Medicare Vital

 

Benefit & Cost-Share

In-
Network

Out-of-Network

Monthly Premium $0
Medical Deductible $0
Primary Care Physician Office Visit Copayment $0 $50
Doctor On Demand $0 N/A
Special Office Visit Copayment $45 40%
Routine Annual Physical Exam Copayment $0 40%
Over-the-counter Items $25 / quarter Not available
Help at Home and Companionship
Up to 30 hours of companionship, transportation, help around the house, and technology assistance
Not available 
Urgent Care Copayment $65 $65
Emergency Room Copayment $90 $90
Ambulance $265 $265
Ambulatory Surgery Center $345 40%
Outpatient Hospital Services $395 40%
Inpatient Hospitalization Days 1-4; $460
No copayment after day 4
40%
Skilled Nursing Facility Care $0 days 1-20
$184 days 21-100
40%
Delta Dental Provider:
Routine Cleanings/Restorative (per year)
1 cleaning; $20 copay
Restorative $60-$595
Not available
Non Delta Dental Provider:
Routine Cleaning/Restorative/Dentures
$250 allowance
Vision
- Annual Routine Eye Exam

$20

40%

 - Frames/Lenses (per year)
(20% coinsurance for one pair after cataract surgery)

$60 allowance
Hearing Care Solutions Hearing Aid Benefit $599 or $899
Meal Delivery Following Inpatient Stay 14 meals provided Not Covered
Diagnostic Tests and Lab Services 0% or 20% 40%
X-rays $45 40%
Advanced Imaging Studies (CT, MRI, etc) $220 40%
Part B Drugs and Radiation Therapy 20% 40%
CaféWell and Incentives $125
OOP Max $7,500 $11,300

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

 

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

  Review your estimated prescription costs with this plan

 


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. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2023. Limitations, copayments, and restrictions may apply.

  4. Out-of-network/non-contracted providers are under no obligation to treat Medicare Vital Rx members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

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

Y_0019_22_16818 – last updated 11/04/2021

Or, fill out the form below if you’d like us to contact you.

Our hours are 8 a.m. – 8 p.m. seven days a week, October 1 – March 31. From April 1 to September 30, Monday – Friday, our hours are 8 a.m. to 8 p.m. A voice messaging service is used weekends, after-hours, and federal holidays. Calls will be returned within one business day.

Medicare Hearing Care

delta dental

Five stars for HMO and PPO


Every year, Medicare evaluates plans based on a 5-star rating system

CDPHP best Medicare by US News - 2022


Best Insurance Companies for Medicare Advantage 2022, U.S. News & World Report