CareWell Benefits*
| For Medicare beneficiaries residing in a contracted Skilled Nursing Facility | |
|---|---|
| Monthly Plan Premium | $0 or up to $38.90* (derived from Part D/LIS applicable) |
| Maximum out-of-pocket (MOOP) | $7,550 |
| Part D Yearly Deductible | $0 or $104 (partial subsidy) or $505 (retiree drug subsidy cost threshold)** |
| Alternative therapy | $0 copay for each therapy: Offered in one to two group sessions covered each month, up to twenty group sessions covered each year. Therapies may be done in person or online.
Alternative therapies may include: |
| Chiropractor | $0 or 20% of the cost* |
| Dental | $0 Comprehensive Dental $1,350 limit per year. |
| Diabetic | $0 copay Precision, OneTouch and FreeStyle preferred brands. No prior authorization required. 20% coinsurance, diabetic shoes/inserts (if the member has Medicaid, they will cover Medicaid cost-share). |
| Emergency Room/ Urgent Care | $0 or 20% of the cost* (up to a maximum of $95 for each emergency room visit and up to a maximum of $60 for urgent care visits) (US + Territories Only) |
| Hearing | $0 annual routine hearing exam; Our plan pays up to $1,500 every 2 years for Hearing Aids. 4 visits for fitting/evaluation for Hearing. Aids are covered within the two years after the purchase of a Hearing Aid. |
| Hospital Inpatient Stay | $0 or same as Original Medicare* |
| Lab/ X-Ray/ Test & Procedures | $0 or 20% of the cost* |
| Outpatient Surgery | $0 or 20% of the cost* |
| Part D Coverage | $0, 15% or 25% coinsurance*. Members with LIS or Medicaid: Generic copay: $0; $1.45; $4.15* or 15%. All other drugs copay: $0; $4.30; $10.35* or 15%. |
| Primary Care Physician | $0 or 20% of the cost* Telehealth or in person. |
| Screening & Immunization | $0 copay |
| Specialist | $0 or 20% of the cost* No referral required. Telehealth or in person. |
| Vision | $0 for two routine eye exams per year; $500 each year for eyeglasses. Prior Authorization is required for eyeglasses. |
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 2023 CareWell Summary of Benefitsopens PDF file .
**Licensed Master Social Worker and a Nurse Practitioner are assigned to members
*Depending on your Medicaid eligibility, you may pay a lower cost share amount.
This plan uses a formulary. Limitations may apply.