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Additional Benefits Diabetic $0 copay at your network retail or Supplies mail-order pharmacy for Diabetic Supplies such as: • Lifescan (One Touch®) Glucose Meters • Lancets • Test Strips Important Note: Insulin, insulin syringes and needles for self - administration in the home are obtained from an in -network retail or mail order pharmacy and are covered under your Medicare Part D pharmacy benefit. Applicable Part D co -pays and deductibles apply. Lifescan (OneTouch®) as well as other brands of glucose meters and test strips can also be obtained through our participating DME network. ■ 40% of the Medicare -allowed amount after $2,000 out -of -network deductiblE Medicare Diabetes . $0 co a for Medicare -covered p y 40% of the Medicare -allowed amount Prevention services Program Podiatry ■ $45 copay for each Medicare -covered ■ 40% of the Medicare -allowed amount podiatry visit after $2,000 out -of -network deductiblE Chiropractic ■ $20 copay for each Medicare -covered ■ 40% of the Medicare -allowed amount chiropractic service after $2,000 out -of -network deductible Medical ■ 20% of the Medicare -allowed amount ■ 40% of the Medicare -allowed amount Equipment and for all plan approved, Medicare- after $2,000 out -of -network Supplies 0 covered motorized wheelchairs and deductible (Authorization electric scooters applies to in- ■ 0% of the Medicare -allowed amount network for all other plan approved, services only.) Medicare -covered durable medical equipment Occupational ■ $35 copay per visit 0 40% of the Medicare -allowed amount and Speech after $2,000 out -of -network Therapy deductible 11 337