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.