AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS) H0609-012-000 Plan Details & Costs 2023 (2023)

Visit to the doctor's office:
Co-payment for attending primary care$ 0,00

Specialist visit:
Co-payment for visiting a specialized doctor's office$ 10,00
Prior approval is required for specialist visits
A referral is required to see a specialist

Services in the acute hospital:
$ 225,00per day for days 1 to 5
$ 0,00per day for days 6 to 90
Prior approval is required for acute hospital services
A referral is required for acute hospital services

Worldwide Coverage:
Co-payment for Global Urgent Coverage$ 0,00

Worldwide Coverage:
Co-pay for global emergency response$ 0,00
Co-payment for worldwide emergency transport$ 0,00

Ambulance on the ground:
Co-payment for ground rescue services$ 250,00

Ambulance:
Co-payment for air ambulance services$ 250,00

Section B - General 10a Notice - AUTHORIZATION NOTE: Authorization is required for ground and air ambulance services not covered by Medicare. Ambulances do not require a permit. Section B - General 10a Note - REFERRAL NOTE: References are required for non-Medicare ground and air ambulances. The ambulance does not require a referral.
See the Proof of Coverage for pre-approval rules

Chiropractic Services:
Co-payment for Medicare-covered chiropractic services$ 10,00
Regular care co-payment$ 10,00

• Maximum 12 routine care per year

Care and services for diabetics:
Co-payment for Medicare-covered diabetic items$ 0,00
Co-insurance for shoes or therapeutic insoles for Medicare-insured diabetics20%
Prior approval is required for supplies and services to diabetics

Durable Medical Equipment:
Co-insurance for Medicare-covered long-life medical devices20%
Prior approval is required for long-life medical devices

Outpatient diagnostics/tests/laboratory services:
Co-payment for Medicare-covered diagnostic procedures/tests$ 25,00
Co-payment for Medicare-covered laboratory services$ 0,00
Prior approval is required for outpatient diagnostic laboratory procedures/tests/services
Required referral for outpatient diagnostic procedures/tests/laboratories

Outpatient diagnostics/therapeutic radiation therapy:
Co-payment for Medicare-covered diagnostic radiology services$ 0,00for$ 85,00
Co-payment for Medicare-covered therapeutic radiology services$ 60,00
Co-payment for Medicare-covered X-ray services$ 15,00
Prior approval required for ambulatory diagnostic/therapeutic radar services
Required referral to outpatient diagnostic/therapeutic radiotherapy services

General Practitioner Services:
Co-payment for Medicare-covered home healthcare services$ 0,00
Prior approval is required for home health care
Necessary referral to GP services

Psychiatric hospital services:
$ 225,00per day for days 1 to 5
$ 0,00per day for days 6 to 90
Prior approval is required for psychiatric hospital services
Necessary referral to psychiatric hospital services

Outpatient psychiatric services:
Co-payment for individual sessions covered by Medicare$ 25,00
Co-payment for Medicare-covered group sessions$ 15,00
Prior approval is required for outpatient mental health services
Required referral to outpatient mental health services

Outpatient hospital services:
Co-payment for Medicare-covered outpatient hospital services$ 0,00for$ 200,00
Prior approval is required for outpatient hospital services
A referral is required for outpatient hospital services

Ambulatory Observation Services:
Co-payment for Medicare-covered monitoring services - per day$ 200,00
Prior approval required for ambulatory observation services
Necessary referral to outpatient observation services

Ambulatory surgery center services:
Co-payment for outpatient surgery center services$ 0,00for$ 125,00
Prior approval is required for outpatient surgical center services
Necessary referral to outpatient surgical centers

drug ambulances:
Co-payment for individual sessions covered by Medicare$ 25,00
Co-payment for Medicare-covered group sessions$ 15,00
Prior approval is required for outpatient substance abuse services
Required referral to outpatient addiction support services

Over-the-counter (OTC) Artikel:
Co-payment for over-the-counter (OTC) items$ 0,00
Maximum benefit of the plan$ 60,00every three months
Nicotine Replacement Therapy (NRT) offered as an OTC Part C service

Podiatry services:
Co-payment for Medicare-covered podiatry services$ 10,00
Co-payment for routine foot care$ 10,00

• Maximum 6 visits per year

Qualified care service:
$ 0,00per day during days 1 to 20
$ 196,00per day during days 21 to 38
$ 0,00per day for days 39 to 100
Prior approval is required for specialized care facilities
Required referral to qualified care facilities

Preventive Dentistry:
Additional payment for oral exams$ 0,00

• Maximum 2 visits per year

• Maximum 3 visits per year

• Maximum 2 visits per year

• Maximum 1 visit (see proof of cover for details)

Comprehensive Dentistry:
Co-insurance for Medicare-covered services20%
Co-payment for non-routine services$ 0,00
Co-payment for diagnostic services$ 0,00

• Maximum 1 visit (see proof of cover for details)

• Maximum 1 visit (see proof of cover for details)

• Maximum 1 visit (see proof of cover for details)

• Maximum 1 visit (see proof of cover for details)

• Maximum 1 visit (see proof of cover for details)

• Maximum 1 visit (see proof of cover for details)

eye exams:
Co-payment for Medicare-covered benefits$ 0,00
Co-payment for routine eye exams$ 0,00

• Maximum 1 routine eye exam per year

Glasses:
Co-payment for Medicare-covered benefits$ 0,00
Supplement for contact lenses$ 0,00
Additional payment for glasses (lenses and frames)$ 0,00

• Maximum 1 pair per year

Hearing tests:
Co-payment for Medicare-covered benefits$ 0,00
Co-payment for routine hearing tests$ 0,00

• Maximum 1 visit per year

hearing aids:
Co-payment for hearing aids$ 175,00for$ 1.225,00

• Maximum 2 hearing aids per year

Bauchaortenaneurysma-Screening
Testing and advice on alcohol abuse
Bone mass measurements (bone density)
Cardiovascular disease screening
Cardiovascular diseases (behavioral therapy)
Cervical and vaginal cancer screening
Colorectal Cancer Prevention
Depressionsscreenings
diabetes tests
Diabetes self-management training
Glaucoma-Test
Screening for hepatitis B infection (HBV).
Hepatitis-C-Screening-Test
HIV-Screening
lung cancer screening
Mammographie (Screening)
nutritional therapy services
Obesity screening and counseling
One-time Medicare Welcome Visit
Prostatakrebstests (PSA)
Screening and counseling for sexually transmitted infections
shots:

• Covid-19 vaccinations

• Summary of Benefits
• Rating in stars