Council on Aging Answers 2015 - 107

COUNCIL ON AGING - ORANGE COUNTY

Medicare Advantage Plans Comparison Chart
easy choice
best plan

easy choice
plus plan

golden state
medicare health plan,
golden

health net
healthy heart

health net
seniority plus
sapphire

New enrollment:
866-999-3945
Current members:
866-999-3945
easychoicehealthplan.com
ma-pd (hmo) medicare Advantage
plan with prescription Drug benefit.
must utilize plan physicians, providers
and hospitals.
$0 monthly premium

New enrollment:
877-541-4111
Current members:
877-541-4111
goldenstatemhp.com
ma-pd (hmo) medicare Advantage
plan with prescription Drug benefit.
must utilize plan physicians, providers
and hospitals.
$0 monthly premium

New enrollment:
800-877-4814
Current members:
800-275-4737
healthnet.com/medicare
ma-pd (hmo) medicare Advantage
plan with prescription Drug benefit.
must utilize plan physicians, providers
and hospitals.
$0 monthly premium

17001-18000 physicians and providers
$6,700 In-Network
$0 each visit
$12 copay each visit
Days 1-5: $125/day. Days 6-90: $0/day.
$0/day after 90 days. Unlimited days
each benefit period.

8001-8500 physicians and providers
$6,700 In-Network
$0 each visit
$0 each visit
Days 1-3: $500/day. Days 4-90: $0/day.
90 days each benefit period. 60 lifetime
reserve days.

4001-4500 physicians and providers
$3,400 In-Network
$0 each visit
$0 each visit
$0 copay. Unlimited days each benefit
period.

1001-1500 physicians and providers
$3,400 In-Network
$0 each visit
$0 each visit
Days 1-5: $200/day. Days 6-90: $0/day.
$0/day after 90 days. Unlimited days
each benefit period.

13001-14000 physicians and providers
$5,900 In-Network
20% of the cost each visit
20% of the cost each visit
90 days each benefit period. 60 lifetime
reserve days. Contact plan for more
details.

Days 1 -20: $0/day, Days 21-100: $50/
day. 100 days each benefit period.
Days 1-3: $300/day. Days 4-90: $0/day.
190-day psychiatric hospital lifetime
limit.
$35 each individual and
$25 each group therapy visit.
$0 - $50 each visit

Days 1-20: $0/day, Days 21-100: $50/day.
100 days covered each benefit period.
$0 copay. 190-day psychiatric hospital
lifetime limit.

Days 1-20: $0/day, Days 21-100: $75/day.
100 days each benefit period.
$900 per stay. 190-day psychiatric
hospital lifetime limit.

100 days each benefit period. Contact
plan for more details.
190-day psychiatric hospital lifetime
limit. Contact plan for more details.

$0 each individual or group therapy
visit.
$0 each visit

$25 each individual or group therapy
visit.
$0 - $200 each visit

20% of cost each individual or group
therapy visit.
20% of cost each visit

$200 each service

Days 1-20: $0/day, Days 21-100: $156.50/
day. 100 days each benefit period.
Days 1-3: $494/day. Days 4-90: $0/day.
190-day psychiatric hospital lifetime
limit.
$0 each individual or group therapy
visit.
$0 copay ambulatory
20% of cost outpatient
20% each service

$60 each service

$250 each service

20% each service

$65 each visit, waived if admitted
within 24 hrs.
$12 each visit

20% of the cost each visit, waived if
admitted within 24 hrs.
$0 each visit

$65 each visit, waived if admitted
within 24 hrs.
$0 each visit

$65 each visit, waived if admitted
immediately.
$0 each visit

20% of cost each visit, waived if
admitted immediately.
20% of cost each visit

0%-20% for medicare-covered items.

20% of cost for medicare-covered items. 20% of cost for medicare-covered items.

$0 for diagnostic procedures and tests.
$0 for diagnostic radiology services.

$0 for diagnostic procedures and tests.
$60 for diagnostic radiology services.

20% of the cost for medicare-covered
items.
$0 for diagnostic procedures and tests.
$75 for diagnostic radiology services.

20% of the cost for medicare-covered
items.
$0 for diagnostic procedures and tests.
20% of the cost for diagnostic radiology
services.
$0 each x-ray
$0 each x-ray
$0 copay for lab services.
$0 copay for lab services.
20% of cost for therapeutic radiology
20% of cost for therapeutic radiology
services.
services.
20% of the cost for part b chemotherapy 20% of the cost for part b chemotherapy
drugs
drugs
$12 for medicare-covered benefits.
$0 for medicare-covered benefits. $0 for
$0-$40 for up to 1 oral exam/6mo.
up to 1 oral exam, up to 1 cleaning, up
$0-$30 for up to 1 x-ray. $10-$55 for
to 1 fluoride treatment/6 mo., $0 copay
up to 1 cleaning and $9-$20 for up to 1 for up to 1 x-ray. ($1,500 limit/yr. most
fluoride treatment/6 mo. ($1,000 limit/ services).
yr. most services)
$12 copay for diagnostic exams. $0
$0 copay for diagnostic exams. $0 copay
copay for up to 1 routine exam and up
for up to 1 routine exam and hearing aid
to 1 hearing aid fitting-eval./yr. $0
fitting-eval./ yr. $0 copay for hearing
copay for hearing aid. ($350 limit/yr. for aid. ($350 limit/yr. for hearing aids)
hearing aids)
$0-$12 copay to diagnose & treat eye
$0 copay to diagnose & treat eye
conditions. $0 copay for eyewear after conditions. $0 copay for eyewear after
cataract surgery. $0 copay for up to 1
cataract surgery. $0 copay for up to 1
routine exam/yr. $0 copay for up to
routine exam, up to 1 pair of glasses,
1 pair of glasses, contacts, lenses and
contacts, lenses and frames/yr. ($100
frames/yr. ($100 limit/yr. for eyewear) limit/yr. for eyewear)

$0 each x-ray
$0 copay for lab services. $0 copay for
therapeutic radiology services.

20% of cost for diagnostic procedures
and tests. 20% of the cost for diagnostic
radiology services.
20% of cost each x-ray
$0 copay for lab services. 20% of cost for
therapeutic radiology services.

$0 each x-ray
$0 copay for lab services.
$60 copay for therapeutic radiology
services.
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. 20% of the cost for medicare-covered
$8/single office visit that includes up to
benefits. $0 for up to 1 oral exam. $0 for
2 cleanings, up to 1 fluoride treatment,
up to 2 cleanings/yr. $0 for up to 1 x-ray
up to 2 oral exams/yr., up to 1 x-ray/3
and up to 1 fluoride treatment/yr.
yrs.
$0 for diagnostic exams. $0 for 1 routine $30 copay for diagnostic exams. $30
exam/yr. $0 for up to 1 hearing aid
copay for up to 1 routine exam/yr.
fitting-eval./2 yrs. $0 for hearing aid.
($400 limit/2 yrs. for hearing aids)
$0 copay to diagnose & treat eye
conditions and up to 1 routine exam/
yr. $0 copay for eyewear after cataract
surgery. $0 for glasses, contacts. ($150
limit/2 yrs. for eyewear)

$0-$30 copay to diagnose & treat eye
conditions. $0 copay for eyewear after
cataract surgery. $30 copay for up to
1 routine exam/yr.

20% of cost for diagnostic exams. $0
copay for up to 1 routine exam/yr. $0 for
up to 1 hearing aid fitting-eval/3 yrs. $0
copay for hearing aid. ($2000 limit/3
yrs. for hearing aids)
20% of cost to diagnose & treat eye
conditions. $0 copay for eyewear after
cataract surgery. $0 copay for up to 1
routine exam/yr. $0 copay for up to 2
pairs of contact lenses, glasses, frames,
lenses/2 yrs. ($500 limit/2 yrs. for
eyewear)

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

107

http://www.easychoicehealthplan.com http://www.easychoicehealthplan.com http://www.goldenstatemhp.com http://www.healthnet.com/medicare http://www.healthnet.com/medicare http://www.medicare.gov

Council on Aging Answers 2015

Table of Contents for the Digital Edition of Council on Aging Answers 2015