FeelWell (HMO D-SNP) Benefits*
| FeelWell Benefits | |
|---|---|
| Monthly Plan Premium | $0* copay |
| Yearly Deductible | $0* |
| Maximum out-of-pocket (MOOP) | $0 or $3,650* |
| PCP/ Specialist/ Telehealth | $0* copay, no referral required |
| Acupuncture | $0 copay per visit, 30 additional visits per year |
| Chiropractor | $0* copay |
| Dental | $0 copay, Up to $3,000 maximum per year Preventive/Comprehensive Services |
| Diabetic | $0* copay OneTouch, Precision Xtra and FreeStyle brands. Plus $150 diabetic healthy food card per month |
| Emergency Room/ Urgent Care | $0* copay (U.S. + Territories) and up to $50,000 for emergency and urgent care outside the U.S. |
| Hearing | $0 annual hearing exam; $1,500 for Hearing Aids every 2 years, 4 visits for fitting/ evaluation for Hearing Aids are covered within the first year after purchasing a Hearing Aid |
| Hospital Inpatient/ SNF | $0* copay |
| Lab/ X-Ray/ Test & Procedures | $0* copay |
| Over-the-Counter (OTC) | $225 per month |
| Outpatient Surgery | $0* copay |
| Physical Therapy | $0* copay |
| Screening & Immunization | $0 copay |
| Telemonitoring Services | $0 copay |
| Transportation | $0 for 24 one-way trips post-hospitalization or as approved by the plan. Taxi, rideshare services, bus/subway, van, medical transport |
| Vision | $0 copay for Routine Eye Exam per year; $200 for eyewear per year |
| Post Discharge Meals | Two meals per day for two weeks after hospital discharge provided by FarmboxRx at $0 copay offered up to twice per enrollment year |
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 FeelWell Summary of Benefitsopens PDF file .
* Depending on your Medicaid eligibility.
This plan uses a formulary. Limitations may apply.