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Medical Benefits and Costs

  • PHP (HMO SNP) covers the medical services listed below at the specified cost sharing. For more details about the coverage and costs for these services, see Chapter 4, Medical Benefits Chart (what is covered and what you pay), in your 2024 Evidence of Coverage.

    Benefit

    Original Medicare

    PHP

    Acupuncture

    Not covered.

    $0 copay for Medicare-covered acupuncture services for chronic low back pain.

     

    Up to 12 visits in 90 days are covered for Medicare beneficiaries under the following circumstances:

     

    For the purpose of this benefit, chronic low back pain is defined as:

    •    Lasting 12 weeks or longer;

    •    nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory or infectious disease, etc.);

    •    not associated with surgery;  and

    •    not associated with pregnancy.

    Dental Services

    Preventive dental services (such as cleaning) not covered.

    $0 copay for Medicare covered preventive dental services such as oral exams, cleanings, fluoride treatments and dental x-rays, and other dental services.

    In addition to the preventive services above, plan covers up to $1,200 a year for comprehensive dental services such as non-routine, diagnostic, and restorative services; endodontics, periodontics, and extractions; and prosthodontics, oral and maxillofacial surgery, etc.

    Health and Wellness

    Supplemental health and wellness programs not covered.

    The Health and Wellness Benefit is not covered. The gym membership and over-the-counter (OTC) pharmacy benefits are decoupled so you receive both a gym membership and OTC pharmacy benefits.

    $0 copay for access to 24 hour nurse hotline.

    Hearing Services

    Supplemental routine hearing exams and hearing aids not covered.

    $0 copay for a routine hearing exam every year.

    $0 copay for up to 2 hearing aids every year including a fitting evaluation.

    Plan covers up to $2,500 a year for hearing aids.

    In-Home Support Services (IHSS)

    Not covered.

    $0 copay for up to 16 hours a week of IHSS for up to 2 weeks per year. IHSS include personal care and domestic services. IHSS are available to members after discharge from an acute hospital or skilled nursing facility.

    Meal Benefit

    Not covered.

    $0 copay for up to 2 meals per day for up to 28 days. (56 meal limit per year.) Meal benefit is available to members post-inpatient discharge from an acute hospital or skilled nursing facility and members who have a chronic condition or other medical condition that prevents leaving the home to grocery shop. Meals may be provided in multiple increments through the year up to the 56-meal limit for the year.

    Non-Emergency Transportation

    Not covered.

    $0 copay for unlimited round trips to plan-approved locations every year.

    Therapeutic Massage

    Not covered.

    $0 copay for up to 2 therapeutic massages per month for members diagnosed with AIDS-related neuropathy.

    Vision Services

     Supplemental routine eye exams and glasses not covered.

    $0 copay for one routine eye exam every year.

    $0 copay for glasses, lenses or contacts.

    Plan covers up to $250 a year for eye wear.

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    Page Updated: April 4, 2024 @ 7:09pm