2022 Lycoming Tioga MA Kit

UPMC for Life HMO No Rx (HMO) $0 per month No prescription drug coverage $0 per visit $45 per visit PCP: $0 per visit; Specialist: $40 per visit $300 per stay $225 per surgery $0 per day (days 1-20); $80 per day (days 21-100) $90 per visit $50 per visit $40 per visit $5 per day per facility $30 per service $110 per service 20% of the cost per item 20% of the cost per item No deductible $7,550 for Medicare-covered services, including copays and coinsurance $0 for one hearing exam per year; $0 for one hearing aid fitting per year; $500 allowance for hearing aids per year $0 for two oral exams and cleanings per year; $0 for one bitewing x-ray per year; $0 for one panoramic x-ray every 36 months; $200 allowance for dental services like fillings and simple tooth extractions per year $0 for one routine vision exam every two years; $150 allowance for contact lenses or eyewear (all lens types) every two years $50 allowance per quarter