At ApexHealth, we like to say, “Welcome to a
new you kind of Medicare.” We create our Medicare Advantage plans to deliver the extra value our members need to help them live life boldly and save money along the way. As we kick off the 2023 Medicare Annual Enrollment Period (AEP), let’s take a look at some 2023 ApexHealth benefits highlights.
1. $0 medical and prescription drug deductible
A deductible means the amount of money you pay before your insurance begins to pay. Deductibles are part of the basic costs for people with Medicare. The amount you pay for a Medicare Advantage plan deductible varies by plan.
For 2023, ApexHealth Medicare Advantage plans have a $0 deductible for both medical and prescription drug coverage. This means that your coverage kicks in right away, regardless of the spending amount!
2. Dental coverage
We’ve already been over what’s missing from Original Medicare – Parts A and B – including most dental care such as cleanings, fillings, tooth extractions, dentures and dental plates. (Just remember Original Medicare will pay for complicated or emergency dental procedures that you get while in the hospital.) You can fill in this coverage gap by enrolling in a Medicare Advantage plan. Coverage and offerings vary by plan, so check with the plan that you’re interested in directly for more information.
For 2023, ApexHealth Medicare Advantage plans give you up to $2,000 for preventive and comprehensive dental services, like cleanings, crowns, dentures, oral surgeries and more (depending on the plan you choose).
3. Vision coverage
Routine vision coverage is not covered by Original Medicare, meaning you will have to pay for eyeglasses, contact lenses and annual routine eye exams yourself. Medigap plans do not offer routine vision coverage either, but Medicare Advantage plans often include coverage or allowance for vision care.
For 2023, ApexHealth Medicare Advantage plans offer up to $200 for glasses and contacts, plus $0 copay for routine optometrist visits (depending on the plan you choose).
4. Hearing aid coverage
We’ve talked about how Original Medicare does not cover hearing aids or the exams to fit them. This means you will pay 100% of the cost for hearing aids and exams for fitting hearing aids. A Medicare Advantage plan will pay for routine annual hearing exams along with fitting and evaluation for hearing aids, and hearing aid allowance, depending on what plan you choose.
For 2023, ApexHealth Medicare Advantage plans offer up to $1,350 in coverage for hearing aids.
5. Health and wellness product allowance
Neither Original Medicare nor Part D pay for Over-the-counter (OTC) drugs or other health and wellness products. Medicare Advantage plans can offer OTC allowances for members so that they can purchase certain medications, first aid supplies, vitamins and other health and wellness products that you may need. Just remember the exact OTC allowances and other benefits of Medicare Advantage plans may vary. (Check out our previous blog post to learn more.)
For 2023, ApexHealth Medicare Advantage plans offer up to $60 per quarter (depending on the plan you choose) to spend on hundreds of health and wellness products listed in our OTC catalog. Unused balances roll over to the next quarter as long as they’re used by the end of the 2023 plan year.
6. Lower prescription out-of-pocket costs and $0 tier 1 preferred generic prescription drug coverage.
Remember that Original Medicare does not cover prescription drugs. This means that you must purchase a Medicare Part D plan or enroll in a Medicare Advantage (MA) plan with Part D coverage (MAPD). If you’re looking for more basics on Medicare Part D, we have you covered in a previous blog post.
For 2023, ApexHealth MAPD plans offer $0 Tier 1 preferred generic prescription drug coverage including $0 Viagra (generic) with a maximum of six (6) tablets per month, up to 72 per year. Also, our plans offer lower prescription out-of-pocket costs including $0 deductible, $0 copay for Tier 1 drugs, newly reduced Tier 2 and Tier 3 drug copays, and $0 for select maintenance medications for diabetes, hypertension and cholesterol, remaining $0 during coverage gap.*
7. The Apex PayFlex Card
Flex cards are debit cards offered by Medicare Advantage plans designed to hep you pay for eligible medical expenses. This helps you avoid paying for these costs out of pocket. Original Medicare does not offer flex cards. Each flex card is different and spending limits depend on the Medicare Advantage plan and the provider.
This is a new benefit offered by ApexHealth Medicare Advantage plans for 2023, and it includes up to $360 (depending on the plan you choose) that you can use for transportation to/from any health location and out-of-pocket expenses that exceed what we cover for your vision and dental benefits. This is a combined benefit up to an annual limit to be used on any or all of the eligible expenses listed above.
8. Free gym membership
At ApexHealth, we like to say that staying active is a great way to live life boldly. Original Medicare does not cover gym memberships or fitness programs, but these may be part of the extra coverage offered by Medicare Advantage plans.
ApexHealth Medicare Advantage plan members have access to free gym memberships in the Silver&Fit network**, including Planet Fitness, YMCA and more. Members also have the option of a Home Fitness Kit also provided through Silver&Fit.
9. Routine chiropractic, acupuncture and therapeutic massage supplemental benefit
Generally, Original Medicare does not cover services ordered by a chiropractor including acupuncture, massage therapy or x-rays, unless certain conditions apply. Visit Medicare.gov for more information on both chiropractic services and acupuncture. Medicare Advantage plans offer the same benefits as Original Medicare, and they may offer more coverage, including supplemental benefits such as massage therapy. Keep in mind that coverage and offerings vary by plan.
For 2023, ApexHealth Medicare Advantage plans include up to 20 combined visits per year with a $30 copay per visit.
At ApexHealth, we like to say we take your health care personally. Our team of ApexAssistants will support your personal healthcare needs for as long as you’re a member of our plan. ApexAssistants are your personal Medicare experts, who know you, your plan, your preferences, and your needs. Your ApexAssistant is your advocate who’s on your side to help and guide you through open enrollment and your time as an ApexHealth member. Learn more.
ApexHealth is also working together with Atrium Health’s nationally recognized network of hospitals and physicians to ensure our members get unmatched expertise and personalized care.
Throughout open enrollment, remember to choose which plan works best for you. If you’re interested in ApexHealth, see where we’re available, and give us a call at (844) 279-0508 (TTY: 711) if you have any questions. Our ApexAssistants will be happy to help you! Our hours of operation are Monday through Friday 8 a.m. – 8 p.m. (local time) from Apr. 1 through Sept. 30 and seven days a week 8 a.m. – 8 p.m. (local time) from Oct. 1 through Mar. 31.
* If you’re wondering what prescriptions are covered by ApexHealth MAPD plans, we try and keep it very easy for you! Visit our online search tool to find covered prescriptions and pharmacies. Or call (844) 279-0508 and ask an ApexAssistant to do the searching for you!
** The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit is a trademarks of ASH and used with permission herein. Kits are subject to change.
***Other providers are available in our network.