Ambulatory surgical center Covered Covered 
Dentures Not Covered Covered 
Diagnostic 
services/labs/imaging Covered Covered 
Doctor office visits (Primary 
care provider (PCP)/specialists Covered Covered 
Emergency care Covered Covered 
Eyeglasses Not Covered Covered 
Hearing aids Not Covered Covered 
Home and community based 
waiver service programs Covered Not Covered 
Inpatient hospital, nursing 
facility and intermediate care 
facility services in institutions 
for mental diseases (MD), age