[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-197849-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-197849-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","gh00357ghsmn-value-anoc-0825","GH00357GHSMN-Value-ANOC-0825","","Coverage and cost details compare benefit years 2025 and 2026 for Medicare-related services, including premiums, maximum out-of-pocket limits, and cost-sharing for Part A and Part B. The plan premium is listed alongside how out-of-pocket maximums are calculated for covered services, plus copay amounts for primary care, specialist visits, emergency care, inpatient hospital stays, and specific benefit categories such as ambulance services, Brain Fitness, dental services, and colorectal cancer screening. Updates describe prior authorization rules and coverage changes across 2025 to 2026.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/general/","General",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/gh00357ghsmn-value-anoc-0825/197849/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/gh00357ghsmn-value-anoc-0825/197849.png","ImageObject",442,249,{"name":42,"@type":43},"Patrick","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-27","2026-09-03",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",5,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"How do monthly plan premium and maximum out-of-pocket amounts work for 2025 vs 2026?","Question",{"text":63,"@type":64},"The plan lists a monthly plan premium and explains that the premium does not count toward the maximum out-of-pocket amount. The out-of-pocket maximum increases from $3,450 in 2025 to $4,200 in 2026, after which covered Part A and Part B services are paid at no cost for the rest of the calendar year.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What copay changes apply to doctor visits from 2025 to 2026?",{"text":68,"@type":64},"Primary care office visit copays stay the same at $15 per visit. Specialist office visit copays increase from $45 per visit in 2025 to $50 per visit in 2026.",{"name":70,"@type":61,"acceptedAnswer":71},"What are the key coverage and authorization differences for ambulance services and Brain Fitness?",{"text":72,"@type":64},"For non-emergency Medicare air ambulance services, prior authorization is not required in 2025 but is required in 2026. Brain Fitness has a $0 copayment in 2025, while the program is not covered in 2026.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},197849,1788471271,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,114,119,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},17,"Forms",40,"forms",{"id":115,"doc_module":22,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},18,"Letters",30,"letters",{"id":120,"doc_module":22,"doc_module_name":25,"category_name":121,"show_sort_weight":55,"slug":122},21,"Paper Templates","papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":4,"slug":125},158,"general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":124,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":120,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":80,"read_time":139},549758146520,"https://ap-avatar.wpscdn.com/avatar/80002397d8c0411e94?_k=1775819394049821470","|  |  | 2025\u003Cbr>(this year) | 2026\u003Cbr>(next year) |  |  |\n| --- | --- | --- | --- | --- | --- |\n| | Monthly plan premium*\u003Cbr>* Your premium can be higher or lower than this amount. Goto Section 1.1 for details. | $0 | $0 | |  |\n| | Maximum out-of-pocket amount\u003Cbr>This is the most you’ll pay out of pocket for covered Part A and Part B services.(Go to Section 1.2 for details.) | $3,450 | $4,200 | |  |\n| Primary care office visits\u003Cbr>|  | $15 copayment per visit | $15 copayment per visit |  | |\n| Specialist office visits\u003Cbr>|  | $45 copayment per visit | $50 copayment per visit |  | |\n| | Inpatient hospital stays\u003Cbr>Includes inpatient acute, inpatient rehabilitation, longterm care hospitals, and other types of inpatient hospital services. Inpatient hospital care starts the day you’re formally admitted to the hospital with a doctor’s order. The day before you’re discharged is your last inpatient day. | For Medicare-covered inpatient hospital stays, you pay $225 copayment per day for days 1-6; $0 copayment per day for days 7-90 | For Medicare-covered inpatient hospital stays, you pay $225 copayment per day for days 1-6; $0 copayment per day for days 7-90 |  | |\n\n\n|  | 2025\u003Cbr>(this year) | 2026\u003Cbr>(next year) |\n| --- | --- | --- |\n| Monthly plan premium\u003Cbr>(You must also continue to pay your Medicare Part B premium.) | $0 | $0\u003Cbr>There is no change for the upcoming benefit year. |\n| Additional premium for the Optional Dental Rider\u003Cbr>If you’ve enrolled in the Optional Dental Rider, you’ll pay this premium in addition to the monthly plan premium above.\u003Cbr>(You must also continue to pay your Medicare Part B premium.) | $44 | $48 |\n\n\n|  | 2025\u003Cbr>(this year) | 2026\u003Cbr>(next year) |\n| --- | --- | --- |\n| Maximum out-of-pocket amount\u003Cbr>Your costs for covered medical services (such as copayments) count toward your maximum out-of-pocket amount. Our plan premium doesn’t count toward your maximum out-of-pocket amount. | $3,450 | $4,200\u003Cbr>Once you’ve paid $4,200 out of pocket for covered Part A and Part B services, you’ll pay nothing for your covered Part A and Part B services for the rest of the calendar year. |\n\n\n| | 2025\u003Cbr>(this year) | 2026\u003Cbr>(next year) |\n| --- | --- | --- |\n\n\n| Ambulance Services |  |\n| --- | --- |\n| No prior authorization required for non-emergency Medicare air ambulance services. | Prior authorization is required for non-emergency Medicare air ambulance services. |\n| Brain Fitness |  |\n| $0 copayment for the Brain Fitness program. | Brain Fitness program is not covered. |\n\n| Colorectal Cancer Screening\u003Cbr>(Barium Enemas)\u003Cbr>In-Network\u003Cbr>$0 copayment for each Medicare-covered barium enema. | In-Network\u003Cbr>Barium enemas are not covered. |\n| --- | --- |\n\n| Dental Services\u003Cbr>In-Network\u003Cbr>$40 copayment for each Medicare-covered visit. | In-Network\u003Cbr>$50 copayment for each Medicare-covered visit. |\n| --- | --- |\n| $0 copayment for each removable prosthodontics services visit (unlimited visits every year) . | 50% of the total cost for each removable prosthodontics services visit (unlimited visits every year) . |\n| $0 copayment for each implant services visit (unlimited visits every year) . | 50% of the total cost for each implant services visit (unlimited visits every year) . |\n| $0 copayment for each fixed prosthodontics services visit (unlimited visits every year) . | 50% of the total cost for each fixed prosthodontics services visit (unlimited visits every year) . |\n\n\n| | 2025\u003Cbr>(this year) | 2026\u003Cbr>(next year) |\n| --- | --- | --- |\n| Dental Services (continued) | $350 combined maximum plan coverage amount every year. This amount is combined for diagnostic, preventive and comprehensive dental services. | $1,000 combined maximum plan coverage amount every year. This amount is combined for diagnostic, preventive and comprehensive dental services. |\n\n\n| Diabetes Self-Management\u003Cbr>Training, Diabetic Services\u003Cbr>and Supplies\u003Cbr>In-Network\u003Cbr>0% to 35% of the total cost for Medicare-covered diabetic monitoring suppl","cbCaiaqYRlHzJnis","https://ap.wps.com/l/cbCaiaqYRlHzJnis","pdf",1402150,"English","# Cost and Premium Overview\n## Monthly Plan Premium and Optional Dental Rider\n## Maximum Out-of-Pocket Amount\n# Service Copayments and Coverage Rules\n## Primary and Specialist Office Visits\n## Emergency Care\n## Inpatient Hospital Stays\n# Specific Covered Benefits and Changes\n## Ambulance Services\n## Brain Fitness\n## Dental Services\n## Colorectal Cancer Screening\n## Diabetes Self-Management Supplies\n## Fitness Benefit and Hearing Services","[{\"question\":\"How do monthly plan premium and maximum out-of-pocket amounts work for 2025 vs 2026?\",\"answer\":\"The plan lists a monthly plan premium and explains that the premium does not count toward the maximum out-of-pocket amount. The out-of-pocket maximum increases from $3,450 in 2025 to $4,200 in 2026, after which covered Part A and Part B services are paid at no cost for the rest of the calendar year.\"},{\"question\":\"What copay changes apply to doctor visits from 2025 to 2026?\",\"answer\":\"Primary care office visit copays stay the same at $15 per visit. Specialist office visit copays increase from $45 per visit in 2025 to $50 per visit in 2026.\"},{\"question\":\"What are the key coverage and authorization differences for ambulance services and Brain Fitness?\",\"answer\":\"For non-emergency Medicare air ambulance services, prior authorization is not required in 2025 but is required in 2026. Brain Fitness has a $0 copayment in 2025, while the program is not covered in 2026.\"}]","GH00357GHSMN-Value-ANOC-0825 | PDF",7]