| | 2026 Plan Sharp Direct Advantage (HMO) |
| |
| Monthly plan premium | $291.38 |
| Deductible | $0 |
| Annual out-of-pocket maximum (medical) | $1,500 |
| |
| Preventive care | $0 |
| Primary care physician visit | $0 |
| Specialist physician visit | $0 |
| Lab services / x-rays | $0 |
| Diagnostic radiology (e.g., MRIs) | $0 |
| Physical therapy | $0 |
| Outpatient rehabilitation | $0 |
| |
| Urgently needed services | $0 |
| Emergency room (waived if admitted to hospital) | $50 |
| Hospitalization | $0/day |
| Outpatient surgery | $0 |
| |
| Routine eye exam | $10 |
| Hearing aids | $1,000 allowance every 36 months |
| Silver&Fit | $0 |
| Chiropractic care | $15, limit 20 visits per year |
| Acupuncture |
| Over-the-counter (OTC) items | Up to $100 per quarter |
| Prescription drug
coverage | |
| 30-day retail prescription drugs | |
| Preferred generic / generic | $5 / $5 |
| Preferred brand / non-preferred | $20 / $50 |
| Specialty / Select Care
| $20 / $0 |
| 100-day mail prescription drugs | |
| Preferred generic / generic | $10 / $10 |
| Preferred brand / non-preferred | $40 / $100 |
| Specialty / Select Care
| N/A / $0 |
| 100-day long-term at retail | |
| Preferred generic / generic | $15 / $15 |
| Preferred brand / non-preferred | $60 / $150 |
| Specialty / Select Care
| N/A / $0 |