LiveWell (HMO) Benefits

  • $42.30 monthly plan premium
  • $350 Part D yearly deductible
    (Drugs in Tier 1 and Tier 2 are excluded from the deductible)
  • Medicare Prescription Drug Coverage (Part D)
    Copays:
    Tier 1 – $3
    Tier 2 – $15
    Tier 3 – $47
    Tier 4 – $100
    Tier 5 – 26% coinsurance
  • $15 copay for Primary Care Provider (PCP) visits – in person or via telehealth ($0 annual routine physical exam)
  • $40 copay for specialist visits – in person or via telehealth
  • $20 copay for physical therapy
  • $0 copay for annual routine eye exam
  • Optional $9 vision monthly premium (covers up to $275 every year for eyeglasses)
  • $0 copay for annual routine hearing exam (up to $1,000 every 2 years for hearing aids)
  • Optional $16 dental monthly premium (preventive & comprehensive services)
  • $10 copay for acupuncture (10 treatments per year)
  • $20 copay for chiropractor services
  • $0 screenings & immunizations (vaccines)
  • $0 telehealth services
  • Wellness Coach to help you access all your health 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 LiveWell Summary of Benefits.opens PDF file