ambulance Services benefits are covered. Prior Authorization is required.
More Details:
Is there a coinsurance?
No
Is there a copayment ?
No
Ground Ambulance Services
Not covered.
Air Ambulance Services
Not covered.
Transportation Services
Transportation Services benefits are covered.
Transportation Services - Plan Approved Health-related Location
Not covered.
Transportation Services - Any Health-related Location
Not covered.
Emergency Services
Emergency Services benefits are covered.
Emergency Services
Emergency Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a copayment?
No
Urgently Needed Services
Urgently Needed Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a copayment?
No
Worldwide Emergency Services
Worldwide Emergency Services benefits are covered.
Worldwide Emergency Coverage
Not covered.
Worldwide Urgent Coverage
Not covered.
Worldwide Emergency Transportation
Not covered.
Primary Care
Primary Care benefits are covered.
Primary Care Physician Services
Primary Care Physician Services benefits are covered.
Chiropractic Services
Chiropractic Services benefits are covered.
Routine Chiropractic Care
Not covered.
Occupational Therapy Services
Occupational Therapy Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a copayment ?
No
Authorization required for this benefit?
Yes
Referral required for this benefit?
No
Does this plan provide Non-Medicare-covered Occupational Therapy Services?
No
Physician Specialist Services
Physician Specialist Services benefits are covered. A doctor referral is required.
Mental Health Specialty Services
Mental Health Specialty Services benefits are covered. Prior Authorization is required.
Individual Sessions for Mental Health Specialty Services
Not covered.
Group Sessions for Mental Health Specialty Services
Not covered.
Podiatry Services
Not covered.
Other Health Care Professional
Other Health Care Professional benefits are covered. Prior Authorization is required.
Psychiatric Services
Psychiatric Services benefits are covered. Prior Authorization is required.
Individual Sessions for Psychiatric Services
Not covered.
Group Sessions for Psychiatric Services
Not covered.
Physical Therapy and Speech-Language Pathology Services
Physical Therapy and Speech-Language Pathology Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a copayment ?
No
Authorization required for this benefit?
Yes
Referral required for this benefit?
No
Additional Telehealth Benefits
Additional Telehealth Benefits benefits are covered – including services not usually covered by Medicare plans.
More Details:
Medicare-covered benefits that may have Additional Telehealth Benefits available
7a: Primary Care Physician Services
Opioid Treatment Program Services
Opioid Treatment Program Services benefits are covered. Prior Authorization is required.
Preventive Services
Preventive Services benefits are covered.
Medicare-covered Zero Dollar Preventive Services
Medicare-covered Zero Dollar Preventive Services benefits are covered.
Annual Physical Exam
Not covered.
Additional Preventive Services
Additional Preventive Services benefits are covered – including services not usually covered by Medicare plans.
More Details:
Is there a service-specific Maximum Plan Benefit Coverage amount for Other Defined Supplemental Benefits?
No
Health Education
Health Education benefits are covered.
In-Home Safety Assessment
In-Home Safety Assessment benefits are covered.
Personal Emergency Response System (PERS)
Not covered.
Medical Nutrition Therapy (MNT)
Not covered.
Post discharge In-Home Medication Reconciliation
Post discharge In-Home Medication Reconciliation benefits are covered.
Re-admission Prevention
Not covered.
Wigs for Hair Loss Related to Chemotherapy
Not covered.
Weight Management Programs
Not covered.
Alternative Therapies
Not covered.
Therapeutic Massage
Not covered.
Adult Day Health Services
Not covered.
Nutritional/Dietary Benefit
Nutritional/Dietary Benefit benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
12
Setting for Nutritional/Dietary Benefit
Both Sessions (Individual and Group)
Home-Based Palliative Care
Not covered.
In-Home Support Services
Not covered.
Support for Caregivers of Enrollees
Not covered.
Additional Sessions of Smoking and Tobacco Cessation Counseling
Additional Sessions of Smoking and Tobacco Cessation Counseling benefits are covered.
More Details:
Number of visits
8
Fitness Benefit
Not covered.
Enhanced Disease Management
Enhanced Disease Management benefits are covered.
Telemonitoring Services
Telemonitoring Services benefits are covered.
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) benefits are covered.
Home and Bathroom Safety Devices and Modifications
Not covered.
Counseling Services
Not covered.
Kidney Disease Education Services
Kidney Disease Education Services benefits are covered.
Other Preventive Services
Other Preventive Services benefits are covered.
More Details:
Is a referral required for any Services?
No
Glaucoma Screening
Glaucoma Screening benefits are covered.
Diabetes Self-Management Training
Diabetes Self-Management Training benefits are covered.
Barium Enemas
Barium Enemas benefits are covered.
Digital Rectal Exams
Digital Rectal Exams benefits are covered.
EKG following Welcome Visit
EKG following Welcome Visit benefits are covered.
Hearing Services
Hearing Services benefits are covered.
Hearing Exams
Hearing Exams benefits are covered – including services not usually covered by Medicare plans.
More Details:
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
No
Routine Hearing Exams
Routine Hearing Exams benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
1
Periodicity
Every year
Fitting/Evaluation for Hearing Aid
Fitting/Evaluation for Hearing Aid benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
1
Periodicity
Every two years
Prescription Hearing Aids
Prescription Hearing Aids benefits are covered – including services not usually covered by Medicare plans.
More Details:
Service maximum plan benefit coverage
Yes
Select Coverage
Both ears combined
Maximum plan benefit coverage type
Plan-specified amount per period
Maximum amount
1500.00
Periodicity
Every year
Prescription Hearing Aids (all types)
Prescription Hearing Aids (all types) benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Prescription Hearing Aids - Inner Ear
Not covered.
Prescription Hearing Aids - Outer Ear
Not covered.
Prescription Hearing Aids - Over the Ear
Not covered.
OTC Hearing Aids
Not covered.
Vision Services
Vision Services benefits are covered.
Eye Exams
Eye Exams benefits are covered – including services not usually covered by Medicare plans.
More Details:
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
Yes
Maximum amount
300.00
Periodicity
Every year
Routine Eye Exams
Routine Eye Exams benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Eyewear
Eyewear benefits are covered – including services not usually covered by Medicare plans.
More Details:
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
Yes
Maximum plan benefit coverage type
Covered under Eye Exams Category 17a
Contact Lenses
Contact Lenses benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Eyeglasses (lenses and frames)
Eyeglasses (lenses and frames) benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Eyeglass lenses
Eyeglass lenses benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Eyeglass frames
Eyeglass frames benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Upgrades
Upgrades benefits are covered.
Dental Services
Dental Services benefits are covered.
Medicare Dental Services
Medicare Dental Services benefits are covered.
Other Dental Services
Other Dental Services benefits are covered.
More Details:
Is there a maximum plan benefit coverage?
Yes
Maximum amount
4000.00
Periodicity
Every year
Oral Exams
Oral Exams benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Dental X-Rays
Dental X-Rays benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Prophylaxis (Cleaning)
Prophylaxis (Cleaning) benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Fluoride Treatment
Fluoride Treatment benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Orthodontic Services
Orthodontic Services benefits are covered.
More Details:
Is there a maximum plan benefit coverage?
Yes
Maximum plan benefit coverage type
Covered under Diagnostic and Preventive Dental (16b)
Restorative Services
Restorative Services benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Adjunctive General Services
Adjunctive General Services benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Endodontics
Endodontics benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Periodontics
Periodontics benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Prosthodontics, removable
Prosthodontics, removable benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Maxillofacial Prosthetics
Not covered.
Implant Services
Not covered.
Prosthodontics, fixed
Not covered.
Oral and Maxillofacial Surgery
Oral and Maxillofacial Surgery benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Orthodontics
Not covered.
Home Infusion bundled Services
Home Infusion bundled Services benefits are covered. Prior Authorization is required.
More Details:
Does this plan have a service specific maximum enrollee out-of-pocket cost (MOOP)?
No
Does the plan offer step therapy?
Yes
Does the benefit step from?
Part B to Part D
Does the plan provide Part D home infusion drugs as part of a bundled service as a mandatory supplemental benefit?
No
Does the plan pay for Part D home infusion services and supplies as a Medicaid benefit?
No
Insulin
Insulin benefits are covered.
Medicare Part B Insulin Drugs
Medicare Part B Insulin Drugs benefits are covered.
Medicare Part B Chemotherapy/Radiation Drugs
Not covered.
Dialysis Services
Dialysis Services benefits are covered.
Medical Equipment
Medical Equipment benefits are covered.
Durable Medical Equipment (DME)
Durable Medical Equipment (DME) benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a coinsurance?
No
Is there a copayment ?
No
Is there a copayment ?
No
Are there preferred vendors/manufacturers for Durable Medical Equipment (DME)?
Yes
Authorization required for this benefit?
Yes
Does this plan provide Non-Medicare-covered Durable Medical Equipment?
Yes
Non-Medicare-covered Durable Medical Equipment
Other 2
Is there a maximum plan benefit coverage amount?
No
Authorization required for this benefit?
Yes
Durable Medical Equipment for use outside the home
Not covered.
Other 1 for Durable Medical Equipment
Other 1 for Durable Medical Equipment benefits are covered.
More Details:
Enter name of Other 1 Service
Specialized Supplies
Prosthetics/Medical Supplies - Non-Medicare benefit
Prosthetics/Medical Supplies - Non-Medicare benefit benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a coinsurance?
No
Is there a copayment ?
No
Is there a copayment ?
No
Authorization required for this benefit?
Yes
Does this plan provide Non-Medicare-covered Prosthetics/Medical Supplies?
Yes
Enter name of Non-Medicare-covered Service
Non-Medicare Prosthetics/Medical Supplies
Is there a maximum plan benefit coverage amount?
No
Authorization required for this benefit?
Yes
Prosthetic Devices
Not covered.
Medical Supplies
Not covered.
Diabetic Equipment
Diabetic Equipment benefits are covered. Prior Authorization is required.
More Details:
Do you limit Diabetic supplies and services to those from specified manufacturers
Yes
Diabetic Supplies
Not covered.
Diabetic Therapeutic Shoes/Inserts
Not covered.
Diagnostic and Radiological Services
Diagnostic and Radiological Services benefits are covered.
All Diagnostic services
All Diagnostic services benefits are covered. Prior Authorization is required.
More Details:
Is there a copayment?
No
Diagnostic Procedures/Tests
Not covered.
Lab Services
Not covered.
All Radiological Services
All Radiological Services benefits are covered. Prior Authorization is required.
More Details:
Is there a copayment?
No
Diagnostic Radiological Services
Not covered.
Therapeutic Radiological Services
Not covered.
Outpatient X-Ray Services
Not covered.
Home Health Services
Home Health Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there an enrollee Coinsurance?
No
Is there a copayment ?
No
Is there an enrollee Copayment?
No
Authorization required for this benefit?
Yes
Referral required for this benefit?
No
Is there a limit on the services provided?
Yes
Does this plan provide Non-Medicare-covered Home Health Services?
Yes
Non-Medicare-covered Home Health Services where limit applies
Other 1, Other 2
Non-Medicare-covered Home Health Services
Other 1, Other 2
Is there a maximum plan benefit coverage amount?
No
Does any service require qualification for and enrollment in a state-operated waiver program?
No
Authorization required for this benefit?
No
Referral required for this benefit?
No
Additional Hours of Care
Not covered.
Personal Care Services
Personal Care Services benefits are covered.
More Details:
Units
Visits
Numerical limit
50
Periodicity
Every year
Other 1 for Home Health Services
Other 1 for Home Health Services benefits are covered.
More Details:
Enter name of Other 1 Service
Incontinence Supplies
Units
Items/Other, Describe
Description
As medically necessary.
Numerical limit
9999
Periodicity
Other, Describe
Description
As medically necessary.
Cardiac Rehabilitation Services
Cardiac Rehabilitation Services benefits are covered. Prior Authorization is required.
Cardiac Rehabilitation Services
Not covered.
Intensive Cardiac Rehabilitation Services
Not covered.
Pulmonary Rehabilitation Services
Not covered.
SET for PAD Services
Not covered.
Skilled Nursing Facility (SNF)
Skilled Nursing Facility (SNF) benefits are covered. Prior Authorization and a doctor referral are required.
More Details:
Does the plan provide Skilled Nursing Facility Services as a supplemental benefit under Part C?
Yes
Enhanced benefits (2)
Additional days beyond Medicare-covered
Do you allow less than 3 day inpatient hospital stay prior to SNF admission?
Yes
Days
Zero
Periodicity
Original Medicare
Additional Days beyond Medicare-covered for Skilled Nursing Facility (SNF)
Not covered.
Non-Medicare-covered Stay for Skilled Nursing Facility (SNF)
Non-Medicare-covered Stay for Skilled Nursing Facility (SNF) benefits are covered.
Cost Sharing:
Other Services
Other Services benefits are covered.
Acupuncture
Not covered.
Over-the-Counter (OTC) Items
Over-the-Counter (OTC) Items benefits are covered.
More Details:
Does the plan provide Over-The-Counter (OTC) Items as a supplemental benefit under Part C?
Yes
Is there a maximum plan benefit coverage amount?
Yes
Maximum plan benefit coverage amount
100.00
Periodicity
Every three months
Does your Maximum Plan Benefit Coverage amount carry forward to the next period if it is unused?
No
Plan offers Nicotine Replacement Therapy (NRT) as a Part C OTC benefit?
Yes
The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.
The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.
Plan offers Naloxone coverage as a Part C OTC benefit?
Yes
Does this cover all of the drugs on the CMS OTC list which may be found in Chapter 4 of the Medicare Managed Care Manual
Yes
Meal Benefit
Not covered.
Other 1
Other 1 benefits are covered.
More Details:
Service Name
Behavioral Health Services
Is there a maximum plan benefit coverage?
No
Dual Eligible SNPs with Highly Integrated Services
Not covered.
Other Services
Other Services benefits are covered.
More Details:
Does the plan provide Additional Services?
Yes
Additional Services
13h5: Family Planning Services, 13h7: Home and Community Based Services, 13h8: Personal Care Services, 13h9: Self-Directed Personal Assistance Services, 13h10: Private Duty Nursing Services, 13h11: Case Management (Long Term Care), 13h12: Institution for Mental Disease Services for Individuals 65 or Older, 13h14: Case Management, 13h15: Other 1, 13h16: Other 2, 13h17: Other 3, 13h18: Other 4, 13h19: Other 5, 13h20: Other 6, 13h21: Other 7, 13h22: Other 8, 13h23: Other 9, 13h24: Other 10, 13h25: Other 11, 13h26: Other 12, 13h27: Other 13, 13h28: Other 14, 13h29: Other 15
Is there a limit on the Additional Services provided?
Yes
Additional Services where a limit applies
13h19: Other 5, 13h20: Other 6, 13h28: Other 14, 13h29: Other 15
Is there a maximum plan benefit coverage amount?
Yes
Additional Services have a Maximum Plan Benefit Coverage Amount
13h22: Other 8
Does any service require qualification for and enrollment in a state-operated waiver program?
Yes
Services that require qualification for and enrollment in a state-operated waiver program
13h7: Home and Community Based Services, 13h8: Personal Care Services, 13h9: Self-Directed Personal Assistance Services, 13h10: Private Duty Nursing Services, 13h11: Case Management (Long Term Care), 13h18: Other 4, 13h20: Other 6, 13h21: Other 7, 13h22: Other 8, 13h24: Other 10, 13h25: Other 11, 13h27: Other 13, 13h28: Other 14, 13h29: Other 15
Is a beneficiary receiving any benefit subject to a state-required monthly payment amount that is based on his or her financial resources (for example: a "patient pay amount")?
No
Is Authorization required for one or more Additional Services?
Yes
Which Additional Services need an Authorization
13h7: Home and Community Based Services, 13h8: Personal Care Services, 13h9: Self-Directed Personal Assistance Services, 13h10: Private Duty Nursing Services, 13h11: Case Management (Long Term Care), 13h14: Case Management, 13h15: Other 1, 13h17: Other 3, 13h18: Other 4, 13h19: Other 5, 13h20: Other 6, 13h21: Other 7, 13h22: Other 8, 13h24: Other 10, 13h25: Other 11, 13h26: Other 12, 13h27: Other 13, 13h28: Other 14, 13h29: Other 15
Is a referral required for one or more Additional Services?
Yes
Which Additional Services need a Referral
13h7: Home and Community Based Services, 13h8: Personal Care Services, 13h9: Self-Directed Personal Assistance Services, 13h10: Private Duty Nursing Services, 13h11: Case Management (Long Term Care), 13h12: Institution for Mental Disease Services for Individuals 65 or Older, 13h15: Other 1, 13h16: Other 2, 13h18: Other 4, 13h19: Other 5, 13h20: Other 6, 13h21: Other 7, 13h23: Other 9
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services
Not covered.
Private Duty Nursing Services
Not covered.
Case Management (Long Term Care)
Not covered.
Institution for Mental Disease Services for Individuals 65 or Older
Not covered.
Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities
Not covered.
Case Management
Not covered.
Other 1
Other 1 benefits are covered.
More Details:
Enter name of Other 1 Service
Palliative Care
Other 2
Other 2 benefits are covered.
More Details:
Enter name of Other 2 Service
Outpatient Mental Health Services
Other 3
Other 3 benefits are covered.
More Details:
Enter name of Other 3 Service
Infusion Centers
Other 4
Other 4 benefits are covered.
More Details:
Enter name of Other 4 Service
Residential Personal Care Services
Other 5
Other 5 benefits are covered.
More Details:
Enter name of Other 5 Service
Nursing Home Transition Services
Units
Sessions
Numerical limit
1
Periodicity
Every year
Tobacco Cessation Counseling for Pregnant Women
Not covered.
Other 6
Other 6 benefits are covered.
More Details:
Enter name of Other 6 Service
Respite Care
Units
Items/Other, Describe
Description
As medically necessary.
Numerical limit
9999
Periodicity
Other, Describe
Description
As medically necessary.
Other 7
Other 7 benefits are covered.
More Details:
Enter name of Other 7 Service
Adult Day Health Services & Nursing Services
Other 8
Other 8 benefits are covered.
More Details:
Enter name of Other 8 Service
Environmental Modifications
Maximum plan benefit coverage amount
7500.00
Periodicity
Other, Describe
Description
Per lifetime.
Other 9
Other 9 benefits are covered.
More Details:
Enter name of Other 9 Service
Telemedicine
Other 10
Other 10 benefits are covered.
More Details:
Enter name of Other 10 Service
Companion Services
Other 11
Other 11 benefits are covered.
More Details:
Enter name of Other 11 Service
Adult Day Health Transportation
Other 12
Other 12 benefits are covered.
More Details:
Enter name of Other 12 Service
Two (2) Additional Prescription Drugs
Other 13
Other 13 benefits are covered.
More Details:
Enter name of Other 13 Service
Personal Emergency Response System
Other 14
Other 14 benefits are covered.
More Details:
Enter name of Other 14 Service
Meal Benefit
Units
Meals
Numerical limit
2
Periodicity
Every day
Other 15
Other 15 benefits are covered.
More Details:
Enter name of Other 15 Service
Oral Nutritional Supplements (Cans)
Units
Items/Other, Describe
Description
Waiver limitations: Community Choices: 2 cases per month maximum, HIV / AIDS: 4 cases per month maximum.
Numerical limit
96
Periodicity
Every month
Freestanding Birth Center Services
Not covered.
Respiratory Care Services
Not covered.
Family Planning Services
Not covered.
Nursing Home Services
Not covered.
Home and Community Based Services
Not covered.
Personal Care Services
Not covered.
Self-Directed Personal Assistance Services
Not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
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