Tennessee D-SNP Options

Preventive Dental $3,000 / Year 120 one way trips, Tennessee Carriers <a href="https://www.uhc.com/communityplan/alphadog/CSTN26HP0337363_000" target="_blank">UHC Evidence of Coverage</a> Drug Formulary Hearing Aids Utilities UHC Dual Complete TN-S001 $2,500 / 2 Years Star Rating $5,000/year DP/DC; $395/month O/F/SSBCI/Other; $3,200/2 years; Lmtd to 1+ of H $3,200 / 2 Years FIDE $5,000 / Year <a href="https://www.uhc.com/communityplan/alphadog/UHTN26HM0350306_001" target="_blank">UHC Drug List Formulary</a> NA - New Plan for 2026 $3,000/year DP/DC; $251/month O/F/SSBCI/Other; $2,500/2 years; Lmtd to 1+ of H <a href="https://www.uhc.com/communityplan/alphadog/CSTN26HP0320018_000" target="_blank">UHC Annual Notice of Changes</a> $4,000 / Year $350 / Year Evidence of Coverage 1-800-690-1606 2026 Plan Name 100 one way trips, Tennessee Carriers UHC Dual Complete TN-Y2 <a href="https://www.uhc.com/communityplan/alphadog/CSTN26HP0320023_000" target="_blank">UHC Summary of Benefits</a> Non Emergency Medical Transportation <a href="https://www.uhc.com/communityplan/alphadog/CSTN26HP0319995_000" target="_blank">UHC Summary of Benefits</a> $251 / Month UHC Dual Complete TN-Y001 $283 / Month Combined Supp. Benefits Coordination Only Food Comprehensive Dental Eyewear $300 / Year Summary of Benefits Plan Phone # $600 / Year <a href="https://www.uhc.com/communityplan/alphadog/CSTN26HP0320022_000" target="_blank">UHC Evidence of Coverage</a> <a href="https://www.uhc.com/communityplan/alphadog/CSTN26HP0332354_001" target="_blank">UHC Summary of Benefits</a> <a href="https://www.uhc.com/communityplan/alphadog/UHTN26HM0360138_001" target="_blank">UHC Drug List Formulary</a> <a href="https://www.uhc.com/communityplan/alphadog/CSTN26HP0319994_000" target="_blank">UHC Evidence of Coverage</a> Plan Type $4,000/year DP/DC; $283/month O/F/SSBCI/Other; $2,500/2 years; Lmtd to 1+ of H <a href="https://www.uhc.com/communityplan/alphadog/CSTN26HM0348851_001" target="_blank">UHC Drug List Formulary</a> <a href="https://www.uhc.com/communityplan/alphadog/CSTN26HP0340694_002" target="_blank">UHC Annual Notice of Changes</a> Annual Notice of Change $395 / Month OTC

Preventive Dental Combined monthly allowance with OTC & Food <a href="https://bluecareplus.bcbst.com/docs/2026_bluecare_plus_fide_formulary.pdf" target="_blank">BlueCross BlueShield Drug List Formulary</a> BlueCare Plus Choice Combined monthly allowance with OTC & Transportation N/C <a href="https://bluecareplus.bcbst.com/docs/2026_bluecare_plus_select_evidence_of_coverage.pdf" target="_blank">BlueCross BlueShield Evidence of Coverage</a> 1-888-413-9637 1-888-413-9639 Non Emergency Medical Transportation Drug Formulary 1-888-413-9638 <a href="https://bluecareplus.bcbst.com/docs/2026_bluecare_plus_summary_of_benefits.pdf" target="_blank">BlueCross BlueShield Summary of Benefits</a> <a href="https://bluecareplus.bcbst.com/docs/2026_bluecare_plus_select_summary_of_benefits.pdf" target="_blank">BlueCross BlueShield Summary of Benefits</a> Combined monthly allowance with Food & Transportation Hearing Aids <a href="https://bluecareplus.bcbst.com/docs/2026_BlueCare_Plus_ANOC.pdf" target="_blank">BlueCross BlueShield Annual Notice of Change</a> 2 every 3 years Utilities Combined Supp. Benefits <a href="https://bluecareplus.bcbst.com/docs/2026_bluecare_plus_choice_evidence_of_coverage.pdf" target="_blank">BlueCross BlueShield Evidence of Coverage</a> <a href="https://bluecareplus.bcbst.com/docs/2026_bluecare_plus_evidence_of_coverage.pdf" target="_blank">BlueCross BlueShield Evidence of Coverage</a> Star Rating <a href="https://bluecareplus.bcbst.com/docs/2026_bluecare_plus_select_formulary.pdf" target="_blank">BlueCross BlueShield Drug List Formulary</a> BlueCare Plus Select Food Comprehensive Dental Eyewear Summary of Benefits Plan Phone # <a href="https://bluecareplus.bcbst.com/docs/2026_bluecare_plus_choice_anoc.pdf" target="_blank">BlueCross BlueShield Annual Notice of Change</a> HMO Plan Type <a href="https://bluecareplus.bcbst.com/docs/2026_bluecare_plus_choice_summary_of_benefits.pdf" target="_blank">BlueCross BlueShield Summary of Benefits</a> BlueCare Plus covered Annual Notice of Change Evidence of Coverage <a href="https://bluecareplus.bcbst.com/docs/2026_bluecare_plus_select_anoc.pdf" target="_blank">BlueCross BlueShield Annual Notice of Change</a> 2026 Plan Name OTC

Preventive Dental $203/month comb. w/ OTC & food $288/month Drug Formulary $0; many svcs; Max $5,500/year Hearing Aids Utilities <a href="https://file.anthem.com/MED2026/1083279TNSENWLP_0138.pdf" target="_blank">Wellpoint Evidence of Coverage</a> <a href="https://file.anthem.com/MED2026/1082158TNSENWLP_0001.pdf" target="_blank">Wellpoint Drug List Formulary</a> $288/month Food/OTC/Utilities/SSBCI; $6,000/year DP/DC <a href="https://file.anthem.com/MED2026/1083280TNSENWLP_0138.pdf" target="_blank">Wellpoint Full Dual Advantage (HMO D-SNP)</a> 833-713-1074 $600/year Star Rating $288/month comb. w/ OTC & food <a href="https://file.anthem.com/MED2026/1083137TNSENWLP_0163.pdf" target="_blank">Wellpoint Summary of Benefits</a> FIDE Wellpoint Full Dual Advantage 2 (HMO D-SNP) <a href="https://file.anthem.com/MED2026/1083137TNSENWLP_0164.pdf" target="_blank">Wellpoint Summary of Benefits</a> $203/month Unlimited One-way trips $175/month comb. w/ OTC & food CO-Only Evidence of Coverage 2026 Plan Name $175/month Non Emergency Medical Transportation $0; Max: Both Ears Combined $3,000/year <a href="https://file.anthem.com/MED2026/1083279TNSENWLP_0140.pdf" target="_blank">Wellpoint Evidence of Coverage</a> Wellpoint Full Dual Advantage Support (HMO D-SNP) Wellpoint Full Dual Advantage (HMO D-SNP) $0; many svcs; Max $6,000/year Combined Supp. Benefits <a href="https://file.anthem.com/MED2026/1083280TNSENWLP_0136.pdf" target="_blank">Wellpoint Full Dual Advantage Support (HMO D-SNP)</a> $203/month Food/OTC/Utilities/SSBCI; $6,000/year DP/DC <a href="https://file.anthem.com/MED2026/1082136TNMENWLP_0151.pdf" target="_blank">Wellpoint Drug List Formulary</a> Food Comprehensive Dental Eyewear $650/year Summary of Benefits Plan Phone # $288/month comb. w/ OTC & utilities <a href="https://file.anthem.com/MED2026/1082158TNSENWLP_0002.pdf" target="_blank">Wellpoint Drug List Formulary</a> $175/month comb. w/ OTC & utilities <a href="https://file.anthem.com/MED2026/1083280TNSENWLP_0140.pdf" target="_blank">Wellpoint Full Dual Advantage 2 (HMO D-SNP)</a> Plan Type <a href="https://file.anthem.com/MED2026/1083126TNSENWLP_0232.pdf" target="_blank">Wellpoint Summary of Benefits</a> Annual Notice of Change $203/month comb. w/ OTC & utilities OTC $175/month Food/OTC/Utilities/SSBCI; $6,000/year DP/DC

Preventive Dental Not Covered <a href="https://assets.humana.com/is/content/humana/H4461038000ANOC26pdf" target="_blank">Humana Annual Notice of Change</a> CO-ONLY Member line: 1-800-457-4708 Non-member line: 1-888-873-0686 $150/month $0; many svcs; Max $4,000/year <a href="https://assets.humana.com/is/content/humana/H4461022000SB26pdf" target="_blank">Humana Summary of Benefits</a> PrevSvcs; Max $4,000/year Non Emergency Medical Transportation Drug Formulary Hearing Aids 100 One-way trips <a href="https://assets.humana.com/is/content/humana/H4461022000ANOC26pdf" target="_blank">Humana Annual Notice of Change</a> Utilities $450/year at PLUS provider; $350/year otherwise PrevSvcs; Max $2,000/year $4,000/year DP/DC; $3,360/year <a href="https://www.humana-medicare.com/BenefitSummary/2026PDFs/H4461038000EOC26.pdf" target="_blank">Humana Evidence of Coverage</a> $280/month comb. w/ OTC & food. Must have qualifying chronic condition and meet other program criteria Combined Supp. Benefits Star Rating $0; limited svcs; Max $2,000/year Food Comprehensive Dental Eyewear Summary of Benefits Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) Plan Phone # $280/month comb. w/ OTC & utilities. Must have qualifying chronic condition and meet other program criteria $2,000/year DP/DC; $1,800/year Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) Plan Type $280/month <a href="https://www.humana-medicare.com/BenefitSummary/2026PDFs/H4461038000SB26.pdf" target="_blank">Humana Summary of Benefits</a> $150/month comb. w/ OTC & food. Must have qualifying chronic condition and meet other program criteria <a href="https://assets.humana.com/is/content/humana/H4461022000EOC26pdf" target="_blank">Humana Evidence of Coverage</a> $150/year at PLUS provider; $75/year otherwise $150/month comb. w/ OTC & utilities. Must have qualifying chronic condition and meet other program criteria <a href="https://assets.humana.com/is/content/humana/20260009PDG2640826Cpdf" target="_blank">Humana Drug List Formulary</a> Annual Notice of Change Evidence of Coverage 2026 Plan Name OTC

Preventive Dental N/A Non Emergency Medical Transportation Drug Formulary <a href="https://content.medicareadvantage.com/2026/Healthspring-H4513-26-1622124028-M-Summary-of-Benefits-HealthSpring-TotalCare-Plus-HMO-D-SNP-H4513-034-SB-2026-SF20250923.pdf" target="_blank">Healthspring Summary of Benefits</a> Hearing Aids HealthSpring TotalCare Plus (HMO-D-SNP) Utilities Combined Supp. Benefits <a href="https://www.healthspring.com/static/docs/medicare/plans/2026/anoc-h4513-034-000.pdf" target="_blank">HealthSpring Annual Notice of Change</a> Star Rating $0 until you’ve spent your $500 yearly allowance. Routine Eyewear Use your yearly allowance for 1 set of eyewear: •Eyeglasses (lenses and frames) •Eyeglass lenses •Eyeglass frames •Contact lenses (including contact lens fitting) •Upgrades 1-800-668-3813 member line 1-800-313-0973 non-member line Food Comprehensive Dental Eyewear Summary of Benefits Plan Phone # $0, many svcs, Max $4,000 year $4,000 yearly dental allowance $225 allowance each quarter Plan Type $0 copay for 1 hearing aid fitting each year. $399–$1,800 copay per device, limited to 2 devices each year. Your actual cost-share depends on the hearing aid(s) you choose. $399 copay per OTC hearing aid kit, limited to 2 kits each year. Kit includes 1 device for each ear and an optional charger. <a href="https://www.healthspring.com/static/docs/medicare/plans/2026/eoc-h4513-034-000.pdf" target="_blank">HealthSpring Evidence of Coverage</a> $0 copay for 50 one-way trips to health-related locations each year <a href="https://www.healthspring.com/medicare/member-resources/drug-list-formulary" target="_blank">HealthSpring Drug List Formulary</a> Annual Notice of Change CO-Only Evidence of Coverage 2026 Plan Name OTC

Preventive Dental HMO-POS D-SNP Yes Non Emergency Medical Transportation Drug Formulary <a href="https://www.healthspring.com/static/docs/medicare/plans/2026/eoc-h4513-034-000.pdf" target="_blank">Wellcare/Centene Evidence of Coverage</a> Hearing Aids <a href="https://www.healthspring.com/static/docs/medicare/plans/2026/anoc-h4513-034-000.pdf" target="_blank">Annual Notice of Change Wellcare/Centene</a> Utilities Wellcare Dual Access Combined Supp. Benefits Star Rating Food Comprehensive Dental Eyewear Summary of Benefits Plan Phone # 1-833-444-9089 <a href="Summary%20of%20Benefits%20Wellcare/Centene" target="_blank">Summary of Benefits Wellcare/Centene</a> Yes* (*If qualified for SSBCI can use your Wellcare Spendables® allowance towards Healthy Food) Yes** (**Special Supplemental Benefits for the Chronically Ill (SSBCI) if qualified) Plan Type Annual Notice of Change <a href="https://fm.formularynavigator.com/FBO/67/12_6T_Basic_Select_MAPD_Comp_Form_26330.pdf" target="_blank">Wellcare/Centene Drug List Formulary</a> Evidence of Coverage 2026 Plan Name OTC