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- Kauai County, HI
Medicare Advantage Plans in Kauai County, HI
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Devoted CHOICE GIVEBACK Hawaii (PPO)Summary of Benefits (PDF)Updated September 12, 2024 | Devoted CHOICE Hawaii (PPO)Summary of Benefits (PDF)Updated September 12, 2024 | Devoted CHOICE PLUS Hawaii (PPO)Summary of Benefits (PDF)Updated September 12, 2024 | |
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Monthly premium | $0 | $0 | $23 |
Part B premium reduction | $117 per month back in your Social Security check | None | None |
Annual out-of-pocket maximum | $8,300*, in-network $10,000, in- and out-of-network | $6,700*, in-network $10,000, in- and out-of-network | $6,700*, in-network $10,000, in- and out-of-network |
Food & Home CardPre-loaded card for purchase of food, over-the-counter, utilities, and mortgage or rent.** | Not covered | $37 per month | $47 per month |
Dental, Eyewear & Alternative Therapy | $250 per year in coverage for dental services, eyewear, and alternative therapies, such as routine acupuncture, massage therapy, and naturopathy services | $1,000 per year in coverage for dental services, eyewear, and alternative therapies, such as routine acupuncture, massage therapy, and naturopathy services | $1,500 per year in coverage for dental services, eyewear, and alternative therapies, such as routine acupuncture, massage therapy, and naturopathy services |
Primary care provider (PCP) visits | $0 copay*, in-network $25 copay, out-of-network | $0 copay*, in-network $25 copay, out-of-network | $0 copay*, in-network $25 copay, out-of-network |
Specialist visitsCost shares for Balance Exams with a Specialist may differ. See your Summary of Benefits for details. | $55 copay*, in-network $55 copay, out-of-network | $50 copay*, in-network $50 copay, out-of-network | $60 copay*, in-network $60 copay, out-of-network |
Inpatient hospital stays | In-network*: | In-network*: | In-network*: |
Pharmacy (Part D) Deductible | $450 for Tiers 3-5 only If you receive Extra Help from Medicare, your deductible is $0. The deductible does not apply to covered Part D insulins and most adult Part D vaccines. | $395 for Tiers 3-5 only If you receive Extra Help from Medicare, your deductible is $0. The deductible does not apply to covered Part D insulins and most adult Part D vaccines. | $590 for Tiers 3-5 only If you receive Extra Help from Medicare, your deductible is $0. The deductible does not apply to covered Part D insulins and most adult Part D vaccines. |
30-Day Supply Retail PharmacyFor Part D prescriptions. If you get Extra Help from Medicare, your costs may be lower. |
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*When you use an in-network provider or pharmacy.
Next Steps
Now that you know what our plans are all about, you can:
- See if your doctors are in our network
- Make sure we cover your medications
And if you have any questions, call us at (1-800-990-0723) (TTY 711) You can also see and compare more plan options at www.Medicare.gov.