In-Network: Diabetic Supplies and Services: Copayment for Medicare-covered Diabetic Supplies $0.00 Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20% Prior Authorization Required for Diabetic Supplies and Services Diabetic Supplies and Services limited to those from specified manufacturers(Please see Evidence of Coverage) In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $20.00 Prior Authorization Required for Chiropractic Servicesĭiabetes supplies, training, nutrition therapy and monitoring Learn more about Ascension Complete Seton Secure (HMO) benefits, some of which may not be covered by Original Medicare (Part A and Part B). Health Care Services and Medical SuppliesĪscension Complete Seton Secure (HMO) covers a range of additional benefits. In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $235.00 Air Ambulance: Copayment for Air Ambulance Services $235.00 Please see Evidence of Coverage for Prior Authorization rules Urgent Care: Copayment for Urgent Care $30.00 Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours Worldwide Coverage: Copayment for Worldwide Urgent Coverage $125.00 Maximum Plan Benefit of $50,000Įmergency Care: Copayment for Emergency Care $125.00 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $125.00 Maximum Plan Benefit of $50,000 In-Network: Acute Hospital Services: $250.00 per day for days 1 to 6 $0.00 per day for days 7 to 90 Prior Authorization Required for Acute Hospital Services In-Network: Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $30.00 Prior Authorization Required for Doctor Specialty Visit In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0.00 Learn more about Texas Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price. Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover. Texas Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options.Ī Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.
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