South Texas Benefits2024-01-04T13:30:08-05:00
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South Texas Plan Benefit Overview

2024 South Texas Benefits

Benefit/Coverage Plus BEYOND GIVEBACK $130 EXTRA HELP
Medicare Extra Help Required
Dual
Medicare & Medicaid Required
Inpatient Hospital * $0-$50 /day, days 1-5 $40- $250/day,
days 1-5
$300- $375/day,
days 1-6
$0-$50 /day,
days 1-5
$0
Doctor Visits $0 Primary Care
$0-$10 Specialist
$0 Primary Care
$25 Specialist
$0 Primary Care
$45 Specialist
$0 $0
Prescription Drug Coverage Many drugs for $0 Many drugs for $0 Many drugs for $0 $0 $0
Emergency Visits $60-$125 $110-$135 $75-$100 $60-$125 $0
X-rays, CT Scans & MRIs $0 X-rays
$0 CT & MRI
$0 X-rays
$50 CT & MRI
$0 X-rays
$100 CT & MRI
$0 $0
Urgent Care $0 $0 $35 $0 $0
Chiropractic
(Routine)
$0 $10 $15 $0 $0
PLUS, ADDED VALUE!
Dental Coverage $3,000
and $0 copays
$4,000
and $0 copays
$1,000
and $0 copays
$3,000
and $0 copays
$4,000
and $0 copays
Premium Dental Coverage
(Bigger network & more coverage)
$7,500 total coverage
$30 monthly premium
$7,500 total coverage
$24 monthly premium
$7,500 total coverage
$31 monthly premium
Not available Not available
Healthy Food Benefit
(Depending on Medical Condition)
$50 -$250 per month $250 per month ESRD Only $250 per month ESRD Only $100 to $250 per month
food or utility payment
$125 to $275 per month
food or utility payment
Transportation
(Rides to health-related locations)
Unlimited rides Unlimited rides
+20 one way trips non-medical
Unlimited rides Unlimited rides Unlimited rides
+20 one way trips non-medical
Vision Care $200 allowance
for glasses or contacts
+ $0 eye exams
$500 allowance
for glasses or contacts
+ $0 eye exams
$200 allowance
for glasses or contacts
+ $0 eye exams
$200 allowance
for glasses or contacts
+ $0 eye exams
$500 allowance
for glasses or contacts
+ $0 eye exams
Hearing Aid Coverage $600 per ear
hearing aid allowance
+ $0 hearing exams
$800 per ear
hearing aid allowance
+ $0 hearing exams
$0 hearing exams $600 per ear
hearing aid allowance
+ $0 hearing exams
$3,000 both ears
hearing aid allowance
+ $0 hearing exams
Over-the-Counter (OTC) $120 per quarter, can also be used for food
at approved OTC retailers
$135 per quarter $60 per quarter $120 per quarter $280 per quarter

You must continue to pay your Part B premium.
*Copay depends on hospital used.

See additional plan and benefit information
Download benefit information

Ready to Enroll?

You can enroll in Prominence Health Plan’s 2024 Medicare Advantage plan if you have Medicare Parts A and B and it is either the Annual Election Period (AEP), Medicare’s Open Enrollment Period or you have a Special Election Period.

Enroll today!

South Texas Plan Benefit Overview

2024 South Texas Benefits

Inpatient Hospital *
$0-$50 /day, days 1-5

Doctor Visits
$0-$50 /day, days 1-5

Prescription Drug Coverage
Many drugs for $0

Emergency Visits
$60-$125

X-rays, CT Scans & MRIs
$0 X-rays
$0 CT & MRI

Urgent Care
$0

Chiropractic (Routine)
$0

PLUS, ADDED VALUE!

Dental Coverage
$3,000
and $0 copays

Premium Dental Coverage
(Bigger network & more coverage)

$7,500 total coverage
$30 monthly premium

Healthy Food Benefit
(Depending on Medical Condition)

$50 -$250 per month

Transportation
(Rides to health-related locations)

Unlimited rides

Vision Care
$200 allowance
for glasses or contacts
+ $0 eye exams

Hearing Aid Coverage
$600 per ear
hearing aid allowance
+ $0 hearing exams

Over-the-Counter (OTC)
$120 per quarter, can also be used for food
at approved OTC retailers

Inpatient Hospital *
$40- $250/day,
days 1-5

Doctor Visits
$0 Primary Care
$25 Specialist

Prescription Drug Coverage
Many drugs for $0

Emergency Visits
$110-$135

X-rays, CT Scans & MRIs
$0 X-rays
$50 CT & MRI

Urgent Care
$0

Chiropractic (Routine)
$10

PLUS, ADDED VALUE!

Dental Coverage
$4,000
and $0 copays

Premium Dental Coverage
(Bigger network & more coverage)

$7,500 total coverage
$24 monthly premium

Healthy Food Benefit
(Depending on Medical Condition)
$250 per month ESRD Only

Transportation
(Rides to health-related locations)

Unlimited rides
+20 one way trips non-medical

Vision Care
$500 allowance
for glasses or contacts
+ $0 eye exams

Hearing Aid Coverage
$800 per ear
hearing aid allowance
+ $0 hearing exams

Over-the-Counter (OTC)
$135 per quarter

Inpatient Hospital *
$300- $375/day,
days 1-6

Doctor Visits
$0 Primary Care
$45 Specialist

Prescription Drug Coverage
Many drugs for $0

Emergency Visits
$75-$100

X-rays, CT Scans & MRIs
$60 X-rays
$100 CT & MRI

Urgent Care
$35

Chiropractic (Routine)
$15

PLUS, ADDED VALUE!

Dental Coverage
$1,000
and $0 copays

Premium Dental Coverage
(Bigger network & more coverage)

$7,500 total coverage
$31 monthly premium

Healthy Food Benefit
(Depending on Medical Condition)

$250 per month ESRD Only

Transportation
(Rides to health-related locations)

Unlimited rides

Vision Care
$200 allowance
for glasses or contacts
+ $0 eye exams

Hearing Aid Coverage
$0 hearing exams

Over-the-Counter (OTC)
$60 per quarter

Inpatient Hospital *
$0-$50 /day,
days 1-5

Doctor Visits
$0

Prescription Drug Coverage
$0

Emergency Visits
$60-$125

X-rays, CT Scans & MRIs
$0

Urgent Care
$0

Chiropractic (Routine)
$0

PLUS, ADDED VALUE!

Dental Coverage
$3,000 and $0 copays

Premium Dental Coverage
(Bigger network & more coverage)

Not available

Healthy Food Benefit
(Depending on Medical Condition)

$100 to $250 per month
food or utility payment

Transportation
(Rides to health-related locations)

Unlimited rides

Vision Care
$200 allowance
for glasses or contacts
+ $0 eye exams

Hearing Aid Coverage
$600 per ear
hearing aid allowance
+ $0 hearing exams

Over-the-Counter (OTC)
$120 per quarter

Inpatient Hospital *
$0

Doctor Visits
$0

Prescription Drug Coverage
$0

Emergency Visits
$0

X-rays, CT Scans & MRIs
$0

Urgent Care
$0

Chiropractic (Routine)
$0

PLUS, ADDED VALUE!

Dental Coverage
$4,000 and $0 copays

Premium Dental Coverage
(Bigger network & more coverage)

Not available

Healthy Food Benefit
(Depending on Medical Condition)

$125 to $275 per month
food or utility payment

Transportation
(Rides to health-related locations)

Unlimited rides
+20 one way trips non-medical

Vision Care
$500 allowance
for glasses or contacts
+ $0 eye exams

Hearing Aid Coverage
$3,000 both ears
hearing aid allowance
+ $0 hearing exams

Over-the-Counter (OTC)
$280 per quarter

You must continue to pay your Part B premium.
*Copay depends on hospital used.

See additional plan and benefit information
Download benefit information

Ready to Enroll?

You can enroll in Prominence Health Plan’s 2024 Medicare Advantage plan if you have Medicare Parts A and B and it is either the Annual Election Period (AEP), Medicare’s Open Enrollment Period or you have a Special Election Period.

Enroll today!

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Last update 1/2/2024

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