AARP Medicare Advantage Walgreens Plan 1 (PPO) H2228-074-000 2023 Plan Details and Costs (2023)

visit to the doctor:
Co-payment to visit the Primary Care Office0,00 $

Specialized visit:
Co-payment for specialist visit$ 30,00
Prior approval is required to see a specialist

Worldwide coverage:
Co-payment for global emergency response0,00 $

Worldwide coverage:
Copayment for global emergency response0,00 $
Co-payment for worldwide emergency transportation0,00 $

Emergency services:
Co-payment for Medicare-covered ambulance services - Boden$ 250,00
Copayment for Medicare-covered ambulance services - air$ 250,00

Chiropractic Services:
Co-payment for Medicare-covered chiropractic services$ 70,00

Accessories and services for diabetics:
Coinsurance for Medicare-covered diabetic supplies and services50%

Durable medical equipment:
Coinsurance for Medicare-covered long-term medical devices20%
Prior approval is required for long-lasting medical devices

Outpatient Diagnostic Laboratory Procedures/Tests/Services:
Co-payment for Medicare-covered diagnostic procedures/tests$ 30,00
Copayment for Medicare-covered lab services0,00 $
Prior approval is required for outpatient diagnostic laboratory procedures/tests/services

RAD outpatient diagnostic/therapeutic services:
Copayment for Medicare-covered diagnostic radiology services0,00 $For$ 125,00
Copayment for Medicare-covered therapeutic radiology services$ 60,00
Co-payment for Medicare-covered X-ray services$ 15,00
Prior approval is required for RAD outpatient diagnostic/therapeutic services

General Practice Services:
Copayment for Medicare-covered home health services0,00 $
Prior approval is required for home health services

Psychiatric hospital services:
$ 300,00per day for days 1 to 5
0,00 $per day for days 6 to 90
Prior approval is required for psychiatric hospital services

Outpatient psychiatric care:
Copayment for individual sessions covered by Medicare$ 25,00
Copayment for Medicare-covered group sessions$ 15,00
Prior approval is required for outpatient mental health services

Ambulatory Hospital and ASC Services:
Coinsurance for Medicare-covered outpatient hospital services40%
Coinsurance for Medicare-covered outpatient surgical centers40%

Outpatient help for chemical dependents:
Copayment for individual or group sessions covered by Medicare$ 30,00For$ 40,00

Over-the-counter (OTC) items:
Co-payment for over the counter (OTC) items0,00 $
Maximum benefit from the plan$ 40,00every three months
Nicotine Replacement Therapy (NRT) provided as an OTC service under Part C

Podiatry services:
Co-payment for Medicare-covered podiatry services$ 30,00
Co-payment for routine foot care$ 30,00

• Maximum 6 visits per year

Qualified service:
0,00 $per day during days 1 to 20
196,00 $per day during days 21 to 43
0,00 $per day for days 44 to 100
Prior approval is required for qualified service facilities

Preventive dental treatment:
Additional payment for oral exams0,00 $

• Maximum 2 visits per year

• Maximum 3 visits per year

• Maximum 2 visits per year

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

Comprehensive Dentistry:
Coinsurance for Medicare-covered benefits20%
Co-payment for non-routine services0,00 $
Co-payment for diagnostic services0,00 $

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

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

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

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

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

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

eye exams:
Co-payment for Medicare-covered services0,00 $
Co-payment for routine eye exams0,00 $

• Maximum of 1 routine eye examination per year

Cups:
Copayment for Medicare-covered benefits0,00 $
Supplement for contact lenses0,00 $
Additional payment for eyeglasses (lenses and frames)0,00 $

• Maximum 1 pair every two years

Listening Tests:
Co-payment for Medicare-covered services0,00 $
Co-payment for routine hearing tests0,00 $

• Maximum 1 visit per year

hearing aids:
Co-payment for hearing aids175,00 $For$ 1225,00

• Maximum 2 hearing aids per year

Bauchaortenaneurysm screening
Screening and counseling for alcohol abuse
Bone mass measurements (bone density)
Cardiovascular disease screening
Cardiovascular disease (behavioral therapy)
Cervical and vaginal cancer screening
Colorectal Cancer Prevention
depression exams
Diabetes Exams
Diabetes self-management training
Glaucoma test
Screening for Hepatitis B Infections (HBV)
Hepatitis C Screening Test
HIV screening
lung cancer screening
Mammography (Screening)
nutritional therapy services
Obesity screening and counseling
One-time Medicare Welcome Visit
Prostate Cancer Screening (PSA)
Screening and counseling for sexually transmitted infections
shots:

• recordings of COVID-19

• Summary of benefits
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