PHP (HMO SNP)

Benefit

Original Medicare

PHP 2026

PHP 2027

Acupuncture

Not covered.

$0 copay for up to 2 acupuncture visits per month.

$0 copay for up to 2 acupuncture visits per month.

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 $1,550 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.

$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 $1,550 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.

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 prescription or over-the-counter hearing aids.

$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 prescription or over-the-counter hearing aids.

Home and bathroom safety devices and modifications

Not covered.

$0 copay for covered home and bathroom safety devices and modifications up to the $5,000 annual limit.

$0 copay for covered home and bathroom safety devices and modifications up to the $5,000 annual limit.

In-Home Support Services

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.

$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.

$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 24 round trips to plan-approved locations every year.

$0 copay for 24 round trips to plan-approved locations every year.

Special Supplemental Benefits for the Chronically Ill

The benefits mentioned here are a part of special supplemental program for the chronically ill. Not all members qualify.

Not covered.

For members who have been diagnosed with AIDS-related neuropathy, you pay nothing for up to two (2) one (1)-hour therapeutic massages per month to increase blood circulation.  Referral and authorization required.

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For members who have been diagnosed with diabetes, you pay nothing for up to two (2) diabetic meals per day.  Nutritious diabetic meals help members who have diabetes and do not have access to appropriate food to manage and control their disease.  Referral and authorization required.

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For members who have been diagnosed with congestive heart failure (CHF), you pay nothing for up to two (2) low-sodium meals per day.  Nutritious low-sodium meals help enrollees who have CHF and do not have access to appropriate food to manage and control their disease.  Referral and authorization required.

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For members who have been diagnosed with asthma or chronic pulmonary conditions and live in a residence that is infested with cockroaches, mice or rats, you pay nothing for pest control services up to the annual benefit limit of $1,000.  Pest control for individuals who have asthma and other chronic pulmonary diseases reduces asthma symptoms.  Referral and authorization required.

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For members who have been diagnosed with asthma or chronic pulmonary conditions and live in an environment whose air quality contributes to asthma and breathing problems, you pay nothing for an air filter device(s) and filter replacements up to the annual benefit limit of $200.  An air filter for individuals who have asthma and other chronic pulmonary diseases reduces asthma symptoms.  Referral and authorization required.

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For members who need daily living assistance and hygiene support and are unable to do their own laundry, you pay nothing for laundry service up to the monthly benefit limit of $156.  Authorization required.

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For members who have a medical plan of care for complex diagnoses such as cancer, end-stage renal disease, mental illness/cognitive impairment, wound management, etc. that requires multiple and frequent transportation to and from providers and facilities, you pay nothing for unlimited transportation.  Plan must authorize and book transportation and will verify that transportation requested is to and from provider offices or facilities.

For members who have been diagnosed with AIDS-related neuropathy, you pay nothing for up to two (2) one (1)-hour therapeutic massages per month to increase blood circulation.  Referral and authorization required.

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For members who have been diagnosed with diabetes, you pay nothing for up to two (2) diabetic meals per day.  Nutritious diabetic meals help members who have diabetes and do not have access to appropriate food to manage and control their disease.  Referral and authorization required.

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For members who have been diagnosed with congestive heart failure (CHF), you pay nothing for up to two (2) low-sodium meals per day.  Nutritious low-sodium meals help enrollees who have CHF and do not have access to appropriate food to manage and control their disease.  Referral and authorization required.

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For members who have been diagnosed with asthma or chronic pulmonary conditions and live in a residence that is infested with cockroaches, mice or rats, you pay nothing for pest control services up to the annual benefit limit of $1,000.  Pest control for individuals who have asthma and other chronic pulmonary diseases reduces asthma symptoms.  Referral and authorization required.

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For members who have been diagnosed with asthma or chronic pulmonary conditions and live in an environment whose air quality contributes to asthma and breathing problems, you pay nothing for an air filter device(s) and filter replacements up to the annual benefit limit of $200.  An air filter for individuals who have asthma and other chronic pulmonary diseases reduces asthma symptoms.  Referral and authorization required.

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For members who need daily living assistance and hygiene support and are unable to do their own laundry, you pay nothing for laundry service up to the monthly benefit limit of $156.  Authorization required.

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For members who have a medical plan of care for complex diagnoses such as cancer, end-stage renal disease, mental illness/cognitive impairment, wound management, etc. that requires multiple and frequent transportation to and from providers and facilities, you pay nothing for unlimited transportation.  Plan must authorize and book transportation and will verify that transportation requested is to and from provider offices or facilities.

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For members who need daily living assistance, you pay nothing for personal emergency response system (PERS).  Authorization required.

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For members who have been diagnosed with HIV, you pay nothing for up to $90 per month for healthy foods and groceries.  Plan provides benefit through a debit card that will be loaded with $90 every month.  Any unused balance will expire December 31, 2027, or the last day of the month of your enrollment if you disenroll before the end of the year.

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 $400 a year for eye wear.

$0 copay for one routine eye exam every year.

$0 copay for glasses, lenses or contacts.

Plan covers up to $400 a year for eye wear.