Medex 2 Benefits at a Glance
Benefit You Pay
Preventive care, routine physicals, GYN, routine hearing and vision exams No cost
Office visits (sick care and 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 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 Summary of Benefits
Prescription Drug 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 $2,960. For more information, download the Summary of Benefits.

Initial Coverage You Pay
Standard Retail Cost Sharing One-month supply Two-month supply Three-month supply
Tier 1: Generic drugs $10 $20 $30
Tier 2: Preferred brand drugs $20 $40 $60
Tier 3: Non-preferred brand drugs $35 $70 $105
    Specialty drugs are limited to a one-month supply per fill.
Mail Order Cost Sharing One-month supply Two-month supply Three-month supply
Tier 1: Generic drugs $10 $20 $20
Tier 2: Preferred brand drugs $20 $40 $40
Tier 3: Non-preferred brand drugs $35 $70 $70
    Specialty drugs are limited to a one-month supply per fill.
Summary of Benefits Summary of Benefits




Summary of Benefits Mail Service Order Form




Summary of Benefits List of Covered Drugs