b'Plan Comparisons: Medicare-Eligible MembersUnitedHealthcare Group Medicare Advantage PPOHumana Group Medicare HMOwith Express Scripts Medicare (PDP) for CTPF Medicarewith Part D Pharmacy Medicare Advantage planAdvantage planOUTPATIENT SERVICES OUTPATIENT SERVICESChemotherapy, Radiation100% after deductible Chemotherapy, RadiationChemotherapy: 100% after $50 copay outpatient hospital; Emergency Room $50 $25 copay specialists office. Radiation: 100% outpatient hospital; 100% after $25 copay specialists office.Lab/X-Ray100% after deductible Emergency Room Speech, Physical & Occupational Therapy,$50 Copay emergency room; waived if admitted Outpatient Rehab100% after deductible within 24 hours; applies for care outside USSurgery100% after deductible Lab/X-Ray100% covered; any applicable office visit copay may applyUrgent Care100% after deductible Speech, Physical & Occupational Therapy, PROFESSIONAL & OTHER SERVICES Outpatient RehabAmbulance100% after deductible 100% per visit after $25-$40 copay(based on where services are rendered)Allergy Shots100% after deductible SurgeryChiropractic Visits100% after deductible (unlimited visits);$100Copay per visit in hospitalMedicare covered services $75Copay per visit in ambulatory surgical facilityDental100% after deductible; Medicare covered services only Urgent Care Diabetic Part B Covered Supplies100% covered $25CopayHearing PROFESSIONAL & OTHER SERVICESMedicare-covered Services: 100% after deductible Ambulance$50 Copay per date of serviceRoutine (Non-Medicare) Services: $0 copay routine examAllergy ShotsNo copayHearing Aids: $1,000 allowance purchased in network through UnitedHealthcare Hearing every three years Chiropractic Visits$20 Copay;Home Health Services100% after deductible Medicare guidelines applyPhysician Office Visits100% after deductible Dental$25 copay (Medicare covered services only)Preventive Care (physicals, diagnostics, someDiabetic Part B Covered Supplies100% coveredimmunizations)100% covered(1 physical per plan year) Hearing$10 Copay at PCP, $25 copay specialist, Prosthetic Devices, Med. Equip100% after deductible Medicare covered services only.PodiatryHome Health ServicesNo copay (prior authorization Medicare-covered Services100% after deductible required) excludes personal home careRoutine (Non-Medicare) Services100% after deductible,Physician Office Visits6 visits per year $10 Copay PCP,$25 Copay specialistRenal Dialysis100% after deductible Preventive Care (physicals, diagnostics, Transplants100% after deductible immunizations)No copayVision ServicesProsthetic Devices, Med. Equip10% at medical Medicare covered Services: 100% after deductible;equipment provider or pharmacyEye Wear: $0 copay Medicare covered standard eyeglassPodiatry$25 Copay; Medicare covered services onlylenses and frames after cataract surgery.Renal DialysisNo copay in dialysis center; 20% at Routine (Non-Medicare Covered) Services: $0 copay annualhospitalroutine eye exam; $300 eye wear allowance every 12 months. TransplantsAs any other disease at Medicare-Extra Benefits (wellness, discounts) $60/quarter over theapproved Humana National Transplant Network only counter products benefit, HouseCalls, Fitness Benefit, hearing aid discount, Wellness programs, Renew Rewards, Lets MoveVision Services$25 Copay; Medicare covered and more. Contact carrier for more benefit details. services only Extra Benefits (wellness, discounts)Contact carrier 1818 CTPF 2026 MEDICARE HEALTH INSURANCE HANDBOOK for extra benefit details. CTPF 2026 MEDICARE HEALTH INSURANCE HANDBOOK'