• Languages
  • Call CDPHP

Value Rx

 

Benefit

CDPHP Value Rx HMO

Monthly Premium* $59
Medical Deductible No deductible
Enhanced Primary Care
Primary Care Physician Office Visit Copayment
$5
$15
Doctor on Demand $15
Specialist Office Visit Copayment $35
Routine Annual Physical Exam Copayment $0
Urgent Care Copayment $60
Emergency Room Copayment1 $90 Worldwide Coverage
Ambulance $250
Ambulatory Surgery Center $200
Outpatient Hospital Services $300
Inpatient Hospitalization Days 1-6: $295 per day
No copayment after day 6
Skilled Nursing Facility Care Days 1-20: $0 per day
Days 21-100: $140 per day
Dental-Routine Cleaning/Exam 2 preventive cleanings per year;
$10 copay for annual exam;
$10 per bitewing x-ray;
$15 per panoramic or full mouth x-ray;
Must use a Delta Dental Medicare Advantage for CDPHP network provider.
Vision
- Annual Routine Eye Exam
- Frames/Lenses (per year) (20% coinsurance for one pair after cataract surgery)

$35
$100 allowance
Diagnostic Tests and Lab Services2 $0 or $35
X-rays $35
Advanced Imaging Studies (CT, MRI, etc) $130
Part B Drugs and Therapeutic Radiology 20%
CaféWell and Incentives Earn up to $125
OOP Max $5,800

*You must continue to pay your Medicare Part B premium.

 

Compare Plans   Enroll Now

View the Value Rx plan Evidence of Coverage (EOC) and Summary of Benefits (SOB) for all covered services.

   

Disclaimer:

  1. Copayment waived if admitted to the hospital within 24 hours for the same diagnosis.

  2. Copayment waived if services received at a preferred laboratory.

  3. The benefit information provided herein is a brief summary, not a comprehensive description of available benefits. For more information, contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2020. Limitations, copayments, and restrictions may apply.

CDPHP Medicare Advantage is an HMO plan with a Medicare contract. Enrollment in CDPHP Medicare Advantage depends on contract renewal.

Y0019_19_7087 - last updated 12/05/2018

 

medicare - call us

enroll now with medicare