Council on Aging Answers 2015 - 103

COUNCIL ON AGING - ORANGE COUNTY

Medicare Advantage Plans Comparison Chart

These charts include some of the information needed to compare the costs and benefits of the health plans available in Orange County. Plan
coverage and costs change annually. For detailed information regarding the plans and their prescription drug coverage, please contact companies
directly or call the Council on Aging-Orange County hICAP program, at (800) 434-0222, for personalized help with this critical decision.

aetna
medicare select plan
telephone numbers Website

plan type
monthly health and
drug plan premium
size of netWork
out of pocket maximum
doctor visit
specialist visit
in-patient hospitalization

skilled nursing facility
in-patient mental health
outpatient mental health
outpatient hospital services
ambulance
emergency room visit
outpatient rehab services
durable medical equipment
diagnostic tests
x-rays
lab services
part b chemotherapy drugs
dental services

hearing services

vision services

aetna
medicare prime plan

anthem blue cross
select advantage

New enrollment:
888-247-1028
Current members:
800-282-5366
aetnamedicare.com

New enrollment:
855-306-4537
Current members:
888-230-7338
anthem.com/ca/medicare

ma-pd (hmo) medicare Advantage
plan with prescription Drug benefit.
must utilize plan physicians, providers
and hospitals.
$28.00 monthly premium

ma-pd (hmo) medicare Advantage
plan with prescription Drug benefit.
must utilize plan physicians, providers
and hospitals.
$0 monthly premium

18001-19000 physicians and providers
$6,700 In-Network
$0 each visit
$0 each visit
Days 1-6: $264/day, Days 7-90: $0/day.
$0/day after 90 days. Unlimited days
each benefit period.
Days 1-20: $0/day, Days 21-100:
$156.50/day.
100 days each benefit period.

251-500 physicians and providers
$1,950 In-Network
$0 each visit
$0 each visit
$0 copay. Unlimited days each benefit
period.

9001-10000 physicians and providers
$3,400 In-Network
$0 each visit
$0 each visit
$0 copay. 90 days each benefit period.

Days 1-20: $0/day, Days 21-100:
$156.50/day.
100 days each benefit period.

Days 1-20: $0/day, Days 21-100: $75/day.
100 days each benefit period.

$1,528 each stay. 190-day psychiatric
hospital lifetime limit.

$0 copay. 190-day psychiatric hospital
lifetime limit.

$40 each individual or group therapy
visit.
$0 - $264 each visit
$200 each service

$40 each individual or group therapy
visit.
$0 each visit
$200 each service

$30 each individual or group therapy
visit.
$0 - $50 each visit
$145 each service

$65 each visit, waived if admitted
immediately.
$0 each visit
20% of cost for medicare-covered items.
$0 for diagnostic procedures and tests.
20% of the cost for diagnostic radiology
services.
$0-$30 each x-ray

$65 each visit.

$0 each lab service. $0-$60 copay for
therapeutic radiology services.

$0 each lab service. $0-$50 copay for
therapeutic radiology services.

$0 each lab service. 20% of cost for
therapeutic radiology services.

$0 each visit
20% of cost for medicare-covered items.
$0 for diagnostic procedures and tests.
$75 for diagnostic radiology services.
$0 each x-ray

20% of the cost for part b chemotherapy 20% of the cost for part b chemotherapy 20% of the cost for part b chemotherapy
drugs
drugs
drugs
$0 copay for medicare-covered benefits. $0 copay for medicare-covered benefits. $0 copay for medicare-covered benefits.
$0 copay for up to 1 cleaning/yr.
$0 copay for up to 1 oral exam/yr.
$0 copay for diagnostic exams. $0 copay $0 copay for diagnostic exams. $0
$0 copay for diagnostic exams. $0 copay
for up to 1 routine exam/yr.
copay for up to 1 routine exam/yr. $0
for up to 1 routine exam/yr. $0 copay
copay for hearing aid ($500 limit/yr. for for up to 1 fitting-eval./yr. $0 copay
hearing aids).
for hearing aid ($1000 limit/yr. for
hearing aids)
$0 copay to diagnose & treat eye
$0 copay to diagnose & treat eye
$0 copay to diagnose & treat eye
conditions. $0 copay for 1 routine
conditions. $0 copay for 1 routine
conditions. $0 copay for up to 1 routine
exam/yr. $0 copay for eyewear after
exam/yr. $0 copay for eyewear after
exam/yr. $0 copay for eyewear after
cataract surgery.
cataract surgery. $0 copay for eyewear cataract surgery.
($125 limit/yr. for contacts and glasses)

Notes
Out of Pocket Maximum: All
local MA plans must establish
a mandatory maximum outof-pocket (MOOP) amount
for all Medicare Parts A and
B services to mirror the
same out-of-pocket costs
an average beneficiary
would have under Original
Medicare's fee for service
program. After meeting
the MOOP, a beneficiary's
MA plan will cover his/her
remaining Medicare-covered
costs for the rest of the
calendar year. The mandatory
MOOP is $6,700, but plans can
voluntarily set a lower MOOP
at $3,400 in exchange for
more flexibility in setting their
cost-sharing amounts.
Medicare Advantage
Plans: These plans are also
called Medicare health Plans
and are offered by private
companies that contract
with Medicare to provide
Part A and Part B benefits to
people with Medicare. There
are several different types of
Medicare Advantage Plans
incuding hMO's and PPO's.
In this chart you will find the
type of plan, offered by each
company, in the "Plan Type"
row.
Dental Coverage: The
dental coverage benefit
section of this chart details
the standard dental coverage
from each plan. Standard
coverage does not require an
additional premium. Please
verify all information with the
respective plan.

Confused by Medicare? Call the Council on Aging Orange County HICAP experts at (800) 434-0222
the information on these charts is subJect to change. 714-479-0107 | current available from the Center for medicare and medicaid Services on the date of publication. Consumers need to verify this
Council On Aging-Orange County | This information is the most www.coaoc.org
information at www.medicare.gov as updates are frequently made. COAOC is not responsible for these changes but can help with accessing the most current information via our HICAp program 1-800-434-0222.

Answers Guide 2015

103

http://www.aetnamedicare.com http://www.aetnamedicare.com http://www.anthem.com/ca/medicare http://www.medicare.gov

Council on Aging Answers 2015

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