Medicare Advantage HMO Plans

A healthy mouth is a sign of a healthy body. Researchers have found that periodontitis is linked with other health problems, like cardiovascular disease, stroke and bacterial pneumonia (American Dental Association).

Frequency of preventive dental benefits vary based on service.

Dental Coverage Overview

CareFirst BlueCross BlueShield Core (HMO)	CareFirst BlueCross BlueShield Enhanced (HMO)
You pay $40.00 copay for each Medicare-covered dental benefit.	You pay $20.00 copay for each Medicare-covered dental benefit.
Our plan also covers preventive dental services:	Our plan also covers preventive dental services:
You pay a $10.00 copayment for oral exams, frequencies vary based on service	You pay a $5.00 copay for oral exams, frequencies vary based on service
You pay a $10.00 copay for prophylaxis (cleaning), frequencies vary based on service	You pay a $5.00 copay for prophylaxis (cleaning), frequencies vary based on service
You pay a $10.00 copay for fluoride treatment, frequencies vary based on service	You pay a $5.00 copay for fluoride treatment, frequencies vary based on service
You pay a $10.00 copay for dental x-rays, frequencies vary based on service	You pay a $5.00 copay for dental x-rays, frequencies vary based on service
There are no additional comprehensive dental services covered in this plan.	Our plan also covers additional comprehensive dental services with a maximum allowance of $800.00 in a calendar year:
	You pay a $15.00 to $30.00 copay for non-routine services
	You pay a $15.00 to $500.00 for restorative services
	You pay a $50.00 to $300.00 copay for periodontics
	You pay a $40.00 to $100.00 copay for extractions
	You pay a $100.00 to $200.00 copay for endodontics
	You pay a $30.00 to $700.00 copay for prosthodontics other oral/maxillofacial surgery

Our routine eye exam coverage includes dilation and refraction from a Davis Vision provider.

The Davis Vision network includes Visionworks, Target, Walmart, Costco, MyEyeDr. and Pearle Vision as well as hundreds of independent providers.

Core Plan: $20 copay per eye exam

Enhanced Plan: $10 copay per eye exam

Frames: Select frames purchased from Davis Vision's exclusive collection are covered in full. Our Core plan also covers up to $75 and our Enhanced plan covers up to $150 for any other frames annually.

Lens: Single Vision, bifocal, trifocal and lenticular lenses have a $20 copay for each type of lenses annually for the Core plan and $10 copay for the Enhanced plan.

Contacts: If contact lenses are medically necessary, they'll be covered in full. Our plan also covers up to $100.00 for elective contact lenses annually for Core plan members and $200.00 for elective contact lenses annually for Enhanced plan members. Contact lens evaluation and fitting is not covered for Core plan member and are covered up to $60 for Enhanced plan members.

One in three people between 65 and 74 has hearing loss (NIH). NationsHearing offers better hearing solutions for the best price. They've simplified the process so you can test your hearing from home using your computer or phone. NationsHearing is a national network of more than 8,000 locations.

Hearing Coverage Overview

	Core Plan	Enhanced Plan
Copay for annual routine hearing exam	$0.00	$0.00
Copay for annual fitting/evaluation for hearing aid(s)	$0.00	$0.00
Copay for one hearing aid, based on technology level	$475.00-$1,950.00	$400.00-$1,875.00

SilverSneakers can help you live a healthier, more active life through fitness and social connection. Your membership includes a free gym membership, which gives you access to thousands of gym locations nationwide.

Fitness Classes

SilverSneakers has fitness classes for all fitness levels, led by trained instructors.

Online Resources

Can't get to the gym or feel safer working out at home? Create an online account to enjoy SilverSneakers On-Demand workout videos from home, LIVE Classes and Workshops and more through SilverSneakers.com and the SilverSneakers GO app. Plus, you can sign up for a home fitness kit.

Make New Connections

Meet people at events like shared meals and holiday celebrations.

Once each year, you're covered for a free wellness exam through your primary care physician (PCP). This important annual exam helps you stay on top of your health by checking up on any existing conditions and getting ahead of any new physical or cognitive diseases or disabilities. Use this time to discuss any health concerns with your PCP. They can help you build a healthcare plan that works for you.

You pay a $0.00 copayment.

Registered nurses are available 24/7 to discuss your symptoms with you and recommend the most appropriate care. Call 833-968-1773 anytime to speak with a nurse. All available with a $0 copay.

The Nurse Advice Line can help you:

• Decide when to visit your doctor or go to an Urgent Care or ER
• Understand your medications
• Find network doctors and prepare for an appointment
• Learn about preventive care

Onduo helps members manage diabetes through a personalized care program. The program offers the day-to-day support you need between doctor visits. Members who enroll get access to the following no-cost benefits:

• Virtual clinics with primary care providers and specialists
• Continuous glucose monitors (CGMs) for eligible members
• Blood pressure cuffs for eligible members
• Additional diabetic supplies such as test strips and lancets
• Health and lifestyle coaching and support
• Services and access through an easy-to-use app

Get Personalized Care Coordination and Assistance through Your Health Plan!

As a valued member, your plan includes the option for you to have a comprehensive health assessment in the comfort of your own home. This benefit is available at no cost through Porter Health, a leader in providing home and telehealth (online) visits.

Care Comes to You

• Initially, a Care Guide will reach out to you by phone. Then they’ll arrange an in-home visit with a licensed health care practitioner. During the visit, you’ll receive a thorough health evaluation including lab work and screenings for diabetes, colon cancer, and kidney and vascular diseases. They’ll review your medical history and medications and answer any questions you may have.

Care Coordination

• As a valued member, you can opt into the Porter Care coordination. This service provides valuable assistance getting the most out of your care. Porter Care can help you schedule appointments or arrange transportation, get lower cost medications or medical equipment, and provide nutrition recommendations to improve your overall health.

Your in-home assessment does not replace your yearly visit with your PCP. Both you and your PCP will receive a Clinical Visit Summary report that summarizes the results of your assessment. This will help you have an informed discussion at your annual check-up or next PCP visit.

Learn more: Member Information - Porter (helloporter.com)

You pay no co-pay. The visit is covered 100%.