福利比較 - PDF 福利比較

Mass General Brigham Advantage (PPO)
麻省總醫院布萊根優勢醫院 (PPO)

Tufts 塔夫茨

In-Network: Primary care physician visit: $0 copay
網路內：初級保健醫師就診：$0 自付費用

預防保健（例如流感疫苗、糖尿病篩檢）網路內所有原始聯邦醫療保險 (Medicare) 承保的預防保健服務共付額為 0 美元，且費用分攤為零。網路外所有原始聯邦醫療保險 (Medicare) 承保的預防保健服務共付額為 0 美元，且費用分攤為零。

Preventive Care (e.g., flu vaccine, diabetic screenings) InNetwork

$0 copay for all preventive services covered under Original Medicare at zero cost sharing. Outnetwork

$0 copay for all preventive services covered under Original Medicare at zero cost sharing.

In-Network and Out-of Network: $90 copay per visit. Worldwide Emergency Coverage: $90 copay. Your copay is waived if you are admitted to the hospital within 24 hours. (HOWEVER Masshealth WILL COVER 100%)
網內及網外：每次就診共付額 90 美元。全球緊急醫療服務：共付額 90 美元。如果您在 24 小時內入院，則免除共付額。（但 Masshealth 將承擔 100% 的費用）

Together both insurance = $0 copay
兩項保險加起來 = 0 美元共付額

Up to $85 per quarter (no carryover) toward over-the-counter health & wellness products.
每季最高可達 85 美元（無結轉），用於購買非處方健康和保健產品。

Over-the-Counter (OTC) Products Card
非處方（OTC）產品卡

85 除以 3 個月 = $28.33 (Visa) Clare Caregiver Challenge 獎金 = $175 (支票) 每月 $203

85 divide by 3month = $28.33 (Visa) Clare Caregiver Challenge bonus = $175 (Check)

$203 per month

$425 credit every 3 month to pay for covered groceries, OTC products for health and hygiene
每 3 個月可獲得 425 美元的抵扣額，用於支付涵蓋的雜貨、健康和衛生用 OTC 產品

That is

$ 61

more per month compared to Tufts as long as they do the health activities that are REQUIRED by Masshealth caregiver. Must do 8hrs annual training. With these classes they can earn time to cut down training next year!
只要他們參加馬薩諸塞州醫療保健機構要求的健康活動，每月收入比塔夫茨大學高出

$ 61

。他們每年必須參加 8 小時的培訓。參加這些課程後，他們可以節省時間，從而減少明年的培訓時間！

Over-the-Counter (OTC) Products Card $0 Limitations, exceptions, & benefit information (rules about benefits) services must be medically necessary
非處方 (OTC) 產品卡 $0 限制、例外和福利資訊（有關福利的規則）服務必須是醫療必需的

常規眼科檢查（每年 1 次）：使用 EyeMed 醫療機構時，共付額為 0 美元。白內障手術後配戴眼鏡或隱形眼鏡（適用於 Medicare 承保的標準眼鏡）：共付額為 0 美元。眼鏡：從 EyeMed 醫療機構購買處方眼鏡或隱形眼鏡，每年最高可享 200 美元。

Routine eye exam (1 every calendar year): $0 copay when using an EyeMed provider.

Eyeglasses or contact lenses after cataract surgery (for Medicare covered standard eyewear): $0 copay.

Eyewear: Up to $200 per calendar year for prescription eyewear or contact lenses purchased from an EyeMed provider.

Eye exams $0 Your provider may need to obtain prior authorization for services. Routine eye exams do not require authorization.
眼科檢查 $0 您的服務提供者可能需要事先獲得服務授權。常規眼科檢查無需授權。

眼鏡或隱形眼鏡 $0 計劃透過 EyeMed Vision Care 網路供應商，每年最高賠償 $300 鏡框或隱形眼鏡。標準單焦、雙焦、三焦或漸進鏡片均可全額報銷。最多

$ 180

來自 EyeMed Vision Care 網路之外的商店。

Glasses or contact lenses $0

Plan pays up to $300year for frames or contact lenses through EyeMed Vision Care network provider.

Standard single, bifocal, trifocal, or progressive lenses are covered in full.

up to

$ 180

from a store not in the EyeMed Vision Care network.

網路內：Medicare 承保的聽力檢查：50 美元自付費用。常規聽力檢查（每年 1 次）：使用 TruHearing 提供者時，0 美元自付費用。助聽器（每年最多 2 個助聽器）：

$ 699

TruHearing Advanced Aids 的每個助聽器共付額為 1 美元，而 TruHearing Premium Aids 的每個助聽器共付額為 999 美元。（但是，只要您就診於 Masshealth 提供者，Masshealth 將承擔 100% 的共付額。Masshealth 將承擔您的所有共付額，因為現在您擁有兩份保險 - 這就是為什麼您的保障非常好的原因。）

In-Network: Medicare- covered hearing exam: $50 copay. Routine hearing exam (1 every calendar year): $0 copay when using a TruHearing provider. Hearing Aids (up to 2 hearing aids every year):

$ 699

copayment per aid for TruHearing Advanced Aids or a $999 copayment per aid for TruHearing Premium Aids.

(HOWEVER Masshealth WILL COVER 100% AS long AS you visit a Masshealth provider Masshealth will pick up all your co-pay cost because now you have 2 INSURANCE- that is WHY your coverage is VERY GOOD)

聽力篩檢 $0 限制、例外及福利資訊（福利規則）- 服務必須具有醫療必要性。您的服務提供者可能需要事先獲得服務授權。常規聽力檢查無需授權。

Hearing screenings $0 Limitations, exceptions, & benefit information (rules about benefits)

- services must be medically necessary Your provider may need to obtain prior authorization for services. Routine hearing exams do not require authorization.

助聽器 $0 您的服務提供者可能需要事先獲得服務授權。作為會員，您可以透過聽力保健解決方案支付 $0 進行常規聽力檢查。您還可以獲得免費的助聽器，並獲得聽力學家的免費評估和驗配。有數量限制。每位會員每 60 個月每隻耳朵可購買一個助聽器。

Hearing aids $0

Your provider may need to obtain prior authorization for services. As a member, you pay $0 for routine hearing exams through Hearing Care Solutions. You can also get free hearing aids with a free evaluation and fitting from an audiologist.

Quantity limit applies. Covers one hearing aid per ear per member every 60 months.

Medicare 承保的牙科檢查：共付額 50 美元。預防服務：使用 DentaQuest 醫療機構時共付額 0 美元。綜合服務：使用 DentaQuest 醫療機構時共付額 0 美元。可能需要事先獲得網路授權。牙科保險涵蓋預防、修復、牙髓治療等 100% 承保（承保人為 DentaQuest），每年最高 1500 美元，最高總承保額。

Medicare-Covered dental exam:

$50 copay.

Preventive Services: $0 copay when using a DentaQuest provider.

Comprehensive Services: $0 copay when using a DentaQuest provider.

May require prior authorization in network.

Dental Coverage 100% coverage for Preventive, Restorative, Endo. & more (Carrier DentaQuest ) $1500/max per Year TOTAL MAX Coverage.

修復和緊急牙科護理 $0 您的提供者可能需要事先獲得服務授權

Restorative and emergency dental care $0

Your provider may need to obtain prior authorization for services

Benefit and/or network limits may apply. Services must be performed by a DentaQuest provider
福利和/或網路限制可能適用。服務必須由 DentaQuest 醫療服務提供者提供

"Routine eye exam (1 every calendar year): $0 copay when using an EyeMed provider. Eyeglasses or contact lenses after cataract surgery (for Medicare covered standard eyewear): $0 copay. Eyewear: Up to $200 per calendar year for prescription eyewear or contact lenses purchased from an EyeMed provider." Eye exams $0 Your provider may need to obtain prior authorization for services. Routine eye exams do not require authorization. "Glasses or contact lenses $0 Plan pays up to $300year for frames or contact lenses through EyeMed Vision Care network provider. Standard single, bifocal, trifocal, or progressive lenses are covered in full. up to $180 from a store not in the EyeMed Vision Care network." "In-Network: Medicare- covered hearing exam: $50 copay. Routine hearing exam (1 every calendar year): $0 copay when using a TruHearing provider. Hearing Aids (up to 2 hearing aids every year): $699 copayment per aid for TruHearing Advanced Aids or a $999 copayment per aid for TruHearing Premium Aids. (HOWEVER Masshealth WILL COVER 100% AS long AS you visit a Masshealth provider Masshealth will pick up all your co-pay cost because now you have 2 INSURANCE- that is WHY your coverage is VERY GOOD)" "Hearing screenings $0 Limitations, exceptions, & benefit information (rules about benefits) - services must be medically necessary Your provider may need to obtain prior authorization for services. Routine hearing exams do not require authorization." "Hearing aids $0 Your provider may need to obtain prior authorization for services. As a member, you pay $0 for routine hearing exams through Hearing Care Solutions. You can also get free hearing aids with a free evaluation and fitting from an audiologist. Quantity limit applies. Covers one hearing aid per ear per member every 60 months." "Medicare-Covered dental exam: $50 copay. Preventive Services: $0 copay when using a DentaQuest provider. Comprehensive Services: $0 copay when using a DentaQuest provider. May require prior authorization in network. Dental Coverage 100% coverage for Preventive, Restorative, Endo. & more (Carrier DentaQuest ) $1500/max per Year TOTAL MAX Coverage." "Restorative and emergency dental care $0 Your provider may need to obtain prior authorization for services" Benefit and/or network limits may apply. Services must be performed by a DentaQuest provider

| Routine eye exam (1 every calendar year): $0 copay when using an EyeMed provider. Eyeglasses or contact lenses after cataract surgery (for Medicare covered standard eyewear): $0 copay. Eyewear: Up to $200 per calendar year for prescription eyewear or contact lenses purchased from an EyeMed provider. | Eye exams $0 Your provider may need to obtain prior authorization for services. Routine eye exams do not require authorization. | Glasses or contact lenses $0 Plan pays up to $300year for frames or contact lenses through EyeMed Vision Care network provider. Standard single, bifocal, trifocal, or progressive lenses are covered in full. up to $\$ 180$ from a store not in the EyeMed Vision Care network. | | :--- | :--- | :--- | | In-Network: Medicare- covered hearing exam: $50 copay. Routine hearing exam (1 every calendar year): $0 copay when using a TruHearing provider. Hearing Aids (up to 2 hearing aids every year): $\$ 699$ copayment per aid for TruHearing Advanced Aids or a $999 copayment per aid for TruHearing Premium Aids. (HOWEVER Masshealth WILL COVER 100% AS long AS you visit a Masshealth provider Masshealth will pick up all your co-pay cost because now you have 2 INSURANCE- that is WHY your coverage is VERY GOOD) | Hearing screenings $0 Limitations, exceptions, & benefit information (rules about benefits) - services must be medically necessary Your provider may need to obtain prior authorization for services. Routine hearing exams do not require authorization. | Hearing aids $0 Your provider may need to obtain prior authorization for services. As a member, you pay $0 for routine hearing exams through Hearing Care Solutions. You can also get free hearing aids with a free evaluation and fitting from an audiologist. Quantity limit applies. Covers one hearing aid per ear per member every 60 months. | | Medicare-Covered dental exam: $50 copay. Preventive Services: $0 copay when using a DentaQuest provider. Comprehensive Services: $0 copay when using a DentaQuest provider. May require prior authorization in network. Dental Coverage 100% coverage for Preventive, Restorative, Endo. & more (Carrier DentaQuest ) $1500/max per Year TOTAL MAX Coverage. | Restorative and emergency dental care $0 Your provider may need to obtain prior authorization for services | Benefit and/or network limits may apply. Services must be performed by a DentaQuest provider |

無共付額。無自付額（不過，只要您就診於 Masshealth 醫療服務提供者，Masshealth 將承擔 100% 的共付額。Masshealth 將承擔您的所有共付額，因為現在您有兩份保險 - 這就是為什麼您的保障非常好的原因）。

No co-pays. No deductibles

(HOWEVER Masshealth WILL COVER 100% AS long AS you visit a Masshealth provider Masshealth will pick up all your co-pay cost because now you have 2 INSURANCE- that is WHY your coverage is VERY GOOD)

Uber、計程車，每季最高 120 美元（不可結轉），用於非緊急交通，例如計程車、公共交通或就診共乘。會員可在接受萬事達卡的地方使用彈性福利卡。 Masshealth 醫療交通 100% 免費；無限次往返於醫生、醫院、實驗室和藥房的就診預約。

Uber, Taxis

Up to $120 per quarter (no carry over)

for non emergent transportation, like taxis, public transportation or rideshare for medical visits. Members can use their Flexible Benefit Card where Mastercard is accepted.

Masshealth 100% Free if Medical transportation; Unlimited rides to and from medical appointments at the doctor, hospital, lab, and pharmacy.

- 無限次往返醫生、醫院、實驗室和藥房的診療預約。 - 每月最多兩次免費往返您選擇的地點（單程20英里）。這包括探望朋友、辦事、參加宗教儀式等等！會員必須使用計劃批准的供應商才能享受此福利。

- Unlimited rides to and from medical appointments at the doctor, hospital, lab, and pharmacy.

- Up to two FREE round-trip rides per month to a location of your choice (20 miles each way of trip). This includes visiting a friend, running errands, attending a religious service, and more! Members must use plan-approved vendor to access benefit.

每 90 天針灸 12 次（最多 20 次）

Acupuncture

12 visits every 90 days (Max 20)

針灸服務：Medicare 為患有慢性下背痛的會員提供 90 天內最多 12 次針灸就診。對於症狀明顯改善的會員，可額外報銷 8 次針灸就診。額外的針灸服務由您的 Medicaid 福利承保。

Acupuncture services:

Medicare covers up to 12 visits in 90 days for members with chronic low back pain. 8 additional visits covered for those demonstrating an improvement.

Additional acupuncture services are covered under your Medicaid benefit.

健康福利每年最高可達 450 美元的綜合津貼，可用於健身、符合資格的減肥計劃（Visa/Mastercard）、Apple Watch 健身器材

Wellness Benefit

Up to a $450 combined annual allowance to use towards fitness, eligible weight loss programs

(Visa/Mastercard)

Apple watch

Exercise machine

免費獲得當地馬薩諸塞州基督教青年會 (YMCA) 設施的年度會員資格，最高可獲得 200 美元的健康津貼，可用於加入健身房、參加活動課程或購買活動追蹤器（每個會員每年僅限購買一個活動追蹤器）

Free annual membership to your local Massachusetts YMCA facility

Up to $200 Wellness Allowance you can use to join a gym, take activity classes or purchase an activity tracker (Activity tracker is limited to one per member per calendar year)