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PPO Plans
Gives you the freedom to choose any doctor.
Freedom Plan (PPO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $35 |
| Medical Deductible | $750 |
| Maximum Out Of Pocket | $5,900 |
| Part "B" Give Back | NA |
| Over The Counter Items | NA |
| Inpatient Deductible | $300 days 1-5, $0 days 6-90 |
| Outpatient Deductible | $0 ‑ $250 copay |
| Urgent Care | $55 copay |
| Ambulance | $260 copay |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $35/$35 copay |
| Transportation | NA |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $1,500 |
| Vision Coverage | $205 |
| Hearing Coverage | $500 per ear |
| Hot Meal After Hospital Stay | NA |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 0% ‑ 20% coinsurance |
Advantage Choice Plus (PPO)
| Plan Premium | $0 per month |
| Primary Care Physician | $6 copay |
| Specialists | $40 copay |
| Medical Deductible | In-Network: $0 |
| Maximum Out Of Pocket | $7,950 |
| Part "B" Give Back | NA |
| Over The Counter Items | Not Covered |
| Inpatient Deductible | Days 1-6: $390 copay per day |
| Outpatient Deductible | $395 copay |
| Worldwide Emergency | $100 copay |
| Emergency Room | $100 copay per visit |
| Urgent Care | $40 copay per visit |
| Ambulance | $275 copay |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $40 copay |
| Transportation | Not covered |
| Fitness/Gym Equipment | $0 copay for SilverSneakers |
| Dental Coverage | $1,000 annual |
| Vision Coverage | $100 Annual |
| Hearing Coverage | $699 copay per Advanced Aid |
| Hot Meal After Hospital Stay | Not Covered |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 20% of the total cost |
Cigna True Choice Medicare (PPO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $35 copay per visit |
| Medical Deductible | $425 Deductible |
| Maximum Out Of Pocket | $9,350 |
| Part "B" Give Back | NA |
| Over The Counter Items | Not Covered |
| Inpatient Deductible | $255 Copay, D 1-5 |
| Outpatient Deductible | $0 - $275 copay |
| Worldwide Emergency | $100 copay |
| Emergency Room | $110 copay per visit |
| Urgent Care | $30 copay |
| Ambulance | $260 copay per trip |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $35 copay |
| Transportation | Not covered |
| Fitness/Gym Equipment | $0 copay |
| Dental Coverage | $2,000 @ $35 copay |
| Vision Coverage | $300 every year |
| Hearing Coverage | $399 - $1,800 copay |
| Hot Meal After Hospital Stay | $0 copay |
| Worldwide Med Coverage | $110 copay |
| Durable Med Equipment | 20% Coinsurance |
Wellcare Simple Rx Plus Open (PPO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $30 |
| Medical Deductible | Not Covered |
| Maximum Out Of Pocket | $6,000 |
| Part "B" Give Back | $0 |
| Over The Counter Items | NA |
| Inpatient Deductible | $350 co-pay per day for days 1-6 |
| Outpatient Deductible | NA |
| Emergency Room | $125 |
| Urgent Care | $40 |
| Ambulance | $285 |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $40 |
| Transportation | 24 one-way trips every year |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | Covered preventive services ($0 copay) |
| Vision Coverage | $300 eyewear allowance |
| Hearing Coverage | $1,000 per ear |
| Hot Meal After Hospital Stay | $0 - Post-Acute Meals |
Value Plus (PPO)
| Plan Premium | $18 |
| Primary Care Physician | $0 |
| Specialists | $30 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $5,900 |
| Part "B" Give Back | NA |
| Over The Counter Items | $90 quarterly benefit |
| Inpatient Deductible | $420 per day, days 1-6 |
| Outpatient Deductible | $30 ‑ $300 copay |
| Emergency Room | $125 copay |
| Urgent Care | $55 copay |
| Ambulance | $260 |
| Utility / Spend Card | $30 |
| Physical / Occupational Therapy | $40 copay/$40 copay |
| Transportation | NA |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $2,000 |
| Vision Coverage | $290 |
| Hearing Coverage | $500 per ear |
| Hot Meal After Hospital Stay | Not Covered |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 0% ‑ 20% coinsurance |
Wellcare Mutual of Omaha Simple Secure Open (PPO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $35 copay per visit |
| Medical Deductible | Not Covered |
| Maximum Out Of Pocket | $5,900 |
| Part "B" Give Back | NA |
| Over The Counter Items | $30 every quarter |
| Inpatient Deductible | $320 co-pay per day for days 1-5 |
| Outpatient Deductible | NA |
| Emergency Room | NA |
| Urgent Care | Not Covered |
| Ambulance | Not Covered |
| Utility / Spend Card | $30 every quarter |
| Physical / Occupational Therapy | NA |
| Transportation | NA |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | Covered preventive services ($0 copay) |
| Vision Coverage | $100 eyewear allowance |
| Hearing Coverage | $350 per ear |
| Hot Meal After Hospital Stay | Post-Acute Meals |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | NA |
Medicare Value (PPO)
| Plan Premium | $30 |
| Primary Care Physician | $0 |
| Specialists | $40 Copay |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $9,350 |
| Part "B" Give Back | NA |
| Over The Counter Items | NA |
| Inpatient Deductible | NA |
| Outpatient Deductible | NA |
| Emergency Room | $110 copay |
| Urgent Care | $45 copay |
| Ambulance | $300 copay |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $35 copay |
| Transportation | 24 one-way trips every year |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $1,000 |
| Vision Coverage | $190 |
| Hearing Coverage | $500 per ear |
| Hot Meal After Hospital Stay | NA |
| Worldwide Med Coverage | $110 copay |
| Durable Med Equipment | 0% ‑ 20% coinsurance |
Eagle Plan (PPO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | NA |
| Medical Deductible | $4,900 |
| Maximum Out Of Pocket | $5,900 |
| Part "B" Give Back | NA |
| Over The Counter Items | $50 quarterly benefit |
| Inpatient Deductible | $445 per day, days 1-6 |
| Outpatient Deductible | $40 ‑ $395 copay |
| Emergency Room | $125 |
| Urgent Care | $55 |
| Ambulance | $270 in-network |
| Utility / Spend Card | $750 |
| Physical / Occupational Therapy | $45 copay/$45 copay |
| Transportation | NA |
| Fitness/Gym Equipment | Covered @$0 |
| Dental Coverage | $2,000 benefit amount |
| Vision Coverage | $300 benefit amount |
| Hearing Coverage | $1,250 benefit amount |
| Hot Meal After Hospital Stay | $0 for 14 meals over 7 days |
| Worldwide Med Coverage | Covered |
| Durable Med Equipment | 0% ‑ 20% coinsurance |
Advantage Choice Premier (PPO)
| Plan Premium | You pay $95 per month |
| Primary Care Physician | $0 copay |
| Specialists | $35 copay |
| Medical Deductible | $750 |
| Maximum Out Of Pocket | $6,355 |
| Part "B" Give Back | NA |
| Over The Counter Items | Not Covered |
| Inpatient Deductible | Days 1-5: $275 copay per day |
| Outpatient Deductible | $325 copay |
| Worldwide Emergency | $100 copay |
| Emergency Room | $100 copay per visit |
| Urgent Care | $40 copay per visit |
| Ambulance | $275 copay |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $40 copay |
| Transportation | Not covered |
| Fitness/Gym Equipment | $0 copay for SilverSneakers |
| Dental Coverage | $1,000 annual maximum |
| Vision Coverage | $100 Annual eyewear |
| Hearing Coverage | $699 - $999 copay |
| Hot Meal After Hospital Stay | Not Covered |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 20% of the total cost |
Advantage Classic (PPO)
| Plan Premium | You pay $0 per month |
| Primary Care Physician | $0 copay |
| Specialists | $35 copay |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $6,850 |
| Part "B" Give Back | NA |
| Over The Counter Items | $50 quarterly allowance |
| Inpatient Deductible | Days 1-6: $395 copay per day |
| Outpatient Deductible | $375 copay |
| Worldwide Emergency | $110 copay |
| Emergency Room | $110 copay per visit |
| Urgent Care | $40 copay per visit |
| Ambulance | $275 copay |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $40 copay |
| Transportation | Not covered |
| Fitness/Gym Equipment | $0 copay for SilverSneakers |
| Dental Coverage | $1,000 annual maximum |
| Vision Coverage | $125 Annual eyewear |
| Hearing Coverage | $699 - $999 copay |
| Hot Meal After Hospital Stay | 2 meals per day for 7 days |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 20% of the total cost |
Dental Premier (PPO)
| Plan Premium | You pay $0 per month |
| Primary Care Physician | $0 copay |
| Specialists | $42 copay |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $6,700 |
| Part "B" Give Back | NA |
| Over The Counter Items | $35 quarterly allowance |
| Inpatient Deductible | Days 1-6: $380 copay per day |
| Outpatient Deductible | $395 copay |
| Worldwide Emergency | $100 copay |
| Emergency Room | $100 copay per visit |
| Urgent Care | $40 copay per visit |
| Ambulance | $275 copay |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $40 copay |
| Transportation | Not covered |
| Fitness/Gym Equipment | $0 copay for SilverSneakers |
| Dental Coverage | $5,000 annual maximum |
| Vision Coverage | $100 Annual eyewear |
| Hearing Coverage | $699 - $999 copay |
| Hot Meal After Hospital Stay | Not Covered |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 20% of the total cost |
Health Choice (PPO)
| Plan Premium | You pay $0 per month |
| Primary Care Physician | $0 copay |
| Specialists | $40 copay |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $7,900 |
| Part "B" Give Back | NA |
| Over The Counter Items | Not Covered |
| Inpatient Deductible | Days 1-6: $390 copay per day |
| Outpatient Deductible | $395 copay |
| Worldwide Emergency | $110 copay |
| Emergency Room | $110 copay per visit |
| Urgent Care | $45 copay per visit |
| Ambulance | $275 copay copay, one way trip |
| Utility / Spend Card | $1,000 annual benefit |
| Physical / Occupational Therapy | $40 copay |
| Transportation | Not covered |
| Fitness/Gym Equipment | $0 copay for SilverSneakers |
| Dental Coverage | $1,000 annual maximum |
| Vision Coverage | $100 Annual eyewear |
| Hearing Coverage | $699 - $999 copay |
| Hot Meal After Hospital Stay | Not Covered |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 20% of the total cost |
Advantage Optimum (PPO)
| Plan Premium | You pay $142 per month |
| Primary Care Physician | $0 copay |
| Specialists | $25 copay |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $3,850 |
| Part "B" Give Back | NA |
| Over The Counter Items | $50 quarterly allowance |
| Inpatient Deductible | Days 1-6: $195 copay per day |
| Outpatient Deductible | $300 copay |
| Worldwide Emergency | $100 copay |
| Emergency Room | $100 copay per visit |
| Urgent Care | $40 copay per visit |
| Ambulance | $275 copay |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $40 copay |
| Transportation | Not covered |
| Fitness/Gym Equipment | $0 copay for SilverSneakers |
| Dental Coverage | $1,000 annual maximum |
| Vision Coverage | $100 Annual eyewear |
| Hearing Coverage | $699 - $999 copay |
| Hot Meal After Hospital Stay | Not Covered |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 20% of the total cost |
Advantage Protect (PPO)
| Plan Premium | You pay $0 per month |
| Primary Care Physician | $0 copay |
| Specialists | $55 copay |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $6,950 |
| Part "B" Give Back | $40 |
| Over The Counter Items | Not Covered |
| Inpatient Deductible | Days 1-6: $370 copay per day |
| Outpatient Deductible | $375 copay |
| Worldwide Emergency | $110 copay per visit |
| Emergency Room | $110 copay per visit |
| Urgent Care | $40 copay per visit |
| Ambulance | $275 copay |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $40 copay |
| Transportation | Not covered |
| Fitness/Gym Equipment | $0 copay for SilverSneakers |
| Dental Coverage | $1,500 annual maximum |
| Vision Coverage | $100 Annual eyewear |
| Hearing Coverage | $699 copay |
| Hot Meal After Hospital Stay | Not Covered |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 20% of the total cost |
HMO Plans
Allows you to see doctors and other health professionals that participate in its network.
Premier Plan (HMO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $35 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $6,350 |
| Part "B" Give Back | $125 |
| Over The Counter Items | $60 quarterly benefit |
| Inpatient Deductible | $300 per day, days 1‑5 |
| Outpatient Deductible | $35 ‑ $250 copay |
| Emergency Room | $125 copay |
| Urgent Care | $55 copay |
| Ambulance | $290 |
| Utility / Spend Card | $0 |
| Physical / Occupational Therapy | $35 copay/$40 copay |
| Transportation | NA |
| Fitness/Gym Equipment | $0 copay |
| Dental Coverage | $2,500 |
| Vision Coverage | $305 |
| Hearing Coverage | $1,000 per ear |
| Hot Meal After Hospital Stay | NA |
| Worldwide Med Coverage | Plan covers for up to 12 mths |
| Durable Med Equipment | 0% ‑ 20% coinsurance |
Advantage Value (HMO)
| Plan Premium | $0 per month |
| Primary Care Physician | $0 copay Primary Care |
| Specialists | $15 copay Physician Specialist |
| Medical Deductible | NA |
| Maximum Out Of Pocket | $4,100 |
| Part "B" Give Back | NA |
| Over The Counter Items | $25 quarterly allowance |
| Inpatient Deductible | $295 copay (days 1-8) |
| Outpatient Deductible | $250 copay |
| Worldwide Emergency | $135 copay |
| Emergency Room | $135 copay per visit |
| Urgent Care | $40 copay per visit |
| Ambulance | $295 copay for one-way trip |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $35 copay |
| Transportation | 12 one-way trips |
| Fitness/Gym Equipment | Covered @ $0 |
| Dental Coverage | $1,000 annual max |
| Vision Coverage | $150 allowance |
| Hearing Coverage | $699 Advanced |
| Hot Meal After Hospital Stay | Not Covered |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 20% of the total cost |
Cigna Courage Medicare (HMO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $30 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $4,300 |
| Part "B" Give Back | $120 |
| Over The Counter Items | 45 Every 3 Months |
| Inpatient Deductible | $375 Copay per stay |
| Outpatient Deductible | $0-$250 Per Visit |
| Worldwide Emergency | NA |
| Emergency Room | $125 Copay Per Visit |
| Urgent Care | $30 copay |
| Ambulance | $200 copay per trip |
| Utility / Spend Card | $75 every 3Months (Pet) |
| Physical / Occupational Therapy | $30 copay per visit |
| Transportation | $0 copay for 24 one way |
| Fitness/Gym Equipment | $0 copay |
| Dental Coverage | $1,500 @ $30 copay |
| Vision Coverage | $250 every year |
| Hearing Coverage | $399-$1800 copay |
| Hot Meal After Hospital Stay | $0 copay |
| Worldwide Med Coverage | $125 copay |
| Durable Med Equipment | 20% copay |
Wellcare Assist (HMO) Product Space LIS
| Plan Premium | $18 |
| Primary Care Physician | $0 |
| Specialists | $20 |
| Medical Deductible | Not Covered |
| Maximum Out Of Pocket | $3,450 |
| Part "B" Give Back | $0 |
| Over The Counter Items | $75 every quarter |
| Inpatient Deductible | $275 copay, days 1-5 |
| Outpatient Deductible | $0 - $280 |
| Emergency Room | $140 |
| Urgent Care | $25 |
| Ambulance | $250 |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $20/$20 |
| Transportation | 24 one-way trips |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $3,000 |
| Vision Coverage | $200 eyewear allowance |
| Hearing Coverage | $1,000 per ear |
| Hot Meal After Hospital Stay | Post-Acute and Chronic Meals |
Devoted Giveback Greater Houston (HMO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $45 |
| Medical Deductible | NO DEDUCTIBLE |
| Maximum Out Of Pocket | $7,200 |
| Part "B" Give Back | $174.70 |
| Over The Counter Items | NA |
| Inpatient Deductible | $425 Copay Per Day |
| Outpatient Deductible | $525 copay |
| Emergency Room | $110 copay per day |
| Urgent Care in USA | $0 PCP - $45 Copay |
| Urgent Care Worldwide | $110 Copay Per Day |
| Ambulance Ground Worldwide | $375 Copay Per Trip |
| Ambulance Air Worldwide | 20% |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $45 copay |
| Transportation | NA |
| Fitness/Gym Equipment | $0 Deductible Covered |
| Dental & Vision Combined | $250 |
| Vision & Dental Coverage | $250 |
| Hearing Coverage | $599 - $899 Per Ear |
| Hot Meal After Hospital Stay | COVERED |
| Worldwide Med Coverage | $110 Copay Per Stay |
| Durable Med Equipment | 20% COPAY |
Aetna Prime (HMO)
| Plan Premium | $0 |
| Primary Care Physician | $0 copay |
| Specialists | $25 copay |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $3,800 |
| Part "B" Give Back | NA |
| Over The Counter Items | $60 |
| Inpatient Deductible | $150 PER 1-4 DAYS |
| Outpatient Deductible | $25 - $200 copay |
| Emergency Room | $135 |
| Urgent Care | $60 |
| Ambulance | $270 |
| Utility / Spend Card | $45 |
| Physical / Occupational Therapy | $30 |
| Transportation | NA |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $3,500 |
| Vision Coverage | $375 |
| Hearing Coverage | $1,250 |
| Hot Meal After Hospital Stay | NA |
| Worldwide Med Coverage | $135 |
| Durable Med Equipment | 0%-20% |
Advantage Saver (HMO)
| Plan Premium | You pay $0 per month |
| Primary Care Physician | $0 copay |
| Specialists | $28 |
| Medical Deductible | $7,500 |
| Maximum Out Of Pocket | $6,355 |
| Part "B" Give Back | $40 |
| Over The Counter Items | Not Covered |
| Inpatient Deductible | Days 1-6: $370 copay per day |
| Outpatient Deductible | $350 copay |
| Worldwide Emergency | $100 copay |
| Emergency Room | $100 copay per visit |
| Urgent Care | $40 copay / Worldwide $100 copay |
| Ambulance | $275 copay for each one-way trip |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $35 copay |
| Transportation | NA |
| Fitness/Gym Equipment | $0 copay for SilverSneakers |
| Dental Coverage | $1,000 annual maximum coverage |
| Vision Coverage | $100 Annual eyewear |
| Hearing Coverage | $699 copay |
| Hot Meal After Hospital Stay | Not Covered |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 20% of the total cost |
Cigna Preferred Medicare (HMO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $25 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $3,500 |
| Part "B" Give Back | NA |
| Over The Counter Items | $90 PER QUARTER |
| Inpatient Deductible | $350 PER STAY |
| Outpatient Deductible | $0 - $150 copay |
| Worldwide Emergency | NA |
| Emergency Room | $140 Copay per Visit |
| Urgent Care | $25 copay |
| Ambulance | $250 copay per trip |
| Utility / Spend Card | $90 PER QUARTER *** |
| Physical / Occupational Therapy | $25 |
| Transportation | $0 - 50 One Way Trip |
| Fitness/Gym Equipment | Free Gym Or Kit |
| Dental Coverage | $2,450 @ $25 Copay |
| Vision Coverage | $200 |
| Hearing Coverage | $399 - $1,800 Copay |
| Hot Meal After Hospital Stay | $0 copay |
| Worldwide Med Coverage | $140 copay |
| Durable Med Equipment | 20% copay |
Wellcare Simple (HMO) Budget-Friendly
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $15 |
| Medical Deductible | No |
| Maximum Out Of Pocket | $3,500 |
| Part "B" Give Back | $0 |
| Over The Counter Items | $131 every quarter |
| Inpatient Deductible | $325 copay, days 1-6 |
| Outpatient Deductible | $0 - $280 |
| Emergency Room | $140 |
| Urgent Care | $20 |
| Ambulance | $250 |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $15/$15 |
| Transportation | 12 one-way trips |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $3,000 |
| Vision Coverage | $300 eyewear allowance |
| Hearing Coverage | $750 per ear |
| Hot Meal After Hospital Stay | Post-Acute Meals |
Devoted Extra Greater Houston (HMO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $30 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $4,900 |
| Part "B" Give Back | NA |
| Over The Counter Items | $87 PER QUARTER |
| Inpatient Deductible | $325 PER DAY |
| Outpatient Deductible | $0 / $425 Copay |
| Emergency Room | $125 COPAY |
| Urgent Care in USA | $0 PCP - $45 Copay |
| Urgent Care Worldwide | $125 COPAY |
| Ambulance Ground Worldwide | $325 GR, ONE WAY |
| Ambulance Air Worldwide | 20% |
| Utility / Spend Card | $87 Per Mount |
| Physical / Occupational Therapy | $30 - $50 Copay |
| Transportation | NA |
| Fitness/Gym Equipment | FREE GYM/$150 Per year |
| Dental & Vision Combined | $1,000 |
| Vision & Dental Coverage | $1,000 |
| Hearing Coverage | $399 - $699 Per Ear |
| Hot Meal After Hospital Stay | $87 Per Mount |
| Worldwide Med Coverage | $25,000 @ $135 COPAY |
| Durable Med Equipment | 20% COPAY |
Dental Value (HMO)
| Plan Premium | $0.00/mo |
| Primary Care Physician | $0 copay Primary Care |
| Specialists | $29 copay Physician Specialist |
| Medical Deductible | NA |
| Maximum Out Of Pocket | $6,355 |
| Part "B" Give Back | NA |
| Over The Counter Items | $50 quarterly allowance |
| Inpatient Deductible | $370 copay (days 1-6) |
| Outpatient Deductible | $325 copay |
| Worldwide Emergency | $125 copay |
| Emergency Room | $125 copay per visit |
| Urgent Care | $40 copay per visit |
| Ambulance | $275 copay |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $35 copay |
| Transportation | NA |
| Fitness/Gym Equipment | $0 copay for SilverSneakers |
| Dental Coverage | $5,000 annual maximum |
| Vision Coverage | $100 Annual eyewear |
| Hearing Coverage | $699 copay |
| Hot Meal After Hospital Stay | Not Covered |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 20% of the total cost |
Cigna Preferred Savings (HMO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $45 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $6,900 |
| Part "B" Give Back | $125 |
| Over The Counter Items | 55 per 3 Months |
| Inpatient Deductible | $325: 1-6 DAYS |
| Outpatient Deductible | $0-$350 COPAY |
| Worldwide Emergency | NA |
| Emergency Room | $110 COPAY |
| Urgent Care | $35 COPAY |
| Ambulance | $250 COPAY |
| Utility / Spend Card | $55 Every 3 Months |
| Physical / Occupational Therapy | $35 COPAY |
| Transportation | NA |
| Fitness/Gym Equipment | $0 COPAY |
| Dental Coverage | $20,000 @ $45 Copay |
| Vision Coverage | $200 @ $0-45 Copay for Exam |
| Hearing Coverage | $399 - $1,800 Copay |
| Hot Meal After Hospital Stay | $0 copay |
| Worldwide Med Coverage | $110 Copay |
| Durable Med Equipment | 20% Coinsurance |
Wellcare Giveback (HMO) * PUSH
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $50 |
| Medical Deductible | $325 |
| Maximum Out Of Pocket | $6,900 |
| Part "B" Give Back | $113 |
| Over The Counter Items | NA |
| Inpatient Deductible | $395 copay days 1-5 |
| Outpatient Deductible | $0 - $350 |
| Emergency Room | $110 |
| Urgent Care | $30 |
| Ambulance | $265 |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | NA |
| Transportation | NA |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | Covered preventive services ($0 copay) |
| Vision Coverage | $100 eyewear allowance |
| Hearing Coverage | $350 per ear every year |
| Hot Meal After Hospital Stay | NA |
Devoted Core Greater Houston (HMO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $25 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $4,150 |
| Part "B" Give Back | NA |
| Over The Counter Items | $87 per month |
| Inpatient Deductible | $225 Per Day |
| Outpatient Deductible | $0 - $325 Copay |
| Emergency Room | $140 COPAY Per Stay |
| Urgent Care in USA | $0 - $45 Copay |
| Urgent Care Worldwide | $140 copay |
| Ambulance Ground Worldwide | $325 Copay One Way |
| Ambulance Air Worldwide | 20% |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $25 -$50 Copay |
| Transportation | NA |
| Fitness/Gym Equipment | FREE GYM/$150 |
| Dental & Vision Combined | $1,000 |
| Vision & Dental Coverage | $1,000 |
| Hearing Coverage | $0- $299 PER EAR |
| Hot Meal After Hospital Stay | NA |
| Worldwide Med Coverage | $140 Copay Per Stay |
| Durable Med Equipment | 20% COPAY |
Advantage Basic (HMO)
| Plan Premium | You pay $0 per month |
| Primary Care Physician | $0 copay |
| Specialists | $17 copay |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $4,750 |
| Part "B" Give Back | NA |
| Over The Counter Items | $50 quarterly allowance |
| Inpatient Deductible | Days 1-7: $350 copay per day |
| Outpatient Deductible | $325 copay |
| Worldwide Emergency | NA |
| Emergency Room | $125 copay per visit |
| Urgent Care | $40 copay per visit |
| Ambulance | $295 copay for each one-way trip |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $35 copay |
| Transportation | $0 copay. 12 one-way trips |
| Fitness/Gym Equipment | $0 copay for SilverSneakers |
| Dental Coverage | $1,000 annual maximum |
| Vision Coverage | $150 Annual eyewear |
| Hearing Coverage | $699 copay per Advanced Aid |
| Hot Meal After Hospital Stay | Not Covered |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 20% of the total cost |
Cigna Alliance Medicare (HMO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $10 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $3,200 |
| Part "B" Give Back | NA |
| Over The Counter Items | $170 Every 3 Months |
| Inpatient Deductible | $225 Copay Per Stay |
| Outpatient Deductible | $0 - $125 Copay |
| Worldwide Emergency | NA |
| Emergency Room | $140 Copay Per Stay |
| Urgent Care | $10 copay |
| Ambulance | $250 Copay Per Trip |
| Utility / Spend Card | $170 Every 3 Months |
| Physical / Occupational Therapy | $25 Copay Per Visit |
| Transportation | $0 Copay Unlimited Trip |
| Fitness/Gym Equipment | $0 copay |
| Dental Coverage | $2,600 @ $10 Copay |
| Vision Coverage | $400 Yearly @ $10 copay |
| Hearing Coverage | $399 - $1,800 Copay |
| Hot Meal After Hospital Stay | $0 copay |
| Worldwide Med Coverage | $140 copay |
| Durable Med Equipment | 20% copay |
Wellcare Assist (HMO)
| Plan Premium | $18 |
| Primary Care Physician | $0 |
| Specialists | $20 |
| Medical Deductible | NA |
| Maximum Out Of Pocket | $3,450 |
| Part "B" Give Back | $0 |
| Over The Counter Items | $120 every quarter |
| Inpatient Deductible | $275 co-pay per day for days 1-7 |
| Outpatient Deductible | NA |
| Emergency Room | $0 |
| Urgent Care | NA |
| Ambulance | NA |
| Utility / Spend Card | $120 every quarter |
| Physical / Occupational Therapy | NA |
| Transportation | 24 one-way trips every year |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $3,000 |
| Vision Coverage | $300 eyewear allowance |
| Hearing Coverage | $1,000 per ear every year |
| Hot Meal After Hospital Stay | Post-Acute and Chronic Meals |
Devoted Premium Greater Houston (HMO)
| Plan Premium | $7 |
| Primary Care Physician | $0 copay |
| Specialists | $25 copay |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $4,150 |
| Part "B" Give Back | NA |
| Over The Counter Items | NA |
| Inpatient Deductible | $325 copay per day |
| Outpatient Deductible | $425 copay |
| Emergency Room | $140 copay per stay |
| Urgent Care in USA | NA |
| Urgent Care Worldwide | $140 copay per stay |
| Ambulance Ground Worldwide | $325 copay per one-way trip |
| Ambulance Air Worldwide | 20% coinsurance per one-way trip |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $25 copay |
| Transportation | NA |
| Fitness/Gym Equipment | FREE GYM/$150 |
| Dental & Vision Combined | $500 yearly allowance combined |
| Vision & Dental Coverage | $500 yearly allowance combined |
| Hearing Coverage | $199 copay per aid for Advanced Aids |
| Hot Meal After Hospital Stay | NA |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 20% coinsurance all other |
Cigna Preferred Full Savings Medicare (HMO)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $55 Copay Per Visit |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $7,500 |
| Part "B" Give Back | $174.70 |
| Over The Counter Items | $30 Every 3 Months |
| Inpatient Deductible | $340 PER DAY |
| Outpatient Deductible | $0 - $350 Copay |
| Worldwide Emergency | NA |
| Emergency Room | $110 Copay Per Visit |
| Urgent Care | $35 Copay |
| Ambulance | $250 |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $35 Copay |
| Transportation | NA |
| Fitness/Gym Equipment | $0 Copay |
| Dental Coverage | $20,000 @ $55 Copay |
| Vision Coverage | $100 Every year |
| Hearing Coverage | $399 - $1,800 Copay |
| Hot Meal After Hospital Stay | $0 copay |
| Worldwide Med Coverage | $110 Copay |
| Durable Med Equipment | 20% Coinsurance |
HMO (POS) Plans
Wellcare TexanPlus Classic Simple (HMO-POS)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $15 |
| Medical Deductible | NA |
| Maximum Out Of Pocket | $3,400 |
| Part "B" Give Back | $0 |
| Over The Counter Items | $89 every quarter |
| Inpatient Deductible | $325 copay up to 90 days per admission |
| Outpatient Deductible | $0 - $225 |
| Emergency Room | NA |
| Urgent Care | $25 |
| Ambulance | $250 |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $35/$35 |
| Transportation | 24 one-way trips every year |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $2,000 for comp dental services |
| Vision Coverage | $200 eyewear allowance |
| Hearing Coverage | $750 per ear every year |
| Hot Meal After Hospital Stay | Post-Acute and Chronic Meals |
Wellcare TexanPlus Simple (HMO-POS)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $25 |
| Medical Deductible | NA |
| Maximum Out Of Pocket | $3,400 |
| Part "B" Give Back | $0 |
| Over The Counter Items | $81 every quarter |
| Inpatient Deductible | $350 co-pay per day for days 1-6 |
| Outpatient Deductible | NA |
| Emergency Room | NA |
| Urgent Care | NA |
| Ambulance | NA |
| Utility / Spend Card | $81 every quarter |
| Physical / Occupational Therapy | NA |
| Transportation | NA |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $1,000 |
| Vision Coverage | $100 eyewear allowance |
| Hearing Coverage | Routine Exam Only |
| Hot Meal After Hospital Stay | Post-Acute and Chronic Meals |
HMO (D-SNP) Plans
Dual Complete (HMO D-SNP)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $0 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $9,350 |
| Part "B" Give Back | $1 per month |
| Over The Counter Items | Under $90 Extra Supports |
| Inpatient Deductible | $0 |
| Outpatient Deductible | $0 copay |
| Emergency Room | $0 |
| Urgent Care | $45 |
| Ambulance | $0 |
| Utility / Spend Card | $90 Extra Supports Wallet |
| Physical / Occupational Therapy | $0 |
| Transportation | 24 one-way trips every year |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $1,250 benefit |
| Vision Coverage | $255 benefit amount |
| Hearing Coverage | $1,000 benefit |
| Hot Meal After Hospital Stay | 7 DAYS FOR 14 MEALS |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | In-Network $0 |
Advantage Dual Care Plus (HMO D-SNP)
| Plan Premium | $10.80 + Part B Premium |
| Primary Care Physician | 0% - 20% coinsurance |
| Specialists | 0% - 20% coinsurance |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $9,350 |
| Part "B" Give Back | Not covered |
| Over The Counter Items | $250 allowance every 3 months |
| Inpatient Deductible | Same as Original Medicare |
| Outpatient Deductible | 0% or 20% of the total cost |
| Worldwide Emergency | NA |
| Emergency Room | 0% - 20% coinsurance Up to $110 |
| Urgent Care | 0% - 20% coinsurance* - Up to $45 |
| Ambulance | 0% or 20% of the total cost |
| Utility / Spend Card | $100/every quarter Grocery benefit |
| Physical / Occupational Therapy | 0% or 20% of the total cost. |
| Transportation | 24 one-way trips every year |
| Fitness/Gym Equipment | $0 copay for SilverSneakers |
| Dental Coverage | $4,000 annual maximum |
| Vision Coverage | $200 Annual eyewear allowance |
| Hearing Coverage | $2,000 maximum |
| Hot Meal After Hospital Stay | 2 meals a day for 28 days |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 0% or 20% of the total cost |
Cigna TotalCare (HMO D-SNP)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $0 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $3,400 |
| Part "B" Give Back | NA |
| Over The Counter Items | $250 PER QUARTER |
| Inpatient Deductible | $0 Per Admission |
| Outpatient Deductible | $0 for Outpatient Hospital Visit |
| Worldwide Emergency | NA |
| Emergency Room | $0 |
| Urgent Care | $0 |
| Ambulance | $100 Copay Per Trip |
| Utility / Spend Card | $275 Every 3 Months |
| Physical / Occupational Therapy | $0 Copay Per Trip |
| Transportation | $0 Copay 50 One Way trips |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $20,000@ $0 Copay |
| Vision Coverage | $475 Every year |
| Hearing Coverage | $399 - $1800 copay |
| Hot Meal After Hospital Stay | $0 COPAY |
| Worldwide Med Coverage | $140 Copay Per Visit |
| Durable Med Equipment | $0 COPAY |
Dual Preferred ** (HMO D-SNP)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $0 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $9,350 |
| Part "B" Give Back | NA |
| Over The Counter Items | $125 monthly benefit ESW |
| Inpatient Deductible | $0 |
| Outpatient Deductible | $0 |
| Emergency Room | $0 copay |
| Urgent Care | $0 copay |
| Ambulance | $0 copay |
| Utility / Spend Card | $125 monthly benefit |
| Physical / Occupational Therapy | $0 |
| Transportation | NA |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $1,000 |
| Vision Coverage | $325 |
| Hearing Coverage | $2,000 per ear. |
| Hot Meal After Hospital Stay | $0 |
| Worldwide Med Coverage | $100 COPAY |
| Durable Med Equipment | $0 copay |
Wellcare Dual Access (HMO D-SNP) H0174004000
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $30 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $9,350 |
| Part "B" Give Back | NA |
| Over The Counter Items | $125 every month |
| Inpatient Deductible | $0 co-pay up to 90 days per admission |
| Outpatient Deductible | NA |
| Emergency Room | $0 |
| Urgent Care | NA |
| Ambulance | NA |
| Utility / Spend Card | $125 every month |
| Physical / Occupational Therapy | NA |
| Transportation | 60 one-way trips every year |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $3,000 |
| Vision Coverage | $300 eyewear allowance |
| Hearing Coverage | $1,000 per ear every year |
| Hot Meal After Hospital Stay | Post-Acute Meals |
Devoted Dual Plus Greater Houston (HMO D-SNP)
| Plan Premium | $0 to $12.90 |
| Primary Care Physician | $0 copay |
| Specialists | $0 copay |
| Medical Deductible | $0 to $595 |
| Maximum Out Of Pocket | $9,350 |
| Part "B" Give Back | NA |
| Over The Counter Items | $150 per month |
| Inpatient Deductible | $0 copay per stay |
| Outpatient Deductible | $0 copay |
| Emergency Room | $0 copay per stay |
| Urgent Care in USA | $0 copay per stay |
| Urgent Care Worldwide | $0 copay per stay |
| Ambulance Ground Worldwide | $0 copay per one-way trip |
| Ambulance Air Worldwide | $0 copay per one-way trip |
| Utility / Spend Card | $150 per month |
| Physical / Occupational Therapy | $0 copay |
| Transportation | NA |
| Fitness/Gym Equipment | FREE GYM/$150 |
| Dental & Vision Combined | $500 yearly allowance |
| Vision & Dental Coverage | NA |
| Hearing Coverage | $399 copay per aid for Advanced Aids |
| Hot Meal After Hospital Stay | NA |
| Worldwide Med Coverage | NA |
Wellcare Dual Liberty (HMO D-SNP)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $30 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $9,350 |
| Part "B" Give Back | NA |
| Over The Counter Items | $144 every month |
| Inpatient Deductible | $0 co-pay up to 90 days per admission |
| Outpatient Deductible | NA |
| Emergency Room | $0 |
| Urgent Care | NA |
| Ambulance | NA |
| Utility / Spend Card | $144 every month |
| Physical / Occupational Therapy | NA |
| Transportation | 60 one-way trips every year |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $5,000 |
| Vision Coverage | $600 eyewear allowance |
| Hearing Coverage | $1,500 per ear every year |
| Hot Meal After Hospital Stay | Post-Acute Meals |
Wellcare Dual Reserve (HMO D-SNP)
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $25 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $3,450 |
| Part "B" Give Back | NA |
| Over The Counter Items | $75 every month |
| Inpatient Deductible | $200 co-pay per day for days 1-5 |
| Outpatient Deductible | NA |
| Emergency Room | $0 |
| Urgent Care | NA |
| Ambulance | NA |
| Utility / Spend Card | $75 every month |
| Physical / Occupational Therapy | NA |
| Transportation | 60 one-way trips every year |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $3,000 |
| Vision Coverage | $200 eyewear allowance |
| Hearing Coverage | $1,500 per ear every year |
| Hot Meal After Hospital Stay | Post-Acute Meals |
Wellcare Dual Access (HMO D-SNP) H5294015000
| Plan Premium | $0 |
| Primary Care Physician | $0 |
| Specialists | $0 |
| Medical Deductible | $0 |
| Maximum Out Of Pocket | $9,350 |
| Part "B" Give Back | NA |
| Over The Counter Items | $101 every month |
| Inpatient Deductible | $0 co-pay up to 90 days per admission |
| Outpatient Deductible | NA |
| Emergency Room | $0 |
| Urgent Care | NA |
| Ambulance | NA |
| Utility / Spend Card | $101 every month |
| Physical / Occupational Therapy | NA |
| Transportation | 60 one-way trips every year |
| Fitness/Gym Equipment | $0 |
| Dental Coverage | $3,000 |
| Vision Coverage | $400 eyewear allowance |
| Hearing Coverage | $1,000 per ear every year |
| Hot Meal After Hospital Stay | Post-Acute Meals |
Advantage Plans
Kelseycare Advantage Core
| Plan Premium | $0 per month |
| Primary Care Physician | $0 copay |
| Specialists | $20 copay |
| Medical Deductible | NA |
| Maximum Out Of Pocket | $4,500 |
| Part "B" Give Back | NA |
| Over The Counter Items | $25 allowance every 3 months |
| Inpatient Deductible | $325 copay per day for days 1-5 |
| Outpatient Deductible | $300 copay |
| Emergency Room | $125 copay |
| Urgent Care | $25 copay |
| Ambulance | $275 copay for each one-way trip |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | $15 copay/$20 copay |
| Transportation | Not Covered |
| Fitness/Gym Equipment | NA |
| Optional Dental Services | Annual Maximum - $3,000 |
| Medicare Covered Dental Services | $0 copay |
| Dental Coverage | $1,500 annual maximum |
| Vision Coverage | $125 plan |
| Hearing Coverage | $750 maximum |
| Hot Meal After Hospital Stay | NA |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 15%-20% coinsurance |
Kelseycare Advantage Signature
| Plan Premium | $0 per month |
| Primary Care Physician | $0 copay |
| Specialists | $20 copay |
| Medical Deductible | NA |
| Maximum Out Of Pocket | $4,500 |
| Part "B" Give Back | NA |
| Over The Counter Items | $25 allowance every 3 months |
| Inpatient Deductible | $325 copay per day for days 1-5 |
| Outpatient Deductible | $300 copay |
| Emergency Room | $125 |
| Urgent Care | $25 copay |
| Ambulance | $275 copay for each one-way trip |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | NA |
| Transportation | $0 copay for 10 one-way |
| Fitness/Gym Equipment | NA |
| Optional Dental Services | NA |
| Medicare Covered Dental Services | $20 copay |
| Dental Coverage | $2,500 annual maximum |
| Vision Coverage | $125 plan |
| Hearing Coverage | $750 maximum |
| Hot Meal After Hospital Stay | NA |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 15%-20% coinsurance |
Kelseycare Advantage Freedom
| Plan Premium | $0 per month |
| Primary Care Physician | $0 copay |
| Specialists | $35 |
| Medical Deductible | NA |
| Maximum Out Of Pocket | $6,500 |
| Part "B" Give Back | NA |
| Over The Counter Items | $25 allowance every 3 months |
| Inpatient Deductible | $375 copay |
| Outpatient Deductible | $350/per stay |
| Emergency Room | $125 |
| Urgent Care | $40 copay |
| Ambulance | $275 copay for each one-way trip |
| Utility / Spend Card | NA |
| Physical / Occupational Therapy | NA |
| Transportation | $0 copay for 10 one-way |
| Fitness/Gym Equipment | NA |
| Optional Dental Services | NA |
| Medicare Covered Dental Services | $35 copay |
| Dental Coverage | $2,000 annual maximum |
| Vision Coverage | $175 plan coverage limit for eyewear |
| Hearing Coverage | $750 per ear every 3 years |
| Hot Meal After Hospital Stay | NA |
| Worldwide Med Coverage | NA |
| Durable Med Equipment | 15% to 20% of the total cost |
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