H5216_SB_MAPD_PPO_324000_2023_M Summary of Benefits H5216324000SB23 To find out more about the coverage and costs of Original Medicare, look in the current “Medicare &You” 
handbook. View it online at  http://www.medicare.gov or get acopy by calling 1-800-MEDICARE (1-800-633-4227), 
24 hours aday, seven days aweek. TTY users should call 1-877-486-2048. 
Telehealth services shown are in addition to the Original Medicare covered telehealth. Your cost may be different