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Dental
$50 copay per service, deductible does not apply 20% coinsurance Preauthorization required for out-of-Network for certain services or benefit reduces to 50% of allowed. X-ray - $75 copay per service, deductible does not apply. Imaging (CT/PET scans, MRIs) $400 copay per service, deductible does not apply. A copay (or copayment) is a flat fee that you pay on the spot each time you go to your doctor or fill a prescription. For example, if you hurt your back and go see your doctor, or you need a refill of your child's asthma medicine, the amount you pay for that visit or medicine is your copay. Your copay amount is printed right on your health plan. Specialists $50 copay $50 copay You do not need areferral to receive covered services from plan providers. Certain procedures, services and drugs may need advance approval from your plan.
$5 copay, Deductible does not apply 50% coinsurance None Inpatient services 5% coinsurance 50% coinsurance None If you are pregnant Office visits No charge 50% coinsurance Depending on the type of services, a copayment, coinsurance, or deductible may apply. Plan N covers 100% of your Medicare Part B coinsurance costs, with the exception of a $20 copay for office visits and a $50 copay for ER visits. Plan N covers basic Medicare benefits including: Hospitalization: pays Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
Don’t worry, CareSource Medicare Advantage also covers your smile. No matter which plan you choose, preventive dental services have $0 copay.
2021 Dental Coverage
| Covered/ Not Covered | Covered/ Not Covered | Copay / Coinsurance | |
| Preventive Dental | Covered | Covered | $0 Copay |
| Comprehensive Dental (Outside Medicare Covered) | Not Covered | Covered | $0 Copay / 30-50% Coinsurance, $1000 annual limit |
Vision
CareSource has partnered with EyeMed Vision Care® to bring a Medicare Advantage vision benefit solution that offers more…
- Access to EyeMed’s Insight network, a vision network made up of the right mix of independent providers, as well as many regional and national retail providers, including:
Service that is always open to new patients and without an appointment
Locations with extended evening and weekend hours in convenient locations
Online solutions that allow members and their caregivers, to evaluate options at home and reduce stress at the provider office
Benefit options that offer more flexibility, choice and savings
2021 Vision Benefits
Call EyeMed at 1-866-248-2011 (TTY: 711) to learn more and to find a network provider.
Additional Savings…
40% off additional pair discount
15% off retail or 5% off promotional price LASIK
Hearing
CareSource has partnered with TruHearing to provide you with high-quality hearing aids and local professional care at a fraction of the cost. Traditional Medicare doesn’t offer a hearing aid benefit, leaving you to pay $2,000–3,000 per hearing aid on the retail market. Your plan covers up to two hearing aids per year.
$50 Copay With Deductible Meaning
2021 Hearing Benefits
$50 Copay After Deductible
| In-Network | CareSource Advantage® Zero Premium (HMO) | CareSource Advantage® (HMO) |
| Routine Hearing Test | $0 copay, one routine hearing exam every year | $0 copay, one routine hearing exam every year |
| Exam to diagnose and treat hearing and balance issues | $50 copay | $45 copay |
| Hearing aid fitting/evaluation | $0 copay, three hearing exams for fitting/evaluation for hearing aid(s) | $0 copay, three hearing exams for fitting/evaluation for hearing aid(s) |
| Hearing Aids | $699/999 copay, one hearing aid per ear per year. Maximum coverage amount: No plan coverage limit | $499/799 copay, one hearing aid per ear per year. Maximum coverage amount: No plan coverage limit |
$50 Copay After Deductible Means
Call TruHearing at 1-855-205-5499 (TTY: 711) to learn more and to find a network provider.