| 2025 Plan Benefits | Leon MediMax (HMO D-SNP) | ||
|---|---|---|---|
| Prescription Drugs | |||
| Initial Coverage Phase | $2,000 | ||
| Dental | |||
| Comprehensive Dental Maximum Benefit | $2,500 | ||
| Vision | |||
| Eyewear Lenses and Frames | $525 maximum benefit (up to 3 pairs each year) | ||
| Hearing Services | |||
| Hearing Aids | $2,100 maximum benefit / 3 years ($1,050 per hearing aid, per ear) | ||
| Drugs/OTC | |||
| Maximum Annual Benefit | $300 | ||
| Leon Plus Card | |||
| Maximum Annual Benefit | $1,500 | ||
| Part B Premium Give Back | |||
| Part B Premium Reduction | not applicable | ||
| Acupuncture | |||
| Routine | $0 for up to 25 visits | ||
| Medical | |||
| PCP Visit | $0 | ||
| Inpatient Hospital (per admission) | $0 | ||
| Lab Services and X-Rays | $0 | ||
| 2025 Plan Benefits |
|---|
| Leon MediMax (HMO D-SNP) |
| Prescription Drugs |
| Initial Coverage Phase |
| $2,000 |
| Dental |
| Comprehensive Dental Maximum Benefit |
| $2,500 |
| Vision |
| Eyewear Lenses and Frames |
| $525 maximum benefit (up to 3 pairs each year) |
| Hearing Services |
| Hearing Aids |
| $2,100 maximum benefit / 3 years ($1,050 per hearing aid, per ear) |
| Drugs/OTC |
| Maximum Annual Benefit |
| $300 |
| Leon Plus Card |
| Maximum Annual Benefit |
| $1,500 |
| Part B Premium Give Back |
| Part B Premium Reduction |
| not applicable |
| Acupuncture |
| Routine |
| $0 for up to 25 visits |
| Medical |
| PCP Visit |
| $0 |
| Inpatient Hospital (per admission) |
| $0 |
| Lab Services and X-Rays |
| $0 |
Membership Benefits
- View Leon MediMax Summary of Benefits
- View Leon MediMax Formulary
- View Leon MediMax Annual Notice of Changes
- View Leon MediMax Evidence of Coverage
- View Dental Schedule of Benefits
- Request Printed Materials
