![[spinner]](/javascripts/ext2/resources/images/default/grid/wait.gif)
Covered Benefits and Services - HealthEase
| Compare Benefits | Medicaid/Medipass Only | HealthEase |
| Adult Dental Basic dental services for adults ages 21 and older | Limited to acute emergency dental services to alleviate pain or infection, and partial and full dentures. | Covered in full office visits; X-rays; exams as needed, 2 cleanings per year; unlimited fillings, 1 deep cleaning per year, 2 root planings per year, and extractions when medically necessary. |
| Children’s Dental | All approved Medicaid services. Covered in full. | Covered in full for all Medicaid approved services. You may go to any Medicaid approved provider. |
| Physician Services Physician visits; preventive care visits; diagnosis and treatment | You pay $2 co-pay per visit. | Covered in full No co-payments |
| Adult Vision Care Routine eye exams | Every 3 years as medically necessary | Unlimited When medically necessary |
| Eyeglasses | Limited to new or replacement of glasses (as medically necessary) Limited to two pairs of glasses per year. | Unlimited When medically necessary |
| Optometrics and medical eye care | Covered | Covered in full No co-payments |
| Prescribed Drug Services Prescription drugs | Unlimited generic prescriptions; 21 and older -limited to four brand name prescriptions per month. Under 21-no limit. | Unlimited Generic 21 and older -limited to four brand name prescriptions. Under 21- No limit No special exception needed. No co-payments |
| Transportation Transportation to or from medical care | Covered - no co-pay | Covered - no co-pay |
| Hearing Services Cochlear implants services; diagnostic testing; hearing aids; hearing aid evaluations; hearing aid fitting and dispensing; hearing aid repairs and accessories | Hearing aids limited to one every three years as medically necessary. | Covered Same benefits as Medicaid for those under 21. Adults over age 21 receive one hearing aid every three years, if medically necessary. |
| Outpatient Hospital Services Emergency room visits; lab tests and X-rays; medical supplies such as casts and splints; oxygen and blood transfusion; outpatient surgical procedures; physical therapy | $3 co-pay per visit | Unlimited No co-pay in outpatient hospital setting |
| Inpatient Hospital Services Full patient care | Limited to 45 days for adults. You pay $3 co-pay for each admission to a hospital. Unlimited for children under age 21. | No co-pay Unlimited for children Limited to 45 days for adults |
| Family Planning Services Initial visit | Covered in full. One visit every year | |
| Annual visit | Covered | Covered in full. One visit every year |
| Supply visit & supplies | Covered | Covered in full. No co-pay |
| Independent Lab & X-ray Services | You pay $1 co-pay, per provider, per day. | Covered in full No co-payments Requires primary care |
| Home Health Care Services | You pay $2 per day, per adult | Covered in full No co-payments |
| Durable Medical Equipment (DME) & Prosthetics Durable medical equipment used in the home | Covered in full | Covered in full |
| Prosthetic devices; heart pacemakers; artificial limbs and eyes | Covered in full | Covered in full |
| Dressings; splints; casts and braces | Covered in full | Covered in full |
| Immunizations Appropriate immunizations and vaccines | Covered in full | Covered in full |
| HealthEase also provides these additional services or referrals to organizations providing these services… | Smoking cessation; children’s programs; pregnancy prevention; prenatal-postpartum pregnancy programs; substance abuse and free 24-hour nurse helpline | |
| HealthEase does not require a referral for the following services provided through participating providers… | Referrals not required for vision, hearing, dental, mental health, family planning, early intervention, and dialysis services. | Podiatry; dermatology; expanded adult dental services; chiropractic services; yearly eye exams and glasses; family planning; one annual ob/gyn visit per year |
| Additional Monthly Household Benefit Over-the-counter medicines, vitamins and health supplies | Not covered You pay full cost | No cost to you $25 value every month delivered to your household |
Last modified: 01/22/2007
