Amerivantage ESRD Care (HMO-POS C-SNP)

H2593-031-0

Amerivantage ESRD Care (HMO-POS C-SNP)

plan information last updated September 14, 2022

Company: Amerigroup
Plan enrollment: 309
Total monthly premium: $0
Max annual payment: $11,300
Plan link on Medicare.gov: Plan on Medicare.gov
Plan website: https://shop.amerigroup.com/medicare
Plan member phone number: 877-269-5660
Plan prospect phone number: 855-593-0917

OTC Hearing Aid Coverage

Supplemental OTC Benefit Amount Per Period: $100.00
Benefit Amount is Every: Every three months
Can The Benefit Rollover Periods? Yes
Total Annual OTC Supplmental Benefit: $400.00

IMPORTANT NOTE:

Plans may not include hearing aids in their eligible OTC supplemental items. Please call the plan to verify if they include hearing aids in their OTC supplement catalog.

Prescription Hearing Aid Coverage

Does plan cover hearing aids?: Yes
How many hearing aids does the plan allow? No limit defined
What is the max coverage amount? $2,000
Is the benefit per ear or for both ears combined?: Both ears combined
Is the benefit ONLY available in-network? Can be out of network
What time period does the coverage apply to? Every year
Is there a maximum out of pocket cost? No out of pocket maximum
Does the member have to pay Coinsurance? No coinsurance required
Is a CoPay required? Yes
Minimum CoPay: $0
Maximum CoPay: $0
Is Prior Authorization Needed? Yes
Is Physician Referral Needed? No

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