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Medicare health plans with drug coverage

What's in this chart

Type: The chart below shows four types of health plans with drug coverage — HMO, PPO, HMO-POS, PFFS. They are explained on the next page.

Premium: The monthly charge for the plan. This is in addition to whatever monthly Part B payment you make to Medicare.

Part B rebate: Some plans pay part of your monthly Part B premium, which for most people will be $104.90.

Doctor copay: This is your cost every time you see a doctor. The first dollar figure is for primary care physicians, the second for specialists. Costs are listed for physicians inside the network (Net:) and outside the network (Out:).

Hospital copay: This is your cost for inpatient hospital care, for each admission. Costs are listed for hospitals inside the network (Net:) and outside the network (Out:).

Estimated total cost: Medicare's estimate of annual out-of-pocket costs under this plan, including Part B premium and drugs. It is based on an average person in good health, but could vary greatly depending on the drugs you take and what services you actually need. The best way to assess the projected cost of different plans is with Medicare's Plan Finder at medicare.gov.

Out-of-pocket cap: Your maximum payment for the year inside the network (Net:) and outside the network (Out:). The lower the cap the better.

Network size: The total number of providers in a network, including doctors, hospitals and other services. Some networks cover a specific region, others the entire state. Before signing up with any plan, check its provider network to see if its hospitals and doctors are acceptable to you.

Generics in the gap: Whether a plan pays for generic drugs in the coverage gap, or "donut hole,'' which begins when total drug costs hit $2,850 and ends when your out-of-pocket costs reach $4,550.

Rating: Medicare rates plans from 1 to 5 stars, based on customer satisfaction and certain health measures. The top rating is five. Plans that have received a low rating three years in a row earn a "warning" symbol.

What's not in this chart

Special Needs Plans: See explanation below.

Copayments for other services: Plans usually charge copayments for drugs, skilled nursing homes, ambulances, emergency rooms and many other services. Check individual plans for these details.

Goodies: Some plans offer some dental, hearing and vision coverage, exercise classes, transportation to the doctor and other extra benefits. Check plans for details.

Health plans without drugs: A few plans are cheaper because they do not offer drug coverage, but choosing those plans can result in stiff penalties in subsequent years unless you receive comparable drug coverage elsewhere

Health plans: how they differ

Medicare allows several types of private health plans, which cover all your care. Here is how they differ:

HMO (Health Maintenance Organization): Generally require you to use providers within a network, unless an emergency forces you to seek treatment elsewhere. A personal physician usually coordinates your care and must approve visits to specialists.

PPO (Preferred Provider Organization): Also encourages you to use providers within a network, with low copayments, but also allows you to use providers outside the network at a higher cost. Usually allows you to see specialists within the network without prior approval of a personal physician. "Regional'' PPOs generally have larger networks, such as the entire state. Some bigger companies allow you to use their PPOs in other states, useful to snowbirds. Verify before signing up.

HMO-POS (HMO-Point of Service): A hybrid between an HMO and PPO. Usually requires you to stay within a network and seek approval of a personal physician before seeing network specialists. But also may cover some care outside the network, with a referral. Some POS plans approve very little coverage outside the network, so check plans for details.

PFFS (Private Fee for Service): Has network, but also allows members to get care outside the network if the provider will accept the plan's payment, which many do not. Make sure your providers will accept payment before incurring bills.

Special Needs Plans: People with certain chronic conditions like diabetes and COPD can sometimes qualify for a Special Needs Plan, which may include extra services for managing their disease. Make sure you qualify before purchasing. People living in nursing homes may also qualify for special plans, as can people on Medicaid.

• Special Needs Plans are not listed in this chart. See medicare.gov for information.

Company Type Counties served Prem. PART B rebate Doctor copay Hospital copay Yearly cost out-of-pocket cap Network size Generics in gap? Rating
AARP Medicare Complete
Contact: 1-800-842-6509
HMO Pin., Hills., Pasco, Her. $0 $0 Net: $5, $45
Out: No coverage
Net: $335 daily for five days
Out: No coverage
$4,220 Net: $5,900
Out: No coverage
20,000 and above No 3.5
AARP Medicare Complete Choice PPO Pin., Hills., Pasco, Her. $0 $0 Net: $10, $45
Out: $40, $70
Net: $335 daily for five days
Out: 40%
$4,250 Net: $5,900
In and out of network: $10,000
20,000 and above No 3
AARP Medicare Complete Choice Plan 2 PPO Pin., Hills., Pasco, Her. $0 $0 Net: $10, $50
Out: $40, $70
Net: $395 daily for four days
Out: 40%
$4,330 Net: $6,700
In and out of network: $10,000
20,000 and above No 3
Aetna Medicare Value
Contact: 1-800-642-0013
HMO Pin., Hills. $37 $0 Net: $10, $45
Out: No coverage
Net: $250 daily for seven days
Out: No coverage
$4,770 Net: $4,900
Out: No coverage
10,001-11,000 No 4
Aetna Medicare Premier HMO Pin., Hills., Pasco $0 $0 Net: $10, $45
Out: No coverage
Net: $250 daily for seven days
Out: No coverage
$4,610 Net: $5,000
Out: No coverage
251-500 Few 4.5
Aetna Medicare Premier PPO Pin., Hills., Pasco $35 $0 Net: $10, $45
Out: 30%, 30%
Net: $275 daily for six days
Out: 30%
$4,850 Net: $6,700
In and out of network: $10,000
20,000 and above No 4
Amerivantage Classic + Rx
Contact: 1-877-470-4131
HMO Pin., Hills., Pasco $0 $0 Net: $0, $25
Out: No coverage
Net: $250 daily for seven days
Out: No coverage
$4,030 Net: $6,700
Out: No coverage
1,501-2,000 No 3.5
BlueMedicare (Plan 5434)
Contact: 1-877-465-1125
PPO Pin., Hills., Pasco, Her. $127 $0 Net: $5, $50
Out: 30%, 30%
Net: $225 daily for seven days
Out: $200 daily for 27 days
$4,860 Net: $3,200
In and out of network: $10,000
2,501-3,000 Many 4
BlueMedicare (Plan 3332) PPO Pin., Hills., Pasco, Her. $0 $0 Net: $15, $50
Out: 50%, 50%
Net: $295 daily for five days
Out: $495 daily for 27 days
$4,490 Net: $6,500
In and out of network: $10,000
4,501-5,000 No 3.5
BlueMedicare LifeTime HMO Pin., Hills., Pasco, Her. $0 $0 Net: $0, $25
Out: No coverage
Net: $150 daily for six days
Out: No coverage
$2,960 Net: $3,900
Out: No coverage
1,001-1,500 Many 3.5
BlueMedicare Prime Time HMO Pin., Hills., Pasco, Her. $0 $0 Net: $0, $35
Out: No coverage
Net: $180 daily for six days
Out: No coverage
$3,290 Net: $3,200
Out: No coverage
2,001-2,500 No 3.5
CareOne
Contact: 1-855-701-8044
HMO Pin., Hills., Pasco $0 $0 Net: $0, $33
Out: No coverage
Net: $125 daily for seven days
Out: No coverage
$3,190 Net: $5,700
Out: No coverage
2,001-2,500 Some, and few brands 4.5
CareOne PLUS HMO Pin., Hills., Pasco $0 $0 Net: $0, $30
Out: No coverage
Net: $95 daily for five days
Out: No coverage
$2,810 Net: $3,400
Out: No coverage
2,001-2,500 Some, and few brands 4.5
CareOne Free HMO Pin., Hills., Pasco $0 $96.40 Net: $0, $35
Out: No coverage
Net: $150 daily for five days
Out: No coverage
$2,300 Net: 5,000
Out: No coverage
2,001-2,500 Few, and few brands 4.5
Coventry Summit Plus
Contact: 1-855-893-1441
HMO Pin., Hills. $0 $32 Net: $0, $25
Out: No coverage
Net: $200 daily for seven days
Out: No coverage
$2,530 Net: $6,700
Out: No coverage
1,001-1,500 No 3.5
Freedom Savings Plan Rx
(Plan 053)
Contact: 1-800-401-2740
HMO Pin. $0 $0 Net: $0, $42
Out: No coverage
Net: $300 daily for seven days
Out: No coverage
$3,750 Net: $3,400
Out: No coverage
12,001-13,000 No 4
Freedom Savings Plan Rx
(Plan 054)
HMO Hills., Pasco, Her. $0 $11 Net: $0, $40
Out: No coverage
Net: $225 daily for seven days
Out: No coverage
$3,530 Net: $3,400
Out: No coverage
11,001-12,000 No 4
Freedom Medicare Plan RX (Plan 059) HMO Pin. $0 $0 Net: $0, $32
Out: No coverage
Net: $225 daily for seven days
Out: No coverage
$3,500 Net: $3,400
Out: No coverage
11,001-12,000 Many 4
Freedom Medicare Plan Rx (Plan 060) HMO Hills., Pasco, Her. $0 $0 Net: $0, $30
Out: No coverage
Net: $175 daily for seven days
Out: No coverage
$3,410 Net: $3,400
Out: No coverage
11,001-12,000 Many 4
Humana Gold Plus
Contact: 1-800-336-6764
HMO Pin., Hills., Pasco, Her. $0 $0 Net: $0, $30*
Out: No coverage
Net: $95 daily for five days**
Out: No coverage
$2,880 Net: $3,400
Out: No coverage
1,001-1,500 Some, and few brands 4.5
Humana Gold Plus
(Plan 141)
HMO Pin., Hills., Pasco, Her. $0 $96.40 Net: $0, $35
Out: No coverage
Net: $150 daily for five days
Out: No coverage
$2,090 Net: $5,000
Out: No coverage
1,501-2,000 Few, and few brands 4.5
Humana Gold Choice PFFS Pin., Hills., Pasco, Her. $103 $0 Net: $10, $35
Out: $10, $35
Net: $290 daily for five days
Out: $290 daily for five days
$5,590 In and out of network: $6,700 11,001-12,000 Few, and few brands 4
Humana Choice PPO Pin., Hills., Pasco, Her. $92 $0 Net: $5, $35
Out: $40, $40
Net: $225 daily for seven days
Out: 30%
$4,760 Net: $5,700
In and out of network: $8,900
20,000 and above Few, and few brands 3.5
Humana Choice
(Plan 74)
PPO Pin., Hills., Pasco, Her. $0 $0 Net: $10, $40
Out: $45, $45
Net: $300 daily for five days
Out: $375 daily for 27 days
$3,980 Net: $5,900
In and out of network: $10,000
20,000 and above Few, and few brands 3.5
Optimum Gold Rewards
(Plan 01)
Contact: 1-866-245-5360
HMO-POS Pin., Hills., Pasco, Her. $0 $80 Net: $0, $25
Out: Limited coverage
Net: $160 daily for five days
Out: No coverage
$2,470 Net: $3,400
Out: No coverage
8,001-8,500 No 3.5
Optimum Gold Rewards
(Plan 032)
HMO-POS Her. $0 $77 Net: $5, $20
Out: Limited coverage
Net: $135 daily for five days
Out: No coverage
$2,250 Net: $3,400
Out: No coverage
8,001-8,500 Many 3.5
Optimum Platinum HMO-POS Pin., Hills., Pasco, Her. $0 $0 Net: $0, $0
Out: Limited coverage
Net: $95 daily for five days
Out: No coverage
$2,830 Net: $3,400
Out: No coverage
8,001-8,500 Many 3.5
Preferred Secure Option
Contact: 1-866-231-7201
HMO Pin., Hills., Pasco, Her. $0 $60 Net: $0, $25
Out: No coverage
Net: $225 daily for seven days
Out: No coverage
$2,690 Net: $6,700
Out: No coverage
2,001-2,500 No 4
Simply More
Contact: 1-888-577-0212
HMO Pin., Hills., Pasco, Her. $0 $0 Net: $0, $15
Out: No coverage
Net: $50 daily for 10 days
Out: no coverage
$2,170 Net: $3,400
Out: No coverage
1,501-2,000 Many 3
Simply Extra HMO Pin., Hills., Pasco, Her. $0 $46 Net: $0, $35
Out: No coverage
Net: $175 daily for 10 days
Out: No coverage
$2,600 Net: $3,400
Out: No coverage
1,001-1,500 No 3
Ultimate Premier
Contact: 1-855-858-7526
HMO Her. $0 $104.90 Net: $0, $20
Out: No coverage
Net: $75 daily for five days
Out: No coverage
$1,850 Net: $3,400
Out: No coverage
251-500 Many No info
Ultimate Premier Plus HMO Her. $0 $0 Net: $0, $0
Out: No coverage
Net: $0
Out: No coverage
$2,640 Net: $3,400
Out: No coverage
251-500 Many No info
WellCare Dividend
Contact: 1-866-765-4385
HMO Pin., Hills., Pasco, Her. $0 $104.60 Net: $0, $30
Out: No coverage
Net: $125 daily for 10 days
Out: No coverage
$2,420 Net: $6,700
Out: No coverage
3,001-3,500 No 3.5
WellCare Value HMO-POS Pin., Hills., Pasco, Her. $0 $0 Net: $0, $0
Out: Limited coverage
Net: $0
Out: 20%
$3,090 Net: $6,700
Out: $6,700
3,501-4,000 No 3.5
WellCare Essential HMO Pin., Hills., Pasco, Her. $0 $0 Net: $0, $0
Out: No coverage
Net: 0
Out: No coverage
$2,930 Net: $6,700
Out: No coverage
5,501-6,000 No 3.5

Note: Physicians United Plan PUP plans are listed by Medicare as available in Florida, but no details were available at press time. Medicare lists Florida Healthcare's Daybreak and Sunrise plans as available in the Tampa Bay area but company management said they are making changes and requested that the plans not be listed on this chart.

* The Humana Gold Plus specialist copay is $24 in Pasco and Hernando counties. ** The Humana Gold Plus hospital copay is $75 daily for five days in Pasco and Hernando counties.

Medicare health plans with drug coverage 10/24/13 [Last modified: Thursday, October 24, 2013 1:18pm]

    

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