Vibra Health Plan  
Enhanced Complete PPO

For a low monthly premium, this Medicare Advantage plan covers all your Medicare Part A and Part B healthcare costs, plus additional benefits – known as Part C. It also includes a prescription drug plan (Part D), hearing, dental and vision coverage, and a fitness benefit.

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Plan Details

Vibra Health Plan Enhanced Complete PPO
Monthly Premium $26
Medical Deductible $0
Primary Care Copay In-network $5 | Out-of-network $5
Specialist Copay In-network $25 | Out-of-network $25
Routine Vision Coverage One eye exam per calendar year:  
In-network $20 copay / Out-of-network 50% coinsurance.
Eyeglass, Contacts & Frames Coverage $125 allowance toward eyeglass frames or contact lenses every 2 years.
Hearing Coverage In-network $0 / Out-of-network 50% coinsurance for routine hearing exam and hearing aid fitting evaluation ($400 allowance every 3 years for hearing aids).
Preferred Pharmacy Initial Coverage (tiered coverage 1/2/3/4/5/6) $0 | $0 | $40 | $93 | 33% | $0
Standard Pharmacy Initial Coverage (tiered coverage 1/2/3/4/5/6) $15 | $20 | $47 | $100 | 33% | $7
Gap Coverage 25% Generic Drugs / 25% Brand
Out-of-pocket Max $5,800 In-network / $10,000 Combined
Enhanced Dental Coverage

Limit 2 Visit per Contract (Calendar) Year

In-network $10 | Out-of-network 50% coinsurance 
Visit Includes: Exam, Cleaning, 2 Bitewing X-Rays, Excludes Fluoride Treatments 
Medicare-Covered Benefits: Physician Specialist Copay 
In-network and Out-of-Network:
Wrap-Around: $2,000 Max Plan Allowance per Contract (Calendar) Year After: 
50% Coinsurance Palliative Emergency Treatment 
50% Coinsurance Amalgam and Composite Fillings 
50% Coinsurance Simple Extractions 
50% Coinsurance Endodontics 
50% Coinsurance Major Restorative (Crowns, Inlays, Onlays) 
50% Coinsurance Prosthodontics 
50% Coinsurance Adjustments and Repairs of Prosthetics 
Out-of-network Coinsurance Applied to Charges
Over-the-counter $25 monthly allowance for over-the-counter (OTC) drugs and supplies. Unused allowance may not be carried over from the one month to the next.
Transportation Benefit 24 plan approved round trips.
Meals Benefit - Post Hospital Discharge 2 meals per day for 7 days.
In-home Support Services: Grandkids on Demand 5 hours per month included.
Medical Nutritional Therapy $0 Copay
Nutritional/Dietary Benefits $0 Copay
Fresh Produce Subscription 
(Limit one box per month)
$0 Copay 
(Member must have diabetes, chronic lung disorder, congestive heart failure or cardiovascular disease)
AmWell Online Doctors  $0 Copay
Health Coaching and Education Benefit $0 Copay
SilverSneakers® Fitness Benefit $0 Copay
Transitional Support Services $0 Copay
Services Supporting Self-Direction $0 Copay

For more details, please review the Summary of Benefits

You can use these Star Ratings to compare our plan's performance to other plans.

Updated October 1, 2020