Summary of Benefits

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$0 Annual Premium*
$0 Deductible
Part D Prescription Drug Coverage
$0 Preventative Care and Screenings
Over-The-Counter Benefits

  • Up to $696 annual over-the-counter benefits
  • Covers health-related drugs and supplies including cough, cold and allergy medications, first aid supplies and much more at no cost

Dental Coverage

  • Up to $750 in preventive and comprehensive dental benefits annually
  • 2 oral exams and x-rays per year
  • 2 cleanings each year

Vision Coverage

  • 1 routine annual eye exam
  • $100 annual allowance for frames, lenses or contact lenses

*Member must continue to pay their Medicare Part B premium

If you want to compare our plan with other Medicare health plans, ask the other plans for their Summary of Benefits. Or, use the Medicare Plan Finder on

If you want to know more about the coverage and costs of Original Medicare, look in your current “Medicare & You” handbook. View it online at or get a copy by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

Download Summary of Benefits Documents

Nascentia Health Dual Eligible Special Needs Plan (HMO D-SNP) Summary of Benefits (pdf)
Nascentia Health Institutional Special Needs Plan (HMO I-SNP) Summary of Benefits (pdf)

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