2015 Piedmont WellStar Medicare Choice (HMO) Benefits
The Piedmont WellStar Medicare Choice (HMO) Plan is a Medicare Advantage health plan designed to help you stay well and live better. In addition to all Original Medicare services, Piedmont WellStar Medicare Choice (HMO) includes additional benefits, health services, and tools to help you maintain the healthy life you deserve.
Our Medicare Advantage HMO Plan offers:
- Comprehensive annual physical exam
- Routine vision care and allowance for eyeglasses/contact lenses
- Routine dental care
- Silver&Fit Exercise & Healthy Aging program
- Care advisory services to coordinate care
- Nurse advice line available 24 hours a day, seven days a week
- Prescription Drug coverage for brand name and generic drugs
Some of the most important plan benefits and copay details for Piedmont WellStar Medicare Choice (HMO) are highlighted in the table below.
The total amount you will have to pay each year for copays and coinsurance for covered services that you receive at in-network providers.
$40 for each specialist visit
$215 per day (days 1-7) / Mental Health
$150 each day (days 21-100)
$15 copay for general X-rays or ultra-sound;
$125 copay for Medicare-covered diagnostic and therapeutic radiology services
$100 allowance toward the cost of glasses or contacts per year
$0 for one fluoride treatment per year
$0 for one X-ray per year
Piedmont WellStar Medicare Choice (HMO) Pharmacy Benefits
A prescription drug formulary is a list of drugs a Medicare Advantage plan covers. The Piedmont WellStar Medicare Choice formulary includes thousands of brand name and generic prescription drug medications. Piedmont WellStar Medicare Choice gives you access to a large network of retail chain and independent pharmacies.
You pay your normal copay ($3 for 30 day supply) for preferred generic drugs.
- $2.65 copay for generic drugs (including brand drugs treated as generic)
- $6.60 copay for all other drugs
- Or 5% of the cost
Piedmont WellStar Medicare Choice is a Medicare Advantage HMO organization with a Medicare Contract. Enrollment in Piedmont WellStar Medicare Choice depends on contract renewal.
The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance] may change on January 1 of each year.
*Our hours of operation change throughout the year. We are available to take your call: Oct. 1 through Feb. 14 Monday through Sunday: 8 a.m. to 8 p.m., and Feb.15 through Sept. 30 Monday through Friday: 8 a.m. to 8 p.m. and Saturday: 8 a.m. to 3 p.m.