services $40 copay 30% of the cost 
Medicare-covered diabetic eye 
exam $0 copay 30% of the cost 
Medicare-covered glaucoma 
screening $0 copay 30% of the cost 
Medicare-covered eyewear 
(post-cataract) $0 copay 30% of the cost You do not need areferral to receive covered services from plan providers. Certain procedures, services and drugs 
may need advance approval from your plan. This is called a"prior authorization" or "preauthorization." Please