FeelWell Benefits*

• $0 monthly plan premium
• $0 Part D deductible
• Medicare Prescription Drug Coverage (Part D)
  • Generic: Copays-$0 or $1.30 or $3.70
  • All other drugs*: Copays—$0 or $4.00 or $9.20
• $0 Primary Care visits in person or telehealth
• $0 Specialist visits in person or telehealth
• $0 Screenings and immunizations
• $0 Annual Routine Eye Exam— Our plan pays up to $150 every year for eyeglasses
• $0 Dental comprehensive Services- $1,500 Maximum Benefit Limit
• $0 Annual routine Hearing Exam— Our plan pays up to $1,000 every 2 years for hearing aids
• $0 Copay Acupuncture – 6 treatments per year
• $0 Chiropractor
• $0 Transportation-8 one-way trips
• $0 Telehealth Services
• Care Manager to coordinate benefits

For more information about covered services associated and cost-sharing (e.g., co-payments, co-insurance and deductibles) including any conditions and limitations please refer to the 2021 FeelWell Summary of Benefits

* Depending on your Medicaid eligibility.
This plan uses a formulary. Limitations may apply.