Plans

Co-pays*

People with Medicare pay the co-pays below except prescription drug co-pays. People with both Medicare and Medicaid get most prescriptions through Medicare Part D. They pay Part D co-pays, not the prescription co-pays listed here.

Ambulance - Per trip $0

Dental care - $0

Inpatient hospital
Per day - $0
Maximum with limits - $0

Medical centers
Ambulatory surgical center - $0
Federal Qualified Health Center or Regional Health Center - $0
Independent medical/surgical center - $0
Short procedure unit - $0

Medical equipment
Purchase - $0
Rental - $0

Medical visits
Certified nurse practitioner - $0
Chiropractor - $0
Doctor - $0
Optometrist - $0
Podiatrist - $0

Outpatient hospital
Per visit – Outpatient surgical, except maternity - $0
Per visit – Non-surgical or diagnostic - $0

Prescriptions
Generic - $0
Brand name - $3

X-rays - Per service $0

• Beyond Medicaid covered services, $500 yearly allowance of certain dental services

• Beyond Medicaid covered vision services, $100 yearly allowance for glasses or contacts and one fitting every 12 months

• Free Smartphone with up to 1000 minutes of talk and unlimited texts for participants who qualify

• Free health coaching services based on health needs and goals
• Online program to ease stress

• 24/7 UPMC provider live video access for minor health issues
• Personal support services for participants waiting for LTSS eligibility decision
• Caregiver support with daily advice, coaching and a stipend instead of personal assistance services
• Help with Medical Assistance renewal process
• Up to $5000 allowance to move from a nursing facility to the community

*There are no co-pays for persons living in a nursing, personal care or domiciliary home. Pregnant women, new mothers and terminally ill participants getting hospice care
have no co-pays. Some services, items and drugs have no co-pays. For co-pay updates, go to ow.ly/WGQM30hern9.