Page 10 - Cover Letter and Medicare Evaluation for Vic Bosiger

Optima AARP Medicare HumanaChoice
Medicare Value Advantage H5216-248

(HMO) Plan 1 (HMO- (PPO)

$0.00 POS) $0.00

Medicare Advantage and $0.00 Medicare Advantage and
drug monthly premium Medicare Advantage and drug monthly premium

drug monthly premium
Outpatient hospital $285 copay per visit In-network: $0-295 In-network: $35-355
coverage copay per visit copay per visit

Out-of-network: 40%

coinsurance per visit

Preventive services $0 copay In-network: $0 copay In-network: $0 copay

Out-of-network: $0
copay or 40%
coinsurance

Extra bene ts

Hearing aids $0 copay In-network: $375-1,425 In-network: $399-699
copay copay

Out-of-network: $399-
699 copay

Preventive dental $0 copay In-network: $0 copay In-network: $0 copay
(like oral exams and Out-of-network: $0 Out-of-network: $0
cleanings)
copay copay

Comprehensive Some coverage Some coverage Not covered
dental (like root canal
and implants)

Eyeglasses (frames & $0 copay In-network: $0 copay In-network: $0 copay
lenses) Out-of-network: $0

copay

Wellness programs Covered Covered Covered
(like tness & nursing
hotline)

Transportation $0 copay In-network: $0 copay Not covered