
If you select a ConnectiCare VIP Prime Plan, you'll enjoy:
*Some services require pre-authorization
| Medical Coverage | Prime 1 | Prime 2 | Prime 3 | Prime 4 |
|---|---|---|---|---|
| Monthly Premium Plus Medicare Part B Premium |
$0 |
$45 |
$99 |
$0 |
| Annual Deductible | NO |
NO |
NO |
NO |
| Annual In-Network Out-of-Pocket Limit |
NO |
$3,000 |
$1,500 |
NO |
| Prescription Drug Coverage |
YES |
YES |
YES |
NO |
| Primary Care Physician Office Visit |
$15 |
$15 |
$5 |
$10 |
| Specialist Physician Office Visit |
$30 |
$25 |
$15 |
$20 |
| Routine Annual Physical Examination |
$0 |
$0 |
$0 |
$0 |
| Preventative Immunizations & Screenings** |
$0 |
$0 |
$0 |
$0 |
| Routine Annual Eye Examination |
$30 |
$25 |
$15 |
$20 |
| Urgent Care | $30 |
$25 |
$15 |
$20 |
| Outpatient Surgery | $0 to $100*** |
$0 to $75*** |
$0 |
$0 to $100*** |
| Emergency Care $100,000 limit for services |
$50 |
$50 |
$50 |
$50 |
| Inpatient Hospital Care Daily Copayment |
Days 1-7: $200 each dayDays 8-90: $0 each day |
Days 1-7: $75 each dayDays 8-90: $0 each day |
$0 |
Days 1-5: $100 each dayDays 6-90: $0 each day |
Annual Inpatient Hospital |
$2400 |
NO |
NO |
$1000 |
| Dental Coverage (Including Preventive Services) $150 annual limit for dental benefits |
$0 |
$0 |
$0 |
$0 |
| Personal Fitness Programs | NO |
$0 |
$0 |
$0 |
Unless otherwise noted, all services must be provided by a ConnectiCare contracted provider for the ConnectiCare VIP Prime and Custom 1 (In-network) plans. If you obtain routine care from out-of-plan providers, neither Medicare nor ConnectiCare will be responsible for the costs.
**Preventive immunizations and screenings include: Part B Immunizations (Flu, Hepatitis B, and Pneumonia), Mammograms, Colorectal Screening Exams, Prostate Cancer Screening Exams, Pap Smears, Pelvic Exams and Bone Mass Measurement and Abdominal Aortic Aneurysm Screenings.
***$0 copay for Preventative Colonoscopies only.
Here are some helpful questions so you can choose a ConnectiCare Medicare plan that really fits you.
Learn about your options
When you look at all of the plans ConnectiCare offers, you'll see that we're all about options. That's an advantage over Original Medicare alone.
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Call toll-free: 1-877-224-8221 (TTY/TDD 1-800-842-9710), Monday - Friday, 8 am - 8 pm. Extended hours 11/15 - 3/1, 8 am - 8 pm, 7 days a week.
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