This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. “The [Formulary, pharmacy network, and/or provider network] may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B premium, unless it is paid for by Medicaid or another third party. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
This plan is available to anyone who has both Medicare and TennCare or receives Medicare cost-sharing assistance from Medicaid.