X Ray Copay
- Copay and dental allowance amounts vary by plan View and compare plans by county. Visit one of our participating UPMC for Life Dental Advantage providers for the following preventive benefits: One oral exam and cleaning every six months One bitewing X-ray per year.
- $30 copay for X-ray. $250 copay for advanced radiology services like MRI/CT/PET. $0 copay for lab & Medicare-covered diagnostic tests and procedures $30 copay for X-ray $250 copay for advanced radiology services like MRI/CT/PET. 20%: Emergency Room: $90 copay (waived if admitted) $90 copay (waived if admitted) 20%: Urgent Care: $55: $55: 20%.
- Blood and blood products No copay: Chiropractor No copay: Dentist No copay: Durable medical equipment (purchase) No copay: Durable medical equipment (rent) No copay. Portable X-ray $1 per visit: Prescription brand name Rx $3 per prescription.
- Then you’ll start paying less — a copay or a percentage of the charges (a coinsurance) for the rest of the year. Depending on your plan, you may pay copays or coinsurance for some services without having to. X-rays, CT Scans, and Other Imaging Studies (continued) Review of CT scan of the head or brain $525: Ultrasound of pelvis $385.
Lab Services $5-$10 copay $15-$25 copay OUTPATIENT X-RAYS $5 copay $30 copay ADDITIONAL BENEFITS FITNESS BENEFIT Unlimited number of visits to a SilverSneakers® participating fitness facility. OVER-THE-COUNTER (OTC) $30 Every quarter (3 months) to spend on Plan-approved OTC items.
Covered Services
Learn more about what we cover -including health, dental, and pharmacy.
TRICARE covers:
- X-ray services when
- Prescribed by a physician, and
- Related to a specific illness or injury or a definitive set of symptoms
- Portable X-ray services
- Suppliers must meet the conditions of coverage of the Medicare program or the Medicaid program in that state in which the covered service is provided.
- Reasonable transportation and set-up charges are covered and separately reimbursable.
TRICARE doesn't cover X-rays that aren't related to a specific illness or injury or a definitive set of symptoms except for:
- Cancer screening mammography
- Cancer screening papanicolaou (PAP) tests
- Other tests allowed under the Preventive Services benefit
X Ray Pay
This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.
Last Updated 6/18/2020
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Prescriptions
Vision
Mental Health Therapeutic Services
Health Partners Medicare Prime is a competitive low-cost plan that costs just $37.50 per month, with medical and prescription coverage, plus lots of extra benefits.
Health Partners Medicare Complete is a plan with a $0 plan premium with all the benefits of Original Medicare plus extra benefits!
No matter which plan you choose, you'll get:
- $0 copay for PCP visits + no referrals
- Comprehensive Part D prescription drug coverage
- Transportation to medical appointments + pharmacies
- Healthcare at home with telehealth + Teladoc®
- $150 quarterly allowance for over-the-counter health items
- No medical or Rx deductibles
- Vision care, dental + hearing benefits with generous allowances
- SilverSneakers® or Salvation Army Kroc Center of Philadelphia membership
| Benefit or Service | Health Partners Medicare Prime (HMO-POS) | Health Partners Medicare Complete (HMO-POS) | Original Medicare |
| Primary Care Provider (PCP) Visit | $0 | $0 | 20% |
| Specialist Visit (No referrals) | $30 in-network, 20% out-of-network* | $45 in-network, 20% out-of-network* | 20% |
| Prescription Drugs (for each 30-day supply during initial coverage period) | $0 Deductible $0 Preferred Generic | $0 Deductible $0 Preferred Generic | Not covered (standalone Part D plan required) |
| Diagnostic Testing and Lab Services | $0 copay for lab & Medicare-covered diagnostic tests and procedures $250 copay for advanced radiology services like MRI/CT/PET | $0 copay for lab & Medicare-covered diagnostic tests and procedures $250 copay for advanced radiology services like MRI/CT/PET | 20% |
| Emergency Room | $90 copay (waived if admitted) | $90 copay (waived if admitted) | 20% |
| Urgent Care | $55 | $55 | 20% |
| Routine Transportation | 50 one-way trips | 24 one-way trips | Not included |
| Fitness | $0 copay for SilverSneakers® membership or membership in the Salvation Army Kroc Center of Philadelphia | $0 copay for SilverSneakers® membership or membership in the Salvation Army Kroc Center of Philadelphia | Not included |
| Dental Care | $0 for 2 exams and cleanings, plus X-rays (limits apply) Plan pays $1,500 a year toward supplemental comprehensive dental services | $0 for 2 exams and cleanings, plus X-rays (limits apply) Plan pays $1,200 a year toward supplemental comprehensive dental services | Routine services not covered |
| Hearing | Hearing aids: $0 copay Up to $1,500 every two years | Hearing aids: $0 copay Up to $1,000 every two years | Routine services not covered |
| Vision | $0 for routine annual vision exam $40 for exam to diagnose and treat diseases and conditions of the eye $0 for Medicare-covered eyewear after cataract surgery $0 for one of the following:
| $0 for routine annual vision exam $45 for exam to diagnose and treat diseases and conditions of the eye $0 for Medicare-covered eyewear after cataract surgery $0 for one of the following:
| Routine services not covered |
| Over-the-Counter Items | $150 quarterly allowance, plus rollover Must be used by December 31, 2021 | $150 quarterly allowance, plus rollover Must be used by December 31, 2021 | Not covered |
| Maxiumum Out-of-Pocket | $7,550 per year (medical care) | $7,550 per year (medical care) | No annual limit |
*Out-of-Network specialists must accept Original Medicare. Out-of-network services do not count toward maximum out-of-pocket for medical care.
Ready to talk with a licensed benefit advisor?
We’re happy to explain plan benefits in detail. Just call us at 1-833-477-4773 (TTY 1-877-454-8477). You can call 8 a.m. – 8 p.m., seven days a week, from October 1 through March 31. Call 8 a.m. – 8 p.m., Monday – Friday, the rest of the year.
Or if it’s more convenient, use the links below to schedule a home visit or phone call:
How Much Is X Ray With Insurance
Get more details about our Prime and Complete plans using the information and tools linked below.
Aetna X Ray Copay
- Learn more about Health Partners Plans
- For a personalized 2021 plan evaluation, visit our online enrollment site and click the “Compare Plans” button.