•$699 copay for each Premium 
level hearing aid up to 1per ear 
per year.  
 
You must see aTruHearing 
provider to use this benefit. Call 
1-844-255-7144 to schedule an 
appointment (for TTY, dial 711). 
DENTAL SERVICES  
The cost-share indicated below is what you pay for the covered service.  
Additional dental benefits are available with aseparate monthly premium. Please see the "Optional 
Supplemental Benefits" page for details. 
Medicare-covered dental $40 copay 30% of the cost 
Routine dental