Braven Medicare Salute (PPO)
Health Insurance Company: Braven Health
Medicare Advantage Plan Details
- Dental
- Vision
- Hearing
General Plan Details
Additional Benefits
Doctor & Hospital Coverage
Out-of-network: $10 copay per visit
Out-of-network: $50 copay per visit
Out-of-network: $0-10 copay
Emergency Room
$110 copay per visit (always covered)
Ambulance Coverage
In-network: $275 copay
Out-of-network: $275 copay or 20% coinsurance
Lab, X-Ray, Radiology Coverage
Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: In-network: $0-75 copay
Out-of-network: $0-100 copay
Medicare-covered lab services: In-network: $0 copay
Out-of-network: $30-60 copay
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): In-network: $0-300 copay
Out-of-network: $0-300 copay
Medicare-covered x-ray services: In-network: $40-100 copay
Out-of-network: $60-100 copay
Outpatient Surgery Coverage
Outpatient hospital:
Medicare-covered outpatient hospital services: In-network: $300 copay per visit
Out-of-network: $225-400 copay per visit
Hospitalization Coverage
Inpatient hospital-acute:
In-network: $300 per day for days 1 through 7
$0 per day for days 8 through 90
$0 per day for days 91 and beyond
Out-of-network: $450 per day for days 1 through 7
$0 per day for days 8 and beyond
Inpatient hospital psychiatric:
In-network: $295 per day for days 1 through 7
$0 per day for days 8 through 90
Out-of-network: $350 per day for days 1 through 7
$0 per day for days 8 through 90
Rehabilitation Coverage
Occupational therapy services:
In-network: $20-35 copay
Out-of-network: $30-50 copay
Physical therapy and speech and language therapy services:
In-network: $20-35 copay
Out-of-network: $30-50 copay
Urgent Care Coverage
$55 copay per visit (always covered)
Skilled Nursing Facility (SNF)
In-network: $0 per day for days 1 through 20
$214 per day for days 21 through 100
Out-of-network: 20% per stay
20% per day for days 1 through 100
Mental Health Coverage
Medicare-covered individual sessions: In-network: $40 copay
Out-of-network: $50 copay
Medicare-covered group sessions: In-network: $40 copay
Out-of-network: $50 copay
Dental, Vision, Hearing Benefits
Dental Services
Oral exams:
In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays:
In-network: $0 copay
Out-of-network: $0 copay
Vision Benefits
Eye exams:
Routine eye exams: In-network: $0 copay
Out-of-network: 0-50% coinsurance
Eyewear:
Contact Lenses: In-network: $0 copay
Out-of-network: 0-50% coinsurance
Eyeglasses: In-network: $0 copay
Out-of-network: 0-50% coinsurance
Hearing Benefits
Hearing exams:
Routine hearing exams: In-network: $30 copay
Out-of-network: $50 copay
Hearing aids:
Hearing aids (all types): In-network: $299-1,199 copay
Out-of-network: $299-1,199 copay
More Additional Benefits
Plan Links
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