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Vital Rx

Medicare Vital Plan

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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 $50 $60
Routine Annual Physical Exam Copayment $0 40%
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%
Dental-Routine Cleaning/Exam 1 preventive cleaning per year
$20 copay per exam
$20 per bitewing
$30 per panoramic x-ray
$30 per full mouth x-ray
N/A
Dental-Restorative Not available
Vision
- Annual Routine Eye Exam
- Frames/Lenses (per year)
(20% coinsurance for one pair after cataract surgery)

$20
$50/2 years

40%
N/A
Hearing Care Solutions Hearing Aid Benefit $599 or $899 N/A
Post-discharge Meals Covered Not Covered
Diagnostic Tests and Lab Services 0% or 20% 40%
X-rays $50 $50
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.

   

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, 2022. Limitations, copayments, and restrictions may apply.

View HMO Plan Options»

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

Y0019_21_13605 - last updated 10/01/2020

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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.

 

CDPHP best Medicare by US News


Best Insurance Companies for Medicare Advantage 2021, U.S. News & World Report