Medicare Plus Dual Eligible Benefits at a Glance
- 2008
| Monthly Premium | $1.40 (paid for by Medicare subsidy) |
| Maximum Out-Of-Pocket Limit (MOOP) | N/A |
| In-Patient Hospital | $0 |
| Skilled Nursing Facility | $0 (100 days per benefit period) |
| Home Health | $0 |
| Hospice | $0 |
| Office Visit | $0 primary care / $0 specialty care |
| Chiropractic Services - Medicare | $0 for each Medicare-covered visit (manual manipulation of the spine) |
| Chiropractic Services - Routine | $0 for up to 12 routine visits per year |
| Podiatry Services - Medicare | $0 for each Medicare-covered visit (medically-necessary foot care) |
| Podiatry Services - Routine | $0 for up to 12 routine visits per year |
| Outpatient Mental Health Care | $0 for each Medicare-covered individual/group therapy visit |
| Outpatient Substance Abuse Care | $0 for each Medicare-covered individual/group visit |
| Outpatient Services / Surgery | $0 for each Medicare-covered ambulatory surgical center visit or outpatient hospital facility visit |
| Ambulance | $0 |
| Emergency Care | $50 for each Medicare-covered ER visit($0 if admitted to the hospital within 24 hours for the same condition) |
| Urgent Care | $0 for each Medicare-covered urgently needed visit |
| Outpatient Rehabilitation Services | $0 for each Medicare-covered visit for occupational, physical, speech or language therapy |
| Durable Medical Equipment | 20% of the cost for each Medicare-covered item |
| Prosthetic Devices | 20% of the cost for each Medicare-covered item |
| Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies | $0 for diabetes self-monitoring training $0 for nutrition therapy for diabetes $0 diabetes supplies |
| Diagnostic Tests, X-Rays, and Lab Services | $0 for Medicare-covered diagnostic procedures and tests $0 for Medicare-covered x-rays $0 for Medicare-covered |
| Radiation Therapy | $0 |
| Preventive Services | |
Bone Mass Measurement |
$0 |
Colorectal Screening Exams |
$0 |
Immunizations (Pneumonia, Flu, Hepatitis B vaccine) | $0 |
Mammograms | $0 |
Pap Smears and Pelvic Exams |
$0 |
Prostate Cancer Screening Exams |
$0 |
| End-Stage Renal Disease | $0 for in and out-of-area dialysis $0 for nutrition therapy for renal disease |
| Dental Services (See Evidence of Coverage for more information about the comprehensive dental benefits) |
In general, preventive dental benefits (such as cleaning) not covered; $0 for Medicare-covered dental benefits |
| Hearing Services | $0 for diagnostic hearing exams |
| Vision Services | $0 for each Medicare-covered eye exam (diagnosis and treatment for diseases and conditions of the eye); routine eye exams covered by Medi-Cal only |
| Eyewear Benefit | $0 for one pair of eyeglasses or contact lenses after each cataract surgery; other eyewear covered by Medi-Cal only |
| Physical Exams | $0 for routine exams, limited to one exam every year |
| Health / Wellness Education | $0 for written health education materials, including newsletters |
| Prescription Drugs | |
| Medicare Part B | $0 for Part-B covered drugs; $0 for chemotherapy drugs |
| Medicare Part D | |
Deductible | $0 - $56 yearly deductible (amount depends on income) |
30-Day Supply - Generic | $0 - $2.25, or 15% coinsurance (depending on income) |
30-Day Supply - Brand | $0 - $5.60, or 15% coinsurance (depending on income) |
90-Day Supply Retail Pharmacy - Generic | $0 - $2.25, or 15% coinsurance (depending on income) |
90-Day Supply Retail Pharmacy - Brand | $0 - $5.60, or 15% coinsurance (depending on income) |
90-Day Supply Mail-order Pharmacy - Generic | $0 - $2.25, or 15% coinsurance (depending on income) |
90-Day Supply Mail-order Pharmacy - Brand | $0 - $5.60, or 15% coinsurance (depending on income) |
Injectables and Specialty Drugs |
$0 - $5.60 |
Coverage Gap |
Not applicable to this plan |
Catastrophic coverage (based on out-of-pocket drug costs) | After yearly drug costs reach $4,050, you pay $0 for your drugs. |