2022 Beaver Butler Washington MA Kit

UPMC for Life HMO No Rx (HMO) MC for Life HMO Salute (HMO) $0 per month $0 per month; $50 Part B premium reduction per month No prescription drug coverage escription drug coverage $0 per visit $20 per visit $45 per visit $50 per visit PCP: $0 per visit; PCP: $15 per visit; Specialist: $40 per visit Specialist: $45 per visit $300 per stay $250 per day (days 1-7); $0 per day (days 8-90) $225 per surgery 5 per surgery $0 per day (days 1-20); $0 per day (days 1-20); $80 per day (days 21-100) $184 per day (days 21-100) $90 per visit $90 per visit $50 per visit $50 per visit $40 per visit $40 per visit $5 per day per facility $5 per day per facility $30 per service $30 per service $110 per service $250 per service 20% of the cost per item 20% of the cost per item 20% of the cost per item 20% of the cost per item No deductible No deductible $7,550 for Medicare-covered services, including 00 for Medicare-covered services, including copays and coinsurance s and coinsurance $0 for one hearing exam per year; or one hearing exam per year; $0 for one hearing aid fitting per year; or one hearing aid fitting per year; $500 allowance for hearing aids per year 000 allowance for hearing aids per year $0 for two oral exams and cleanings per year; or two oral exams and cleanings per year; $0 for one bitewing x-ray per year; or one bitewing x-ray per year; $0 for one panoramic x-ray every 36 months; or one panoramic x-ray every 36 months; $200 allowance for dental services like fillings and simple tooth extractions per year 000 maximum comprehensive dental allowance with $50 deductible and 50% coinsurance per year $0 for one routine vision exam every two years; or one routine vision exam per year; $150 allowance for contact lenses or eyewear (all lens types) every two years $300 allowance for contact lenses or eyewear (all lens types) ear $50 allowance per quarter $50 allowance per quarter Not covered overed