surgery plus coverage surgery plus coverage

If you are enrolled in a medical option through American (except DFW ConnectedCare) and have a covered surgery coming up, SurgeryPlus will: This is a voluntary benefit available to you if youre enrolled in the Core, Standard, Plus, High Cost Coverage, PPO 80 or PPO 90 medical option. Transparency It all depends on your policy. Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which We deem experimental in nature; Services for which covered person would not be required to pay in the absence of Dental Insurance; Services or supplies received by covered person before the Dental Insurance starts for that person; Services which are primarily cosmetic (for Texas residents, see notice page section in Certificate); Services which are neither performed nor prescribed by a Dentist except for those services of a licensed dental hygienist which are supervised and billed by a Dentist and which are for: Services or appliances which restore or alter occlusion or vertical dimension; Restoration of tooth structure damaged by attrition, abrasion or erosion, unless caused by disease; Restorations or appliances used for the purpose of periodontal splinting; Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco; Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss; Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work; covered under any workers compensation or occupational disease law; covered under any employer liability law; for which the Policyholder of the person receiving such services is not required to pay; or. Preventive & screening services, Medicare.gov, last accessed June 10, 2022. Fair and simple terms We pay a fair, transparent rate for cases and streamline reimbursement, decreasing your administrative burden. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. This program will be available on January 1, 2020. Policy number TS 05343606-G (High plan) Call our Health Response Center at. For example, rather than paying separately for the surgeon, facility, anesthesiologist, and radiologist, SurgeryPlus negotiates one bundled rate. When you already have a health plan, youll get an SBC automatically at certain times: Even though an SBC is made to make it easier to understand health plan information, sometimes the terms in them can be confusing. Disclaimer Wearing a Suit After a Body-Altering Surgery. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. Whats a Summary of Benefits and Coverage? The State of Delaware is an Equal Opportunity employer and values a diverse workforce. This program utilizes the MetLife PDP Plus Network of participating dentists. Your SurgeryPlus Care Advocate will provide you one-on-one, personalized help each step of the way. Locations Directory 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. startxref This information is provided for educational purposes only. Pre-/postnatal professional care: 35% of our allowance . However, some UnitedHealthcare policies charge lower deductibles . hb```f`` vAX,Xf000Z\ q1=nIc /( Starting January 1, 2018, HIP State Basic and HIP State Plus will cover members age 21 to 64. 0000392965 00000 n What Part B covers, Medicare.gov, last accessed June 10, 2022. The choice is yours. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. endstream endobj 251 0 obj <. You simply need to provide the plan administrator with advanced written notice along with any required premium. 0000379543 00000 n It is not to be used for medical advice, diagnosis or treatment. 0000377893 00000 n We cover the most expensive costs associated with your surgery so youll pay less for your procedure. The inclusion of a code does not imply any right to . HV[kH~GTfJ4C-lKM#si+4swzZ\|P/_^jji>W(W^"SZE~?xerLgibT}gyQtjSFGil2ZZb6#NWM[]uT{:Gk)0 >IZn,:-/855fOneI4nUGqK9G{-hb!E|VXM)65}`OLX|Tb)k``K}L@6%y+ba}f[#e5pr>i:r. Learn more about the ABN. 0000024865 00000 n This may include surgery to remove cataracts or after an eye injury. Reconstructive Procedures include surgery or other procedures which are related to a health condition. 0000010311 00000 n What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. The primary result of . For example, if youre still working and covered by your employer or your spouses employer sponsored health coverage, you may be able to wait. The effective date of coverage for newly added dependent(s) will depend on when we receive notice and required premium. Do your homework. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 0000024943 00000 n 89 37 These partners are required to comply with all laws protecting privacy. If it contains a form, you can print it and fill it out. If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. 988 0 obj Take your bill (s) to your State Farm agent's office. Original Medicare generally covers most pre-existing conditions. Inpatient (Precertification is required): $350 per admission. Trust in our network Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. Procedures can cost from $700 to $2,000 per eye, depending on . trailer You may choose to share the information with your doctor and other medical professionals. Also, your doctor will need to certify that you need certain eligible in-home services. Bariatric surgery is surgery to help you lose weight. To get all the details, youll want to look at complete health plan documents. Maybe youve heard the term, Summary of Benefits and Coverage also called SBC. Its often talked about when it comes to choosing health plans and learning about costs. Surgical Coverage Surgery Surgery Medicare covers many medically necessary surgical procedures. It has less visits to physical, speech and occupational therapies than HIP Plus. By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. An important note: If you want coverage for prescription drugs, you must sign up as soon as youre eligible, unless you have whats called creditable prescription drug coverage elsewhere. h`06NH+500 Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs. 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. The service categories and plan limitations shown below represent an overview of the plan benefits. <>stream Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 endobj <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> It can include Durable Medical Equipment (DME), mental healthcare or ambulance services.2 Preventive care services are health treatments that prevent illness or detect problems at an early stage, like flu shots or cancer screenings.3, There are some things Original Medicare wont cover. Filing a health claim. Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. (Based on internal analysis by MetLife. Savings from enrolling in the MetLife Dental Plan will depend on various factors, including how often participants visit the dentist and the costs for services rendered. The cost of cataract surgery not only depends on the equipment used and the IOL implanted, but on the skill of the surgeon, your overall health, and where you live in the country. Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Refer to the customer's benefit plan document for coverage details. 6 Original Medicare may even pay for corrective lenses if you have surgery to implant an intraocular lens (IOL). You can choose whether or not to use SurgeryPlus for your surgical procedures. Take some time to understand your Medicare plan. Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S SurgeryPlus offers surgical procedures that are covered under the State Group Health Insurance Program, but is different from your health insurance plan because the healthcare services are "bundled" together. Or Reach Us at. Guided Support Medically necessary services diagnose and treat health problems. We will not exclude payment of benefits for such services if the government plan requires that Dental Insurance under the group policy be paid first; Duplicate prosthetic devices or appliances; Replacement of a lost or stolen appliance, Cast Restoration, or Denture; and. received at a facility maintained by the Policyholder, labor union, mutual benefit association, or VA hospital; Services covered under other coverage provided by the Policyholder; Services for which the submitted documentation indicates a poor prognosis; The following when charged by the Dentist on a separate basis: infection control such as gloves, masks, and sterilization of supplies; or. When it comes to Medicare, the question we hear most often after What does it cost? is, What does it cover?. Arrives by Mon, Mar 13 Buy Samickarr Clearance items!Wireless Support Bras For Women Full Coverage And Lift Plus Size Bras Post-Surgery Bra Wirefree Bralette Minimizer Bra For Everyday Comfort at Walmart.com 0000000016 00000 n In some cases, your association and/or the plan administrator may incur costs in connection with providing oversight and administrative support for this sponsored plan. A prime example is breast implants done during or after breast cancer surgery. You may enroll for membership in the ABN directly through the ABN website or during your dental enrollment. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. Yes. Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. Medicare will not pay for 24-hour in-home care or meals delivered to you at home. Please use this access code on website: surgeryplus. You can make monthly payments by monthly bank draft (ACH) or pay for the entire year via credit card payment. Jacksonville, FL 32256 Bigger. <> Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. E-mail / Text Alerts SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. Elected Officials Many Medicare Advantage plans also provide prescription drug coverage (also known as Part D).5, Original Medicare does not include coverage for prescription drugs, but you can buy a stand-alone prescription drug plan to help manage your drug costs. Mon-Fri, 8:30am-5:00pm (CT). This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. 0000011564 00000 n This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. Home. Medicare won't cover Lasik surgery just to avoid the need for glasses. Click Register Now to create your profile and start exploring this free service. SurgeryPlus negotiates all costs before the surgery, so youll pay a single rate for all associated surgical charges, and any bills will come directly from SurgeryPlus. Continuous Glucose Monitors (CGMs)examples include Dexcom and Libre. Coverage will be considered under your out-of-network benefits. The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. You can choose whether or not to use SurgeryPlus for your surgical procedures. These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. Some types of surgery also change the connection between your stomach and intestines. 1026 0 obj 273 0 obj <>/Filter/FlateDecode/ID[<0FC6C6833B2C26439F46B854E028A8C8>]/Index[250 36]/Info 249 0 R/Length 110/Prev 207371/Root 251 0 R/Size 286/Type/XRef/W[1 3 1]>>stream The sharing of health information between these companies is permitted by regulation. For people 65+ or those under 65 who qualify due to a disability or special situation, For people who qualify for both Medicaid and Medicare, Individual & family plans short term, dental & more, Individual & family plans - Marketplace (ACA). What Part A covers, Medicare.gov, last accessed June 10, 2022. An explanation of whats not covered and/or the limits on coverage, Information on costs you might have to pay like deductibles, coinsurance and copayments, Coverage examples, including how coverage works in the case of a pregnancy or a minor injury. Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. Contact us or connect with customer service by calling the number on your health plan ID card to ask for a copy in the language you need. This symbol denotes a PDF Document. Every SBC is created with four double-sided pages and 12-point type. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. Delaware Marketplace However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. Even though its meant to make the information easier to understand, it can seem like a lot at first. Confirm your coverage before you commit to a procedure youre unsure about. To connect with SurgeryPlus today, call 833-709-2445. Public Meetings Overview . You or your dependent use SurgeryPlus to receive a preoperative to post-operative bundled surgical service; SurgeryPlus validates that you or your dependent received the service; and. *Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full, subject to any co-payments, deductibles, cost sharing and benefits maximums. endstream endobj startxref You may need to exhaust your personal resources on medical care before you are eligible. Call a Care Advocate at 833.709.2444 for more information. search a list of these participating dentists online, https://www.metlife.com/support-and-manage/forms-library/, One fluoride treatment per 12-month period for dependent children up to their 14th birthday, Total number of periodontal maintenance treatments and prophylaxis cannot exceed two treatments in a calendar year, For dependent children up to 14th birthday, once per lifetime per tooth area, One application of sealant material every 60 months for each non-restored, non-decayed 1st and 2nd molar of a dependent child up to their 16th birthday, Crown, Denture, and Bridge Repair / Recementations, Initial placement to replace one or more natural teeth, which are lost while covered by the plan, Root canal treatment limited to once per tooth per lifetime, When dentally necessary in connection with oral surgery, extractions or other covered dental services, Except as mentioned elsewhere in certificate, Periodontal scaling and root planning once per quadrant, every 24 months, Your Children, up to age 19, are covered while Dental Insurance is in effect. 0000001266 00000 n 0000004536 00000 n Tax Center Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). For specific LCDs/LCAs, refer to the table for Although most cosmetic surgery is not covered by insurance, certain operations are typically deemed medically necessary when they're done in conjunction with other medical treatments. 0000018849 00000 n But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. endstream To get one, contact us. You can use the Glossary of Health Coverage and Medical Terms, also called a Uniform Glossary to get clear, simple answers about what terms mean. Connect you with a top-ranked, board-certified and fellowship-trained surgeon near you. 125 0 obj <>stream 0000001036 00000 n Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. Yes. You'll be more confident on the beach with an extensive selection of plus-size swimwear. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. 0000005131 00000 n hbbd```b``+@$}D All rights reserved. Austin, TX 78735 In . This surgery makes the stomach smaller. 10739 Deerwood Park Blvd, Suite 200-B Please refer to your Evidence of Coverage or call Customer Service at the number on the back of your Humana ID card to confirm that the service will be covered by your plan. Through the planning process, you will work with the same Care Advocate. 0 The estimate helps you prepare for the cost of dental services. Its also possible to get an SBC in another language. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. %%EOF It also doesnt cover help for whats called activities of daily living, like bathing, getting dressed, using the toilet, eating or moving from place to place within your home.9. Many Medicare Advantage plans, however, do include coverage for routine dental, vision and hearing care, including glasses and hearing aids. Complete and submit the form and well be in touch soon. Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. When will my medical insurance cover oral surgery? We suggest you discuss treatment options with your dentist before services are rendered, and obtain a pre-treatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` Text Size Smaler, Make Text Size local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide; Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food; Initial installation of a fixed and permanent Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Other fixed Denture prosthetic services not described elsewhere in the certificate; Precision attachments, except when the precision attachment is related to implant prosthetics; Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it; Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Fixed and removable appliances for correction of harmful habits; Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards; Diagnosis and treatment of temporomandibular joint (TMJ) disorders. However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. ic+C@nN`RYva@\}KRr>Wq8=Rw+{a .n!LF40d=DdcB42r7hRXyMQ"wDYfuwO se)D+jd7bLB,2}a'_UOaB:.bwRIQGp)` aHeO\@qPtn#u,{n{@|=V<^N}Ap2,+H>0$_ -C Coverage terminates when your membership ceases, insurance ceases for your class, when your dental contributions cease or upon termination of the group policy by the Policyholder or MetLife. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plans reimbursement for those services, and your out-of-pocket expense. The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. For example, breast augmentation for cosmetic reasons isnt covered by Medicare, but reconstructive surgery after a mastectomy is covered.11, Medicare wont cover Lasik surgery just to avoid the need for glasses. You can also go through the SurgeryPlus member portal. startxref To connect with SurgeryPlus today, call 833-709-2445. Medicare pays $781, and your cost is $195. 0000015692 00000 n SurgeryPlus is separate from your health plan and has its own network of high-quality providers. Board Certification, Specialty Training Requirements, Procedure Volume Requirements, State Sanctions Check, Medical Malpractice Claims Review, Criminal Background Checks, CMS Quality Requirements (Hospital Only), Monthly Network Monitoring. Medicare Advantage plans are provided by private companies with approval from Medicare. <>/Filter/FlateDecode/ID[<4A8EC73074B5B2110A00B0B8D090FC7F>]/Index[988 109]/Info 987 0 R/Length 162/Prev 206109/Root 989 0 R/Size 1097/Type/XRef/W[1 3 1]>>stream 0000014887 00000 n General Assembly Whats especially helpful is that every health plan has to use the same outline to show the costs and coverage for each of the plans they offer. The specific travel benefit depends on the procedure, the provider, and the distance between the provider and a member's residence. A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for services provided to plan members. SurgeryPlus is a voluntary benefit that provides pre-planned, non-emergency surgical services. endobj Blue Distinction Centers for Substance Use Treatment and Recovery aims to improve patient outcomes and value by focusing on providers across the full continuum of care who deliver and facilitate treatment for substance use disorder, including opioid use disorder. This symbol denotes a Web Page. Our licensed Humana sales agents are available to help you select the coverage that best meets your needs. Pick the option that's best for you. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. Adjustable straps allow for a better, customized fit. Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. Effective July 1, 2023, all bariatric surgeries will be required to be completed through the SurgeryPlus benefit and performed by a surgeon in the SurgeryPlus network. Copyright 2023 Member Benefits. So you may be responsible for any difference in cost between the dentists fee and your plans benefit payment. endobj Always err on the side of caution! Medicare covers hospice care if the following conditions are met: Medicare does help cover some in-home health services, including: To be eligible, you must be under the care of a doctor and treated under a plan of care that is monitored and reviewed by your doctor. Corporations %PDF-1.4 % SurgeryPlus Frequently Asked Questions General Questions . (Refer to your dental benefits plan summary for your out-of-network dental coverage.) Franchise Tax For the Plus Size Queens. Once your policy takes effect, you can still add or remove dependents to your coverage once per year on the group plan anniversary date of Jan 1 or if you have a qualifying event such as marriage, divorce, birth of a child, and spouses termination of employment. This website is not intended as a contract of employment or a guarantee of current or future employment. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. Help Center Membership in the ABN in required to enroll in this plan. Premiums and the list of covered drugscalled a formularywill vary by plan.6. Read your certificate of insurance for details on plan benefits, limitations, and exclusions. Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. lbSy This symbol denotes a PDF Document. Please fill out the contact form so the right person can be in touch quickly. Your Care Advocate will provide you with personalized support, helping you to understand your benefit, find you excellent care, coordinate any consults and appointments with your SurgeryPlus surgeon and make sure you feel informed every step of the way. TE 6Uz A$& &`5= X7"yH: wd`^+H(`q] DF9qt 0 This Coverage Policy addresses bariatric surgery and procedures for the treatment of morbid obesity. 0000014251 00000 n . However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. Delaware State Code SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. To get you to the right place, click the link below to indicate whether you are a member of Surgery Direct or Cancer Care Direct. The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". 0000019224 00000 n 1XQg&.9mE#(Tq& 285 0 obj <>stream Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations. The following services that are in progress while coverage is in effect will be paid after the coverage ends, if the applicable installment or the treatment is finished within 31 days after individual termination of coverage: Completion of a prosthetic device, crown or root canal therapy. coinsurance and/or deductible on PPO plans, or copay on EPO plans). Weather & Travel, Contact Us POWER Up to HIP Plus! L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) }4Q2L_L 0fI\l!AN7za|*_)2:lU2_kciTX*R:N%` c8B=3 SurgeryPlus is included in your medical benefits at no additional cost to you. What happens with my health information? 0000001436 00000 n RSS Feeds, Make This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. In addition, it comes with a concierge service (Care Advocate) and travel benefits. By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. A reminder that the SBC is only a summary. Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. Copyright 2022 Employer Direct HealthcareAll Rights Reserved. This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. This guide will explain the different types of . Medicare Part B (medical insurance) helps cover the cost of medically necessary durable medical equipment if your doctor prescribes it for use in your home. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. Negotiated fees may extend to services not covered under your plan and services received after your plan maximum has been met, where permitted by applicable state law. 1096 0 obj 0000019705 00000 n This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on The requirements needed for surgery, including any pre-operative tests, screenings, evaluations, and post-operative care will continue to be covered under your Aetna or Highmark Delaware non-Medicare health plan. Policy number TS 05343606-G (High plan) Policy number 5343606-1-G (Low plan) Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166. Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility.