Vision
Your vision coverage and eyewear allowance
| Your Blue Cross Medicare Advantage plan covers: | Core plan | Comfort plan | Choice plan | Complete plan | Freedom BlueSM plan |
|---|---|---|---|---|---|
| Eye exam (2 per year) 1 per year for Freedom Blue plan | $0 | $0 | $0 | $0 | $0 |
| Eyewear allowance (frames, lenses or contacts) | Core Metro: $275 Core West: $275 Core South: $125 | Comfort Metro: $125 Comfort West: $125 | Choice Metro: $200 Choice West: $150 Choice South: $125 | Complete Metro: $225 Complete West: $200 Complete South: $200 | Freedom: $250 |
| Original Medicare covers: | Core plan | Comfort plan | Choice plan | Complete plan | Freedom Blue plan |
|---|---|---|---|---|---|
| Outpatient services to diagnosis and treat eye diseases and injuries | $0 | $0 | $0 | $0 | $0 |
| Annual glaucoma screening if you are at high-risk: - You have diabetes - You have a family history of glaucoma - You’re African American and age 50 or older - You’re Hispanic and age 65 or older | $0 | $0 | $0 | $0 | $0 |
| Eyewear after cataract surgery | $0 | $0 | $0 | $0 | $0 |
| Diabetic retinopathy exam | $0 | $0 | $0 | $0 | $0 |
For complete details, please visit our Medicare Plan Documents page and select the Evidence of Coverage (EOC) document that is listed under your plan. Vision care information can be found in Chapter 4 of the document.
Dental
Your dental benefits
All Blue Cross and Blue Shield of Minnesota Medicare Advantage plans cover preventive dental care at no extra cost.
| Your Blue Cross plan covers: | Core plan | Comfort plan | Choice plan | Complete plan | Freedom Blue plan |
|---|---|---|---|---|---|
| Preventive Oral exams (2), cleanings (2), fluoride treatments (2), X-rays (1), periodontal cleanings (2) | $0 | $0 | $0 | $0 | $0 |
| Restorative Fillings | Not applicable | 30% coinsurance | 30% coinsurance | 30% coinsurance | 20% coinsurance |
| Comprehensive Extractions, endodontics, periodontics (treatment of periodontitis and gingivitis), special restorative, prosthetics, crowns, oral surgical procedures Note: Cosmetic procedures are not covered. | Not applicable | 50% coinsurance | 50% coinsurance | 50% coinsurance | 20% coinsurance |
| Maximum plan benefit | $2,000 | $2,000 Metro; $1,500 West | $2,000 Metro and South; $1,500 West | $2,000 | $2,500 |
The maximum plan benefit is the maximum amount the plan will pay for all in-network and out-of-network covered dental services.
For dental services performed by an out-of-network dentist, you may be responsible for paying the difference between Blue Cross’ Medicare negotiated fees and the fees your dental provider charges, even for services listed as $0.
For complete details, including the cost sharing of covered services, exceptions and limitations, please visit our Medicare Plan documents page and select the Evidence of Coverage (EOC) document that is listed under your plan. Dental care information can be found in Chapter 4 of the document.
| Original Medicare covers: | Core plan | Comfort plan | Choice plan | Complete plan | Freedom Blue plan |
|---|---|---|---|---|---|
| Hospital performed dental services covered under Part A Generally due to an emergency situation. Fees very based on your plan and in-network or out-of-network facility. | A copayment will apply | A copayment will apply | A copayment will apply | A copayment will apply | A copayment will apply |
Hearing
Your hearing and hearing aid benefits
Your plan covers up to two hearing aids per year.
| Your Blue cross plan covers: | Core plan | Comfort plan | Choice plan | Complete plan | Freedom Blue plan |
|---|---|---|---|---|---|
| Hearing screening (1 per year) Performed by your physician, an audiologist or other qualified provider | $0 | $0 | $0 | $0 | $0 |
| Hearing aid screening (1 per year) Must be performed by your TruHearing provider | $0 | $0 | $0 | $0 | $0 |
| Hearing aid (up to 2 aids per year) Rechargeable battery option is available on select styles for no additional cost. | $699 copay per aid for Advanced Aid or $999 copay per aid for Premium Aid from TruHearing | $599 copay per aid for Advanced Aid or $899 copay per aid for Premium Aid from TruHearing | $599 copay per aid for Advanced Aid or $899 copay per aid for Premium Aid from TruHearing | $499 copay per aid for Advanced Aid or $799 copay per aid for Premium Aid from TruHearing | $599 copay per aid for Advanced Aid or $899 copay per aid for Premium Aid from TruHearing |
Visit TruHearing for more information
| Original Medicare covers: | Core plan | Comfort plan | Choice plan | Complete plan | Freedom Blue plan |
|---|---|---|---|---|---|
| Diagnostic hearing and balance exam Doctor ordered exam to see if you need medical treatment. Your cost share may vary based on your plan and in-network or out-of-network provider/facility. | $0 copay | $0 copay | $0 copay | $0 copay | $0 copay |
TruHearing® is a registered trademark of TruHearing, Inc., an independent company who works with health plans to offer low out-of-pocket costs on hearing aids.
S5743_091024_N01_M
Y0138_091024_N01_M