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CoxHealth Medicare Advantage
Welcome to CoxHealth Medicare Advantage (HMO)!
CoxHealth Medicare Advantage was made for you. We created comprehensive coverage, delivering outstanding benefits and greater flexibility.
Plus, we bundle all your benefits and wellness rewards into one easy-to-manage plan. When you become a member, you get a health plan made with you in mind. CoxHealth Medicare Advantage plans are made with plenty of perks and programs to help you with your health goals.
Care Coordination: Connect to a team of providers who work with your physician to make sure you have the resources you need to stay healthy through your medical issues.
Preventive Care: Focus on preventing sickness and monitoring your health with coverage for a yearly wellness visit, routine screenings like mammograms, colorectal cancer screenings, or a flu shot and more.
Wellness Rewards: As a valued CoxHealth Medicare Advantage member you can earn rewards by completing health-related activities that promote your health and well-being.
We offer benefits you can count on:
$0 Premium
$0 Deductible
$0 copay: Primary Care Physician Visits
Out-of-Pocket: $3,650 per year
Dental Services:
$2,000 benefit/year
(no deductible; no extra premium)
Hearing Aids:
$1,000 per ear allowance every 2 years
(no cost for fitting)
Vision Services:
$150 allowance per year
(frames, lenses, coatings, contacts)
Over the Counter
$90 allowance per quarter
Fitness:
$20 allowance per month
2024
Plan Benefits
CoxHealth Medicare Advantage was made for you. We created comprehensive coverage, delivering outstanding benefits and greater flexibility. Plus, we bundle all your benefits and wellness rewards into one easy-to-manage plan. When you become a member, you get a health plan made with you in mind including all this and more:
$0 Medical and Pharmacy Deductibles
$0 Primary Care Physician Copay
$35 Specialist Visit Copay
$50 Urgent Care Copay
$125 Emergency Care Copay
$0 Lab Tests Copay
$0 Prescription Deductible
$2,950 Annual Out-of-Pocket
$3,000 annual Dental benefit
Extra Benefits
Dental
• Preventive coverage for an annual routine exam, 2 cleanings a year, and more are available to you at no cost.
• Members receive comprehensive dental coverage for services such as fillings, extractions, and crowns.
• $3,000 limit on all covered basic and comprehensive dental services.
• You have the option of teledentistry consultations to discuss dental issues from the comfort of your home.
• Locate your dentist under Find a Physician.
Hearing
• Routine Hearing Exams are limited to one visit per year for a $0 copay.
• You have a $1,150 allowance per ear for hearing aids every 2 years.
• The hearing aid fitting is provided to you at no cost.
• Use an in-network provider for your hearing needs.
Vision
• Routine Eye Exams are limited to one visit per year for a $0 copay.
• Coverage includes $0 copay for one pair of basic uncoated single, bifocal, or trifocal lenses annually.
• Members enjoy a $200 allowance for eyeglass frames, additional lenses, lens upgrades, lens coatings, or contacts each year.
• Use an in-network provider for your vision needs.
Over-the-Counter Benefit
• Receive $100 each quarter for over-the-counter health and wellness products without a prescription.
• Choose from hundreds of products such as bandages, allergy medication, decongestants, sleep-aids, denture adhesive and cleaner, and incontinence supplies.
• Ordering is easy! You can order online, by phone, by mail, or visit select retail locations.
• Online shopping even suggests items for you based on your health needs.
• To use the online option log into your member portal.
Fitness
• SilverSneakers® gives you fitness options for a healthier lifestyle.
• Choose how you want to work out with access to local fitness locations, virtual classes, on-demand classes, and the SilverSneakers GO mobile app.
• Learn more at Get Active with SilverSneakers!
Virtual Visit
• Feeling sick? Visit a physician through your smartphone or computer.
• Use the Virtual Visits on Demand service through CoxHealth to see a physician for illnesses like allergies, the flu, a rash, COVID, and more, from the comfort of your home.
• You can also schedule a Virtual Visit with your CoxHealth Primary Care Physician or Specialist to help you manage a chronic condition, for illness, to establish care, and for mental health.
• Visit coxhealth.com/virtualvisits to use this convenient service.
24/7 Urgent Care
• Visit Urgent Care for conditions that are not life-threatening.
• Urgent Care Centers can treat issues such as fever, broken bones, and other conditions
treated by your Primary Care Physician.
• The Urgent Care located at Cox South in the Turner Center entrance is always open.
• This facility offers care for services including CT scans or ultrasounds for injuries or
conditions.
• Visit coxhealth.com for Urgent Care listings.
Primary Care Physician Visit
• Primary Care Physician visits are available for a $0 copay.
• Primary Care Physicians help you monitor your health and manage chronic conditions to help prevent future hospital and ER visits.
• If you need to see a specialist your Primary Care Physician will provide you with a referral.
Save My Spot
• Illness isn’t planned, but now you can save your spot in line to be seen at CoxHealth Walk-in Clinics and Urgent Care.
• You can view real-time availability and reserve a location and time by signing up online
at coxhealth.com/savemyspot.
• Then you can rest at home until it’s time for your appointment.
Wellness Rewards
Annual Wellness Visit - $25 Reward
• Visit your Primary Care Physician annually to discuss your health concerns, update your medical record, and plan for services you will need in the coming year.
• Your medical record is important. It helps all your healthcare providers communicate and coordinate to give you the best care. Some of the medical updates that are part of your annual visit include:
–Review of your prescriptions, vitamins, and over-the-counter drugs
–Discuss surgeries that have occurred or are scheduled
–Document any advanced care directives
–Determine what preventive tests, screening, or vaccines you need
Flu Vaccine - $10 Reward
• Your flu vaccine helps protect you from getting the flu or reduce the severity of illness.
• The Centers for Disease Control and Prevention estimates the flu vaccination prevented 7.5 million flu illnesses in 2019-2020.
• All members are eligible for a flu vaccine once a year at an in-network Primary Care Physician’s office or pharmacy.
Breast Cancer Screening - $20 Reward
• Receiving an annual mammogram is the best chance of detecting early signs of breast cancer.
• A preventive mammogram is offered annually at no cost to female members.
• To be eligible for the reward the mammogram must occur at a CoxHealth facility and be completed in the coverage year.
Colorectal Screening - $20 Reward
• A colorectal screening can help prevent colorectal cancer according to the Centers for Disease and Prevention.
• Members are eligible for a colorectal cancer screening as outlined by the U.S. Preventive Services Task Force.
• Screenings are covered when completed during the coverage year at an in-network facility by an in-network physician.
Diabetic Eye Exam - $10 Reward
• Diabetic retinopathy is a condition that causes damage to the blood vessels in your eyes.
• Damage can lead to blindness, glaucoma, and cataracts.
• Your annual diabetic eye exam is important to track and manage any vision issues.
• The exam is covered at no cost when completed during the coverage year by an in-network physician.
Diabetic Kidney Function Test - $10 Reward
• Diabetes can lead to kidney issues when the blood sugar is high and your kidneys cannot
function correctly. Over time the build up can get worse and lead to kidney failure.
• Tracking your kidney function is an important part of monitoring your diabetes.
• You can slow down kidney damage, but only if you know about it.
• Eligible members will receive the test at no cost.
• The test must be completed during the coverage year and with an in-network physician.
Diabetic HbA1c Test - $10 Reward
• The HbA1c is a blood test that measures the blood sugar levels over the past 3 months to see if your blood sugar average is in the low, normal, or high range.
• This test provides a snapshot of how your blood sugar levels are impacting your life and what actions can help you live healthier.
• A quick finger-stick is all that is needed for this test.
• Contact your Primary Care Physician to schedule your test and review the results.
• Eligible members will receive the test at no cost.
• The test must be completed during the coverage year by an in-network physician.
Network and Service Area
CoxHealth strives to improve the health of the communities we serve and to be the best for those who need us. Our doctors, nurses and staff put patients first — with safety, compassion, respect, and integrity. CoxHealth has been continually recognized as a Best Regional Hospital by U.S. News & World Report. CoxHealth is also Missouri’s first hospital accredited for quality and patient safety by DNV Healthcare, an approved hospital accreditation organization through the Centers for Medicare and Medicaid (CMS).
The CoxHealth Medicare Advantage plan is available in Barry, Christian, Greene, Lawrence, Stone, Taney, and Webster counties.
Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you. Call Customer Services for more information.
Important Message About What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on. Insulin products are covered at a $0 copay on tier 6.
The benefit information provided does not list every service that we cover or list every limitation or exclusion. Please refer to EOC to get a complete list of services we cover.
