Medex 2 Benefits At-A-Glance
Benefit You Pay (In-Network Costs)
Preventive care, routine physicals, GYN, well child, routine hearing and vision exams, family planning Nothing
Office visits (sick care/ non-preventive) Full coverage of Medicare deductible and co-insurance
Emergency room Full coverage of Medicare deductible and co-insurance
Inpatient hospital care

Full coverage of Medicare deductible and co-insurance

Full coverage of lifetime reserve day co-insurance

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 co-insurance
CT scans, MRIs, and other imaging tests Full coverage of Medicare deductible and co-insurance

 

Summary of Benefits Download Summary of Benefits
Prescription Drug Coverage

Your plan includes prescription drug coverage through our Blue MedicareRxSM (PDP) plan. 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 $2,850. For more information, download the Summary of Benefits.

Prescription Drug Benefits You Pay (In-Network Costs)
Retail pharmacies (up to a 30-day supply) $10 for Tier 1
$20 for Tier 2
$35 for Tier 3
Mail service pharmacy (up to a 90-day supply) $20 for Tier 1
$40 for Tier 2
$70 for Tier 3

 

Summary of Benefits Summary of Benefits




Summary of Benefits Mail Service Order Form




Summary of Benefits List of Covered Drugs