Top 3 options for Jul's Insurance
| Feature |
Anthem Full Dual Advantage Aligned (HMO D-SNP) - H4471 001
|
Wellcare Dual Align (HMO D-SNP) - H3561 008
|
AARP Medicare Advantage from UHC CA-023P (HMO-POS) - H0543 222
|
|---|---|---|---|
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Flex Benefits / Over-the-Counter (OTC) Allowance | Everyday Options Allowance: $85 each month. This is a combined spending allowance for assistive devices, eligible food items, over-the-counter (OTC) wellness products, and utilities. Also provides separate specific allowances for Dental and Vision. | Wellcare Spendables™ Card: $66 every month preloaded. Can be used towards: Over-the-Counter (OTC) items, Gas (pay-at-pump), Healthy Food, Home Improvement and Safety Items, Rent Assistance, Utility Assistance. (Verify details in Evidence of Coverage). | Not applicable for a general flex card/allowance of this type. Plan includes specific allowances for dental, vision and other benefits. |
| Dental | $0.00 copay for preventive and comprehensive dental services. Up to $4,000 allowance per year for covered services. | $0 copay for preventive and comprehensive dental services. Specific annual allowance limit needs confirmation from plan documents. (Medicare.org previously noted 20% for preventive for the base plan, but D-SNPs often cover this at $0). | $0 copay for network preventive dental (oral exams, x-rays, cleanings, fluoride). For comprehensive services like fillings, crowns, root canals, extractions: $0 copay. 50% coinsurance for bridges and dentures. |
| Vision | $0.00 copay for routine eye exam (1 per year). Up to $425 allowance per year for eyeglasses or contact lenses. | $0 copay for routine eye exam (1 per year). Eyewear (glasses/contacts) covered with a $100 allowance per year. | $0 copay for routine eye exam (1 per year). Up to $300 allowance every 2 years for frames or contact lenses. Standard prescription lenses covered in full. |
| Hearing | $0.00 copay for routine hearing exam (1 per year). $0 copay for hearing aids up to maximum plan benefit. $300 allowance for OTC hearing aids OR $3,000 allowance for prescribed hearing aids per year. | $0 copay for routine hearing exam. Hearing aids covered, with a hearing aid allowance (e.g., a similar Wellcare D-SNP showed up to $350 per ear per year, specific amount for this plan needs confirmation). | $0 copay for routine hearing exams (1 per year). Hearing aids available with copays ranging from $99 to $1,249 per aid, up to 2 aids per year. |
| Primary Care Visit Cost | $0.00 copay | $0.00 copay | $0.00 copay |
| Specialist Visit Cost | $0.00 copay | $0.00 copay | $15.00 copay (referral may be required) |
| Prescription Deductible | $0.00 (for dual-eligible members with Extra Help) | Typically $0 for dual-eligible members with Extra Help. (Medicare.org noted a $590 basic Part D deductible for the plan, but this is usually waived for full dual eligibles). | $340.00 annually for Tiers 3-5. Tiers 1 and 2 have a $0 deductible. |
| Prescription Tier Costs (Retail - 30 day supply) | Typically $0.00 for all covered formulary drugs for dual-eligible members with Extra Help. | Typically $0.00 for all covered formulary drugs for dual-eligible members with Extra Help. Specific tier costs for those not fully covered by Extra Help would require plan document confirmation. |
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Important Considerations for D-SNP Plans (Anthem and Wellcare):
- Dual Eligibility: These plans are designed for individuals who are eligible for both Medicare and Medicaid (Medi-Cal in California). Benefits, especially prescription drug costs and other out-of-pocket expenses, are often significantly reduced or eliminated for members who qualify for full Medicaid benefits and/or "Extra Help" with prescription drug costs.
- Flex Card/OTC Details: The specifics of "flex cards" (how much, what they cover beyond basic OTC – e.g., groceries, utilities) can vary and require careful review of the plan's official 2025 documents for your specific county and eligibility level. The information provided above for Anthem and Wellcare flex benefits is based on user-provided data and should be verified.
- Provider Networks: HMO and HMO-POS plans require you to use a network of doctors and hospitals. Ensure your current providers are in-network before enrolling. Referrals are typically needed for specialists in HMOs.
Disclaimer: This table is a summary based on available public information and user-provided updates for 2025 plans as of June 2, 2025. Plan benefits and costs can vary by location and may change. For the most accurate and complete information, please consult the official plan documents (Summary of Benefits, Evidence of Coverage) or contact the insurance plans directly.