| Plan Benefits | MediExtra (HMO) View Plan | MediDual (HMO D-SNP) View Plan | MediMore (HMO) View Plan | ||
|---|---|---|---|---|---|
| Prescription Drugs | |||||
| Initial Coverage Limit (ICL) | $8,000 | $4,430 | $4,430 | ||
| Dental | |||||
| Comprehensive Dental Maximum Benefit | $3,000 | $3,000 | $2,500 | ||
| Vision | |||||
| Eyewear Lenses and Frames | $500 maximum benefit (up to 3 pairs / $167 per eyeglasses) | $525 maximum benefit
(up to 3 pairs / $175 per eyeglasses) | $320 maximum benefit
(up to 2 pairs / $160 per eyeglasses) | ||
| Hearing Services | |||||
| Hearing Aids | $2,100 maximum benefit / 3 years ($1,050 per hearing aid per ear) | $2,100 maximum benefit / 3 years ($1,050 per hearing aid per ear) | $2,100 maximum benefit / 3 years ($1,050 per hearing aid per ear) | ||
| Drugs/OTC | |||||
| OTC | $70 per month | $100 per month | $25 per quarter | ||
| Part B Premium Give Back | |||||
| Part B Premium Reduction | not applicable | not applicable | $110 per month | ||
| Acupuncture | |||||
| Routine | $0 for 6 visits | $0 for 6 visits | $0 for 6 visits | ||
| Medical | |||||
| PCP Visit | $0 | $0 | $0 | ||
| Inpatient Hospital (per admission) | $0 | $0 | $50 copay per day for 1-5 $0 copay per day for 6-90 $0 copay per day for 91+ | ||
| Lab Services and X-Rays | $0 | $0 | $0 | ||
| Plan Benefits | ||
|---|---|---|
| MediExtra (HMO) View Plan |
MediDual (HMO D-SNP) View Plan |
MediMore (HMO) View Plan |
| Prescription Drugs | ||
| Initial Coverage Limit (ICL) | ||
| $8,000 | $4,430 | $4,430 |
| Dental | ||
| Comprehensive Dental Maximum Benefit | ||
| $3,000 | $3,000 | $2,500 |
| Vision | ||
| Eyewear Lenses and Frames | ||
| $500 maximum benefit (up to 3 pairs / $167 per eyeglasses) | $525 maximum benefit
(up to 3 pairs / $175 per eyeglasses) |
$320 maximum benefit
(up to 2 pairs / $160 per eyeglasses) |
| Hearing Services | ||
| Hearing Aids | ||
| $2,100 maximum benefit / 3 years ($1,050 per hearing aid per ear) | $2,100 maximum benefit / 3 years ($1,050 per hearing aid per ear) | $2,100 maximum benefit / 3 years ($1,050 per hearing aid per ear) |
| Drugs/OTC | ||
| OTC | ||
| $70 per month | $100 per month | $25 per quarter |
| Part B Premium Give Back | ||
| Part B Premium Reduction | ||
| not applicable | not applicable | $110 per month |
| Acupuncture | ||
| Routine | ||
| $0 for 6 visits | $0 for 6 visits | $0 for 6 visits |
| Medical | ||
| PCP Visit | ||
| $0 | $0 | $0 |
| Inpatient Hospital (per admission) | ||
| $0 | $0 | $50 copay per day for 1-5 $0 copay per day for 6-90 $0 copay per day for 91+ |
| Lab Services and X-Rays | ||
| $0 | $0 | $0 |
Membership Benefits
Choosing the most convenient health plan is key to your healthcare and wellbeing. LEON health provides many additional benefits that can improve the quality of your life.
