Council on Aging Answers 2015 - 111

COUNCIL ON AGING - ORANGE COUNTY

Medicare Advantage Plans Comparison Chart
unitedhealthcare
medicare complete securehorizons
plan 3

aetna
select plus plan

aetna
choice plan
New enrollment:
888-247-1028
Current members:
800-282-5366
aetnamedicare.com
ma-pd (ppo) preferred provider plan with
prescription Drug benefit. may choose any
provider. plan Network providers at lower cost.
$108 monthly premium
Contact plan for health plan deductible

anthem blue cross
medicare preferred standard

New enrollment:
855-248-5383
Current members:
800-950-9355
AARpmedicareplans.com
ma-pd (hmo) medicare Advantage plan with
prescription Drug benefit. must utilize plan
physicians, providers and hospitals.
$28.80 monthly premium

New enrollment:
888-247-1028
Current members:
800-282-5366
aetnamedicare.com
ma-pd (ppo) preferred provider plan with
prescription Drug benefit. may choose any
provider. plan Network providers at lower cost.
$139.00 monthly premium
Contact plan for health plan deductible

20000 and above physicians and providers
$6,700 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.

251-500 physicians and providers
$6,700 In-Network. $10,000 In&Out
In-Network: $10 Out: 40% cost
In-Network: $40 Out: 40% cost
In-Network: Days 1-6: $289, Days 7-90: $0/day, $0/
day beyond 90 days. Out-of-Network: 40% of cost
per stay. Unlimited days each benefit period.
In-Network: Days 1-20: $0, Days 21-100: $156.50/
day. Out-of-Network: 40% of cost/stay. 100 days
each benefit period
In-Network: $1528/stay. Out-of-Network: 40% of
cost/stay. 190-day psychiatric hospital lifetime
limit.
In-Network: $40 each visit. Out-of-Network: 40%
of cost each visit.
In-Network: $0-$264 each visit. Out-of-Network:
40% of cost each visit.
In- and Out-of-Network:
$300 each service
$65 each visit, waived if admitted immediately.
In-Network: $40 each visit. Out-of-Network: 40%
of cost for each visit
In-Network: 20% of cost for medicare-covered
items. Out-of-Network: 40% of cost for medicarecovered items
In-Network: $0-$15 for diagnostic procedures and In-Network: $10-$40 for diagnostic procedures
tests. $100 for diagnostic radiology services.
and tests. 20% of cost for diagnostic radiology
Out-of-Network: 20% of cost
services.
Out-of-Network: 40% of cost
In-Network: $0-$15 each x-ray. Out-of-Network: In-Network: $10-$40 each x-ray. Out-of-Network: In-Network: $20 each x-ray. Out-of-Network: 30%
20% of cost for each x-ray.
40% of cost for each x-ray.
of cost for each
x-ray.
In-Network: $0 for lab services. 20% of cost for
In-Network: $10-$40 for lab services. 20% of
In-Network: $10 for lab services. 20% for
therapeutic radiology services. Out-of-Network: cost for therapeutic radiology services. Outtherapeutic radiology services. Out-of-Network:
20% of cost for lab services and therapeutic
of-Network: 40% of cost for lab services and
30% of the cost for lab services and therapeutic
radiology.
therapeutic radiology.
radiology.
In- and Out-of-Network: 20% of cost for part b
In-Network: 20% of cost
In- and Out-of-Network: 20% of cost for part b
chemotherapy drugs
Out-of-Network: 40% of cost
chemotherapy drugs
In-Network: $15 copay for medicare-covered
In-Network: $40 copay for medicare-covered
In-Network: $0 copay for medicare-covered
benefits.
benefits.
benefits. $0 for up to 1 cleaning and 1 oral exam/
Out-of-Network: 20% of cost for medicareOut-of-Network: 40% of cost for medicareyr. Out-of-Network: $0 copay for medicarecoveredbenefits.
coveredbenefits.
coveredbenefits. 20% of cost for up to 1 cleaning
In- and out-of-network: $0 for cleaning, x-ray(s),
and 1 oral exam/yr.
fluoride treatment, and oral exams. $150 limit/yr.
for preventive services.
In-Network: $15 for diagnostic exams and $0 for In-Network: $40 for diagnostic exams and $0 for In-Network: $30 for diagnostic exams.
up to 1 routine exam/yr.
up to 1 routine exam/yr.
Out-of-Network: 30% of cost for diagnostic exams.
Out-of-Network: 20% of cost for diagnostic exams Out-of-Network: 40% of cost for diagnostic exams
and up to 1 routine exam/yr.
and up to 1 routine exam/yr.

251-500 physicians and providers
$3,300 In-Network. $5,000 In&Out
In-Network: $0 Out: 20% cost
In-Network: $15 Out: 20% cost
In-Network: Days 1-3: $100/day, Days 4-90: $0/day,
$0/day beyond 90 days. Out-of-Network: 20% of
cost per stay. Unlimited days each benefit period.
100 days each benefit period. Contact plan for
In-Network: Days 1-20: $40/day, Days 21-53: $75/
more details.
day, Days 54-100: $0. Out-of-Network: 20% of
cost/stay. 100 days each benefit period
190-day psychiatric hospital lifetime limit. Contact In-Network: Days 1-5: $200. Days 6-90: $0. Out-ofplan for more details.
Network: 20% of cost per stay. 190-day psychiatric
hospital lifetime limit.
20% of the cost each individual or group therapy In-Network: $40 each visit. Out-of-Network: 20%
visit.
of cost each visit.
20% of the cost each visit
In-Network: $0-$100 each visit. Out-of-Network:
20% of cost each visit.
20% of the cost for each service
In- and Out-of-Network:
$100 each service
$65 each visit, waived if admitted within 24-hours. $65 each visit, waived if admitted immediately.
20% of cost each visit
In-Network: $15 each visit. Out-of-Network: 20%
of cost for each visit
20% of cost for medicare-covered items.
In- and Out-of-Network: 20% of cost for medicarecovered items.
20% of cost for diagnostic procedures and tests.
20% of cost for diagnostic radiology services.
20% of cost for each x-ray
$0 for lab services. 20% of cost for therapeutic
radiology services.
20% of the cost for part b chemotherapy drugs
20% of the cost for medicare-covered benefits.

20% of the cost for medicare-covered diagnostic
exams.

20% of the cost to diagnose & treat eye conditions.
$0 for eyewear after cataract surgery. $0 for up to
1 routine exam/2 yrs. $0 for contacts. $0 for up to
1 pair of lenses, frames/2 yrs. ($105 limit/2 yrs. for
contacts; $70 limit/2 yrs. for frames)

In-Network: $15 copay to diagnose & treat eye
conditions, $0 for up to 1 routine eye exam/yr.
Out-of-Network: 20% of cost to diagnose & treat
eye conditions and for up to 1 routine eye exam/yr.
In- and Out-of Network: $0 for contacts, glasses.
20% cost for eyewear after cataract surgery. ($150
limit/yr. for contacts and glasses)

In-Network: $40 copay to diagnose & treat eye
conditions, $0 for up to 1 routine exam/yr., $0 for
eyewear after cataract surgery. Out-of-Network:
40% to diagnose & treat eye conditions, for up to
1 routine exam/yr., and eyewear after cataract
surgery.

New enrollment:
855-306-4537
Current members:
877-811-3107
anthem.com/ca/medicare
ma-pd (ppo) preferred provider plan with
prescription Drug benefit. may choose any
provider. plan Network providers at lower cost.
$130 monthly premium
$1000 Health plan Deductible;
$210 Drug plan Deductible
20000 and above physicians and providers
$6,700 In-Network. $10,000 In&Out
In-Network: $10 Out: $30
In-Network: $30 Out: $45
In-Network: Days 1-5: $195/day. Days 6-90: $0.
Out-of-Network: 20% of cost per stay. 90 days
each benefit period. 60 lifetime reserve days.
In-Network: Days 1-20: $0, Days 21-100: $80/day.
Out-of-Network: 15% of cost/stay. 100 days each
benefit period
In-Network: Days 1-5: $195. Days 6-90: $0/day.
Out-of-Network: 20% of cost per stay. 190-day
psychiatric hospital lifetime limit.
In-Network: $20 each visit. Out-of-Network: 30%
of cost each visit.
In-Network: $0-$100 each visit. Out-of-Network:
30% of cost each visit.
In- and Out-of-Network:
$325 each service
$65 each visit.
In-Network: $50 cardiac, $25 all others; Out-ofNetwork: 30% of cost for each visit
In-Network: 20% of cost for medicare-covered
items. Out-of-Network: 30% of cost for medicarecovered items
In-Network: $0-$100 for diagnostic procedures
and tests. $100 for diagnostic radiology services.
Out-of-Network: 30% of cost

In-Network and Out-of-Network: $0 copay to
diagnose & treat eye conditions. $0 for up to 1
routine exam/yr. and 1 pair of eyewear after
cataract surgery. plan pays $69/yr. for routine eye
exams from any provider.

Confused by Medicare? Call the Council on Aging Orange County HICAP experts at (800) 434-0222
Council On Aging-OrangeisCountychange. This information ismostmost current available fromCenter for medicare and medicaid Services on the datedate of publication. Consumers need to verify this
the the informationthese charts is subJect to change. This information is the the current available from the the Center for medicare and medicaid Services on the of publication. Consumers need to verify
information on on these charts subJect to | 714-479-0107 | 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.
this 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

111

http://www.AARpmedicareplans.com 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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