Optional supplemental vision coverage

Members of Providence Medicare Prime + RX (HMO-POS)


Supplemental vision administered by VSP: $8.80/month

Your coverage with a VSP provider
Benefit Description Copay
WellVision exam
  • Focuses on your eyes and overall wellness
  • Every calendar year
$0
Prescription glasses   $25
Frame
  • $150 allowance for a wide selection of frames
  • Every calendar year
Included in prescription glasses
Lenses
  • Single vision, lined bifocal and lined trifocal lenses
  • Every calendar year
Covered in full
Lens enhancements
  •  Progressive lenses
  • Covered in full after $25 copay
Additional $25 for progressive lenses only
Contact lenses – in lieu of glasses
  •  $150 allowance for contacts
  • Every calendar year
$25


Members of Providence Medicare Extra Plans (HMO), Providence Medicare Choice Plans (HMO-POS), Providence Medicare Compass + RX (HMO-POS) and Providence Medicare Latitude + RX (HMO-POS) have routine vision exam and hardware benefits through their plans and are not eligible to enroll in the supplemental vision plan.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The provider network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B premium.