03/17/2026
🚨ATTENTION NORTHEAST OHIO SENIORS IN ZIP-CODES 44102, 44103, 44104, 44105, 44106, 44109, 44113, 44114, and 44115.
Discover 's Dual Special Needs Plans, designed to combine Medicare and Medicaid benefits for comprehensive coverage.
These plans offer tailored support for those with specific health needs, ensuring you receive the benefits, care and peace of mind you deserve.
Don't miss this opportunity to secure your health insurance with a plan that truly fits your lifestyle! 🙌🏽
*****LOOK AT WHAT YOU MAY OBTAIN FOR $0.00/Mo. *****
Monthly premium
$0.00
Medical deductible
$0
Out-of-network maximum out-of-pocket
N/A
In-network maximum out-of-pocket
$9,250
Combined maximum out-of-pocket
$0
Drug deductible
$0
Catastrophic coverage limit
$2,100
Benefit details
Outpatient care and services
Acupuncture
In-Network:
Acupuncture:
Copayment for Acupuncture $0
Maximum 20 visits every year
Prior Authorization Required for Acupuncture
Additional Services
Additional Services:
Copayment for Additional Sessions of Smoking and To***co Cessation Counseling $0
Maximum 4 visits
Copayment for Fitness Benefit $0
Copayment for Wigs for Hair Loss Related to Chemotherapy $0
Meal Benefit:
Copayment for Meal Benefit $0
Prior Authorization Required for Meal Benefit
Up to 14 meals over 7 days after an inpatient stay in a hospital or nursing facility, limited to 4 times per year. Meal delivery must be scheduled within 30 days of discharge from inpatient stay.
Ambulance Services
In-Network:
Ground Ambulance:
Copayment for Ground Ambulance Services $0
Air Ambulance:
Copayment for Air Ambulance Services $0
Prior Authorization Required for Air Ambulance
Chiropractic Services
In-Network:
Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $0
Copayment for Routine Care $0
Maximum 12 Routine Care every year
Prior Authorization Required for Chiropractic Services
Dental Services
$0 copayment for gingivectomy, scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years.
$0 copayment for periodontal surgery, sealant up to 1 per tooth every 3 years.
$0 copayment for 3D scans, comprehensive oral exam, occlusal adjustment, occlusal guard, scaling for moderate inflammation up to 1 every 3 years.
$0 copayment for alveoloplasty in conjunction with extractions up to 1 per quadrant every 5 years. Only covered in conjunction with the construction of a prosthodontic appliance.
$0 copayment for complete dentures, cone beam CT imaging, crown recementation, panoramic film or diagnostic x-rays, partial dentures up to 1 every 5 years.
$0 copayment for other preventive services up to 1 per tooth every 6 months.
$0 copayment for orthodontic retention, space maintainer up to 1 per arch per lifetime.
$0 copayment per tooth for crown, endodontic services, oral surgery, removal of impacted tooth, root canal, root canal retreatment, therapeutic pulpotomy up to 1 per lifetime.
$0 copayment for comprehensive orthodontic, harmful habit appliance, implant services, maxillofacial prosthetics, non-clinical procedures, other orthodontic, sleep apnea, temporomandibular disorder (TMD) up to 1 per lifetime.
$0 copayment for parenteral medications up to 1 per visit.
$0 copayment for other restorative services - core buildup and prefabricated post and core up to 1 per tooth per year.
$0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year.
$0 copayment for adjustments to dentures, denture rebase, denture reline, denture repair, emergency diagnostic exam, extra-oral x-rays, other diagnostic services, other diagnostic x-rays, periodontal exam, tissue conditioning up to 1 per year.
$0 copayment for other restorative services up to 2 per tooth per year.
$0 copayment for counseling services, emergency treatment for pain, fluoride, oral surgery, periodic oral exam, prophylaxis (cleaning) up to 2 per year.
$0 copayment for caries medicament up to 3 per tooth per year.
$0 copayment for periodic orthodontic, periodontal maintenance up to 4 per year.
$0 copayment for necessary anesthesia with covered service up to as needed with covered codes per year.
$0 copayment for amalgam and/or composite filling up to unlimited per year.
$0 copayment for extractions up to unlimited.
$1500 maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits.
For certain services, coverage is limited to members younger than 21
Diabetes Supplies and Services
I
n-Network:
Diabetic Supplies and Services:
Copayment for Medicare-covered Diabetic Supplies $0
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:
Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $0
Copayment for Medicare-covered Lab Services $0
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services
20% OP Diag Proc & Tests - OPH20% OP Diag Proc & Tests - PCP20% OP Diag Proc & Tests - SPC20% OP Diag Proc & Tests - UCC20% Sleep Study (Fac Based) - OPH20% Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home
Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $0
Copayment for Medicare-covered Therapeutic Radiological Services $0
Copayment for Medicare-covered X-Ray Services $0
Doctor Office Visits
In-Network:
Doctor Office Visit:
Copayment for Primary Care Office Visit $0
Doctor Specialty Visit
In-Network:
Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $0
Prior Authorization Required for Doctor Specialty Visit
Durable Medical Equipment
In-Network:
Durable Medical Equipment:
Copayment for Medicare-covered Durable Medical Equipment $0
Prior Authorization Required for Durable Medical Equipment
20% Continuous Glucose Monitor - DME Prov$0 Continuous Glucose Monitor - Pharmacy 20% DME - DME Prov20% DME - Pharmacy
Emergency Care
Emergency Care:
Copayment for Emergency Care $0
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours
Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $0
Copayment for Worldwide Emergency Transportation $0
Hearing Services
In-Network:
Hearing Exams:
Copayment for Medicare Covered Benefits $0
Copayment for Routine Hearing Exams $0
Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0
Prior Authorization Required for Hearing Exams
Hearing Aids:
Copayment for Hearing Aids $0
Maximum 2 Hearing Aids every three years
Home Health Care
In-Network:
Home Health Services:
Copayment for Medicare-covered Home Health Services $0
Prior Authorization Required for Home Health Services
Outpatient Mental Health Care
In-Network:
Outpatient Mental Health Services:
Copayment for Medicare-covered Individual Sessions $0
Copayment for Medicare-covered Group Sessions $0
Outpatient Prescription Drugs
In-Network:
Outpatient Part B RX Drugs:
Copayment for Medicare Part B Chemotherapy Drugs $0
Copayment for Other Medicare Part B Drugs $0
Outpatient Rehabilitation Services
In-Network:
Cardiac and Pulmonary Rehabilitation Services:
Copayment for Medicare-covered Cardiac Rehabilitation Services $0
Copayment for Medicare-covered Intensive Cardiac Rehabilitation Services $0
Copayment for Medicare-covered Pulmonary Rehabilitation Services $0
Prior Authorization Required for Cardiac and Pulmonary Rehabilitation Services
Occupational Therapy Rehabilitation Services:
Copayment for Medicare-covered Occupational Therapy Services $0
Prior Authorization Required for Occupational Therapy Rehabilitation Services
Physical Therapy and Speech-Language Pathology Services:
Copayment for Medicare-covered Physical Therapy and Speech-Language Pathology Service $0
Prior Authorization Required for Physical Therapy and Speech-Language Pathology Services
Outpatient Services/Surgery
In-Network:
Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0
Prior Authorization Required for Outpatient Hospital Services
Outpatient Observation Services:
Copayment for Medicare Covered Observation Services $0
Prior Authorization Required for Outpatient Observation Services
Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $0
Prior Authorization Required for Ambulatory Surgical Center Services
Outpatient Substance Abuse
In-Network:
Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $0
Copayment for Medicare-covered Group Sessions $0
Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-Counter Items
Healthy Options Allowance:
$240 monthly allowance on a prepaid spending card. All plan members receive this amount to buy approved over the counter (OTC) health and wellness products at participating retailers. Plus, members may also use this money for eligible groceries, utilities, rent, and more if they have certain qualifying chronic condition(s) and meet other program criteria. Any unused amount rolls over each month and expires at the end of the plan year or upon disenrollment, whichever occurs first.
Podiatry Services
In-Network:
Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $0
Copayment for Routine Foot Care $0
Maximum 12 visits every year
Prior Authorization Required for Podiatry Services
Preventive Services and Wellness/Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services:
Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
COVID-19 shots
Flu shots
Hepatitis B shots
Pneumococcal shots
To***co use cessation
Yearly "Wellness" visit
Prosthetic Devices
In-Network:
Prosthetics/Medical Supplies:
Copayment for Medicare-covered Prosthetic Devices $0
Copayment for Medicare-covered Medical Supplies $0
Prior Authorization Required for Prosthetics/Medical Supplies
Renal Dialysis
In-Network:
Dialysis Services:
Copayment for Medicare-covered Dialysis Services $0
Prior Authorization Required for Dialysis Services
Transportation
Transportation Services:
Copayment for Transportation Services $0
Plan allows 24 one way trips to a Plan-approved location every year
Prior Authorization Required for Transportation Services
This benefit is not to exceed 25 miles per trip.
Urgently Needed Care
Urgent Care:
Copayment for Urgent Care $0
Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $0
Vision Services
In-Network:
Eye Exams:
Copayment for Medicare Covered Benefits $0
Copayment for Routine Eye Exams $0
Maximum 2 Routine Eye Exams (Please see Evidence of Coverage for details)
Prior Authorization Required for Eye Exams
$0 Diab Eye Exam - All POTs 20% Vision Svcs (MC) - SPC
Eyewear:
Copayment for Medicare-Covered Benefits $0
Copayment for Contact Lenses $0
Maximum 1 Pair every year
Copayment for Eyeglasses (lenses and frames) $0
Maximum 1 Pair every year
Copayment for Upgrades $0
Maximum Plan Benefit of $1,100 (Please see Evidence of Coverage for details)
Flexible Extras
Healthy Options Allowance: $240 monthly allowance on a prepaid spending card. All plan members receive this amount to buy approved over the counter (OTC) health and wellness products at participating retailers. Plus, members may also use this money for eligible groceries, utilities, rent, and more if they have certain qualifying chronic condition(s) and meet other program criteria. Any unused amount rolls over each month and expires at the end of the plan year or upon disenrollment, whichever occurs first.
Inpatient care
Inpatient Hospital Care
In-Network:
Acute Hospital Services:
Copayment for Acute Hospital Services per Stay $0
Prior Authorization Required for Acute Hospital Services
Inpatient Mental Health Care
In-Network:
Psychiatric Hospital Services:
Copayment for Psychiatric Hospital Services per Stay $0
Prior Authorization Required for Psychiatric Hospital Services
Skilled Nursing Facility (SNF)
In-Network:
Skilled Nursing Facility Services:
$0 per day for days 1 to 20
$0 per day for days 21 to 100
Prior Authorization Required for Skilled Nursing Facility Services
