Preventive Dental Coverage
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).
Our preventive dental benefit covers oral exams, cleanings, fluoride treatment and dental X-rays twice a calendar year.
| 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 $30.00 copayment for oral exams, limit 2 per year | You pay a $20.00 copay for oral exams, limit 2 per year |
| You pay a $30.00 copay for prophylaxis (cleaning), limit 2 per year | You pay a $20.00 copay for prophylaxis (cleaning), limit 2 per year |
| You pay a $30.00 copay for fluoride treatment, limit 2 per year | You pay a $20.00 copay for fluoride treatment, limit 2 per year |
| You pay a $30.00 copay for dental x-rays, limit 2 per year | You pay a $20.00 copay for dental x-rays, limit 2 per year |
| There are no additional comprehensive dental services covered in this plan. | Our plan also covers additional comprehensive dental services: |
| You pay a $20.00 copay for non-routine services | |
| You pay a $15.00 to $30.00 for restorative services | |
| You pay a $50.00 to $60.00 copay for periodontics | |
| You pay a $40.00 to $50.00 copay for extractions |
- The maximum copayment that Medicaid may charge is based on what the state pays for that service, as described in the following table. These amounts are updated annually to account for increasing medical care costs. FY 2013 Maximum Nominal Deductible and Managed Care Copayment Amounts. Deductible $2.65; Managed Care Copayment $4.00.
- Visit an urgent care center for a minor illness or injury can gain special savings. There are often lower copays for the same services at urgent care centers compared with an ER. If you don’t have medical coverage, many urgent care locations offer discounts or savings on select services.
. Worldwide emergency, urgent care and transportation coverage. Aid fitting and evaluation every three years. $0 to $45 copay for one routine hearing exam each year. $0 to $45 copay for Medicare-covered diagnostic hearing exams. New standard hearing aids every three years. We'll cover up to $750 per ear. Urgent Care Center $35 copay. $30 copay per evaluation; up to 2 per year. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. Free-standing Cardiac Rehabilitation Center Visit: $20 Copayment. Urgent Care Center: $20 Copayment. Contraceptive Drugs and Devices when dispensed in a doctor's office: $20 Copayment. (in addition to any copayment(s) due for Office Visit/Office Surgery and Radiology/Laboratory Tests).
Dental and Vision Add-On
Available with CareFirst BlueCross BlueShieldAdvantage Enhanced Only
CareFirst knows the value of good vision and a healthy smile. That’s why, for individuals looking for comprehensive dental and vision, we offer the Dental and Vision Add-On for an additional low monthly premium.
This package adds comprehensive dental services beyond the services already covered by the Enhanced plan—including non-routine dental services, major restorative services, endodontics, surgical periodontics, surgical extractions, prosthodontics and other oral/maxillofacial surgery services to keep your smile at its best. Our plan has a maximum coverage amount of $1,000 per year total for the additional dental services. Additional allowances for frames and contact lenses gives you the freedom to choose a look that fits your style.
| Featured Dental Benefit Copays | Featured Vision Benefit Copays |
|---|---|
| Non-Routine Services—$15.00 | Additional Money Toward Your Frames—$100.00 |
| Major Restorative Services—$15.00–$500.00 | Additional Money Toward Your Contacts—$100.00 |
| Endodontics—$100.00–$200.00 | Allowance Toward Contact Lens Evaluation—$60.00 |
| Surgical Periodontics—$100.00–$300.00 | |
| Surgical Extractions—$100.00 | |
| Prosthodontics and Other Oral/Maxillofacial Surgery Services—$40.00–$700.00 |
Routine Eye Exams and Eyewear Coverage
Good vision is not just crucial to your overall health—good vision also affects your quality of life. 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.
Core Plan: $20 copay per eye exam
Enhanced Plan: $10 copay per eye exam
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Select frames purchased from Davis Vision's exclusive collection are covered in full. Our plan also covers up to $75 for any other frames annually.
Single Vision, bifocal, trifocal and lenticular lenses have a $20 copay for each type of lenses annually.
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 $125.00 for elective contact lenses annually for Enhanced plan members. Contact lens evaluation and fitting is not covered.
Hearing Exams and Hearing Aids Coverage
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.
| 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 | $475.00-$1,950.00 | $400.00-$1,875.00 |
| Copay for two hearing aids | $975.00-$3,925.00 | $900.00-$3,850.00 |
24-Hour Nurse Advice Line
Urgent Care For Medicare Patients
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
CareFirst Video Visit
CareFirst BlueCross BlueShield’s Video Visit allows members to securely connect with a doctor anytime day or night through your phone, tablet or computer. Get treatment for urgent care services like bronchitis, sinus infections, rashes or flu. Members can also make a Video Visit appointment for behavioral health support with a therapist or psychiatrist. You can even get prescriptions sent to your local pharmacy.
Convenience doesn’t mean extra fees—you’ll pay the same amount as your Urgent Care copay, never exceeding the costs listed below:
Urgent Care
Core: Copay no greater than $30 per Medicare-covered urgent care video visit.
Enhanced: $20 copay per Medicare-covered urgent care video visit.
Behavioral Health Visit Costs
Core: Copay no greater than $40 per Medicare-covered mental health session.
Enhanced: $20 copay per Medicare-covered individual mental health session.
SilverSneakers
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
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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.
Annual Wellness Exam
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.
Worldwide Emergency/Urgent Care Coverage
In the event of an emergency, please get the care you need no matter where you are. That means you may have to visit a non-participating provider or one that doesn’t accept Medicare. It may also mean paying more out-of-pocket or even the full bill. But your health is too important to delay or ignore getting the care you need. You plan includes worldwide coverage for emergency room and urgent care visits.
$90.00 copay for each Medicare-covered emergency care visit.
Copayment waived if admitted to the hospital within 24 hours.
Worldwide emergency coverage also covered. You pay a $90.00 copayment. Copayment is not waived if admitted to the hospital.
In-Home Assessment
Medicare Urgent Care Copay Insurance
The In-Home Assessment is an annual in-home clinical assessment, kind of like a physical. By removing transportation barriers, we've created an easy and effective way for you to gain a more complete picture of your health.
Aetna Insurance Urgent Care Copay
You pay a $ 0.00 copayment.