Medex 2

This plan supplements Medicare coverage for inpatient and outpatient care, including prescription drugs through the Blue MedicareRxSM. This plan gives you the ability to seek care from any provider participating in Medicare. There’s no need to choose a primary care provider (PCP), although it is recommended.

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Copayments Cost

  • Preventive care, routine physicals, GYN, routine hearing and vision exams: $15 per visit
  • Office visits (sick care/ non-Preventive): Full coverage of Medicare deductible and coinsurance after a $15 copayment per visit
  • Inpatient hospital care - After a $50 calendar-quarter copayment:
    • Full coverage of Medicare deductible and coinsurance
    • Full coverage of lifetime reserve day coinsurance
    • Full coverage of up to 365 additional hospital days in your lifetime when Medicare benefits are used up
  • Outpatient surgery: Full coverage of Medicare deductible and coinsurance
  • CT scans, MRIs, and other imaging tests: Full coverage of Medicare deductible and coinsurance

Pharmacy Coverage

For prescription drug coverage, you also need to enroll in Blue MedicareRxSM. Covered medications are separated into three tiers, and the amount you pay depends on the medication’s tier. You pay the following until your total yearly drug costs reach $1,500.

Prescription Drug Benefit Member Pays (In-Network Costs)
Retail pharmacies $10 for generic drugs
$25 for preferred drugs
$45 for non-preferred drugs
Mail order supply $20 for generic drugs
$50 for preferred drugs
$115 for non-preferred drugs

 

Mental Health

Biologically based mental conditions: Medex provides after a $50 calendar-quarter copayment:

  • Full coverage of Medicare deductible and coinsurance
  • Full coverage of lifetime reserve day coinsurance
  • Full coverage up to a lifetime maximum of 365 additional hospital days when Medicare benefits are used up

Non-biologically based mental conditions: Medex provides after a $50 calendar-quarter copayment:

  • Full coverage of Medicare deductible and coinsurance
  • Full coverage of lifetime reserve day coinsurance
  • Full coverage up to a lifetime maximum of 365 additional hospital days when Medicare benefits are used up

 

Preventive Services

  • Medicare provides coverage for certain preventive services at no cost to members. For the current list of covered preventive services, refer to your Medicare & You handbook or go to medicare.gov. For certain services covered by Medex, you pay a $15 copayment per visit. Some preventive covered services are highlighted below.

 

Plan Documents

View Summary of Benefits