| Foreign travel emergency |
Not covered | Covered up to plan limits | Covered up to plan limits | Covered up to plan limits; separate $250 travel deductible applies | Covered up to plan limits | Covered up to plan limits | Covered up to plan limits; separate $250 travel deductible applies | Covered up to plan limits | Covered up to plan limits |
| Selected additional benefits |
$30 monthly New to Part B discount for the first 12 months when eligibility requirements are met | $30 monthly New to Part B discount for the first 12 months when eligibility requirements are met | Standardized Plan F benefits | $2,950 calendar-year plan deductible; $30 monthly New to Part B discount for the first 12 months when eligibility requirements are met | Annual routine eye and hearing exams, up to $250 eyewear allowance every 24 months, two hearing aids each calendar year with level-based member costs, and qualifying New to Part B discount | Standardized Plan G benefits; $30 monthly New to Part B discount for the first 12 months when eligibility requirements are met | $2,950 calendar-year plan deductible; $30 monthly New to Part B discount for the first 12 months when eligibility requirements are met | Vision and hearing benefits, up to 20 combined routine chiropractic and acupuncture visits each calendar year, and qualifying New to Part B discount | $30 monthly New to Part B discount for the first 12 months when eligibility requirements are met |