| Viva Medicare Plus (HMO) | Humana Gold Plus (HMO) | |
|---|---|---|
| Monthly plan premium | $0 | $0 |
| Part B premium reduction / giveback | $20 or $2 per month Part B premium buy-down (county-based) | (Not listed) |
| Maximum out-of-pocket per year (medical) | $9,250 (does not include Part D drugs) | $6,100 |
| Primary care doctor visit | $0 copay | $0 copay |
| Specialist visit | $25 copay ($0 in a Skilled Nursing Facility) | $20 copay |
| Inpatient hospital stay (per day / per stay) | Days 1–6: $375/day; $0 for additional days |
$295/day for days 1–8; $0/day for days 9–90 |
| Outpatient surgery – hospital | $365 at outpatient hospital | $230 copay |
| Outpatient surgery – surgical center | $0 at ambulatory surgical center | $155 copay |
| Emergency room visit |
$115 copay (waived if admitted within 24 hours for same condition) |
$130 copay (waived if admitted to same hospital within 24 hours) |
| Urgent care visit |
$0 with PCP; $25 specialist; about $40 at urgent care clinic |
$50 copay |
| Ambulance (ground or air) | $290 per one-way trip | Emergency ambulance covered (copay not specified here) |
| Lab services | $0 | $0–$50 copay (depending on service and setting) |
| X-rays | $15 per x-ray | $0–$125 copay (depending on type and setting) |
| MRI / CT / other advanced imaging | $200 per service ($15 per ultrasound) |
Diagnostic radiology – imaging: $200–$335 copay; Nuclear medicine: $200–$325 copay |
| Other diagnostic tests | Included under lab/imaging copays above |
Clinic diagnostic tests: $10 copay; Outpatient diagnostic tests: $0–$50 copay; Sleep study (facility): $20–$45 copay; Sleep study (home-based): $0 copay; Wound care: $20 copay |
| Outpatient surgery (summary) |
$0 at ambulatory surgical center; $365 at outpatient hospital; $365 per observation stay; $0 for colonoscopy |
$230 copay (hospital); $155 copay (surgical center) |
| Skilled nursing facility (per day) |
Days 1–20: $0/day; Days 21–63: $218/day; Days 64–100: $0/day |
(Not listed here) |
| Physical / occupational / speech therapy | $25 per visit | (Not listed here) |
| Cardiac / pulmonary rehab | $15 per visit | (Not listed here) |
| Home health care | $0 | (Not listed here) |
| Durable medical equipment (DME) | 20% coinsurance ($0 for ostomy supplies) | (Not listed here) |
| Diabetes supplies / insulin |
$0 per standard-size box for diabetes supplies; 20% for therapeutic shoes/inserts |
(Not listed here) |
| Outpatient mental health / substance use visits | $25 per visit; $55 for intensive outpatient / partial hospitalization | $35 copay (group or individual therapy) |
| Inpatient psychiatric hospital | Days 1–5: $375/day; $0 for additional days |
$272/day for days 1–8; $0/day for days 9–90 (up to 190 lifetime inpatient days in a psychiatric hospital) |
| Medicare-covered eye exam (medical) | $25 copay ($0 for diabetic retinopathy and glaucoma screening) | $20 copay; $0 for diabetic eye exam |
| Routine eye exam | $0 (annual routine vision exam) | $0 copay (1 per year) |
| Eyeglasses / contacts allowance | Up to $100 per year for prescription eyewear and/or contact lens fitting |
Up to $150 per year (standard) OR up to $250 per year at PLUS Provider (lenses/frames and fitting) |
| Medicare-covered dental services | Copay depends on place of service | $20 copay |
| Routine dental (cleanings, exams, fillings, etc.) |
Covered under annual dental allowance (preventive, diagnostic, comprehensive) |
$0 copay for: bitewing x-rays, exams, cleanings, fillings, simple/surgical extractions, anesthesia with covered service |
| Annual dental maximum / allowance |
$700 or $1,000 per year (amount depends on county) |
$3,000 maximum benefit coverage amount per year |
| Routine hearing exam | $0 with PCP; $25 with specialist | $0 copay (1 per year) |
| Hearing aids |
Through NationsHearing: OTC hearing aids (pair): member cost range $750–$2,850; Prescription hearing aids (one per ear): member cost range $500–$1,975 |
Advanced level: $0 copay, 1 per ear every 3 years; Premium level: $299 copay, 1 per ear every 3 years |
| Over-the-counter (OTC) allowance | $30 allowance per calendar quarter | (Not specified here) |
| Fitness / gym benefit | Silver&Fit program (no cost; fitness centers and digital options) | SilverSneakers program (no cost; participating locations and virtual) |
| 24-hour nurse line / telehealth access |
Telehealth for PCP, some specialists, urgent care, and mental health; standard visit copays apply. Includes 24-hour nurse line. |
Preventive benefits at $0; emergency and urgent care covered. (Telehealth details not specified in this text.) |
| Part D drug deductible |
$350 deductible for Tier 3–5 drugs. No deductible for Tier 1–2 drugs. |
$0 deductible for Tiers 1–3. $590 deductible for Tiers 4–5. |
| Tier 1 (preferred generic) copay |
$0 for up to 100-day retail supply; $0 for up to 100-day preferred mail order |
$0 copay (retail and mail-order options) |
| Tier 2 (generic) copay |
$12 for 30-day retail; $30 for 100-day retail; $24 for 100-day preferred mail order |
$5 copay (retail); $5 or $20 mail-order, depending on days' supply |
| Tier 3 (preferred brand) copay |
$47 for 30-day retail; $117.50 for 100-day retail; $94 for 100-day preferred mail order |
$47 copay (retail and mail-order options) |
| Tier 4 (non-preferred drugs) cost share | 42% coinsurance (up to 100-day supply) |
Initial coverage: 48% coinsurance; Deductible applies first to Tier 4 |
| Tier 5 (specialty) cost share | 29% coinsurance (30-day supply) |
Initial coverage: 26% coinsurance; Deductible applies first to Tier 5 |
| Initial coverage limit to reach catastrophic phase |
After $2,100 out-of-pocket on Part D drugs: you pay $0 for covered drugs (catastrophic phase) |
After $2,100 out-of-pocket on Part D drugs: you pay $0 for covered drugs for rest of year |