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Why pay separate monthly premiums for a Medicare
supplement plan and a Prescription Drug Plan when you can get
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less than most supplement plans?
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|
Amount You Pay |
| Premium |
$71 (Must still pay Part B premium) |
$127 (Must still pay Part B premium) |
| Inpatient Copay (includes Mental Health) |
$150 per stay (Not per day)
$750 Max OOP |
$0 |
| SNF Copay |
$50/day for days 1-30;
$0/day for days 31-100.
$1,500 Max OOP |
$0 |
| PCP Copay |
$10 |
$0 |
| Specialist Copay |
$10 |
$0 |
| Outpatient Surgery Copay |
$150 per procedure
$900 Max OOP |
$0 |
| Ambulance Services |
$100 per one-way trip |
$0 |
| ER Visit |
$50 (Waived if admitted to hospital within 24
hours) |
$0 |
| Lab and X-Ray Copays |
$0 |
$0 |
| Diagnostic procedures/tests |
$0 |
$0 |
| Diagnostic Radiology |
$0 |
$0 |
| Radiation Therapy |
$0 |
$0 |
| Perscription Coverage |
Yes |
Yes |
| Part D Deductible |
$0 |
$0 |
| 1-Generics |
$5 |
$5 |
| 2-Preferred Brand |
$30 |
$30 |
| 3-Non-Preferred Brand |
$55 |
$55 |
| 4-Specialty |
33% |
33% |
| Prescription Gap Coverage |
Many Formulary Generics |
Many Formulary Generics |
| Health/Wellness Education |
$20 per month at a participating health club |
$20 per month at a participating health club |
This table is a brief comparison of copays for frequently used
benefits among the premium plans offered by VIVA MEDICARE
Plus that include Part D precription drug coverage. Other
plans not shown here are available. This is a summary
only. For complete details on plan benefits and limitations,
please see the Evidence of Coverage.