MEDICARE 2018
Medicare Advantage: Health Plans with Drug Coverage

What’s in this chart

Type: The chart shows three types of health plans with drug coverage: HMO, PPO and HMO-POS.

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. If you are new to Medicare in 2017 or your premium is not deducted from your Social Security check, Part B premiums are $134 per month (can be higher depending on income or other criteria). Rebates in this chart are based on $134.

Drug deductible: In some plans, you pay a deductible before drug coverage kicks in. A drug deductible might not apply to all drugs or tiers.

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

Hospital copay: This is your cost for each inpatient hospital admission - both inside the network (Net) and outside the network (Out). For outpatient hospital coverage, refer to Medicare’s Plan Finder at medicare.gov.

Yearly cost (Est.): Medicare’s estimate of your out-of-pocket costs under this plan, including your Part B premium and drugs. It is based on an average person in good health, but could vary greatly depending on the actual drugs and services you need. The best way to project costs 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.

IMPORTANT: These out-of-pocket limits do not apply to your prescription drug costs.

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 $3,750 and ends when your out-of-pocket costs reach $5,000.

Rating: Medicare rates plans from 1 to 5 stars, based on customer satisfaction and certain health measures. The top rating is a 5. People with Medicare can switch into a 5-star plan at any time during the year even if it is not during an enrollment period.

What’s not in this chart

Private Fee for Service Plans (PFFS) and Special Needs Plans (SNPs): See explanation below and medicare.gov for details.

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. Unless you have comparable coverage elsewhere, using these plans can result in stiff penalties if you ever want Medicare drug coverage in later years.

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 requires you to use providers within a network. A personal physician usually coordinates your care and may need to approve visits to specialists.

PPO (Preferred Provider Organization): 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 may require you to seek approval of a personal physician before seeing network specialists. It may cover some care outside the network. 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 provider 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.

PlanTypeCounties ServedPrem.Part B RebateDrug Deduct.Doctor Copay (per visit)Hospital CopayYearly Cost (est.)Out-of-pocket CapNetwork SizeGenerics in Gap?Rating: Out of 5 stars
AARP MedicareComplete
H1045-028
Contact: 1-800-555-5757
HMOPin., Hills., Pasco, Her.$0$0$245Net: $0-$10, $45
Out: N/A
Net: $295 daily for 6 days
Out: N/A
$4,760Net: $4,900
Out: N/A
18,001-19,000No4
AARP MedicareComplete Choice
H2228-033
PPOPin., Hills., Pasco, Her.$77$0$250Net: $5, $35
Out: $45-$70,$70
Net: $275 daily for 4 days
Out: 40% per stay
$5,390Net: $3,600
In and Out of network:$10,000
18,001-19,000No3.5
AARP MedicareComplete Choice Plan 2 R7444-003PPOPin., Hills., Pasco, Her.$0$0$395Net: $15, $50
Out: $45, $70
Net: $395 daily for 4 days
Out: 40% per stay
$5,050Net: $6,700
In and Out of network:$10,000
18,001-19,000No4
Aetna Medicare Choice Plan
H1609-028
Contact: 1-833-828-1713
HMO- POSPin., Hills.$0$0$200Net: $0, $45
Out: N/A, $50
Net: $375 daily for 4 days
Out: 50% per stay
$4,340Net: $6,700
In and Out of network:$10,000
7,501-8,000Yes4
Aetna Medicare Premier Plan
H5521-033
PPOPin., Hills., Pasco$0$0$250*Net: $10, $50
Out: $50, $50
Net: $395 daily for 4 days
Out: 50% per stay
$4,730Net: $6,700
In and Out of network:$10,000
9,001-10,000Yes4
Allwell Medicare
H9276-006
Contact: 1-844-293-2636
HMOHills.$0$0$0Net: $0, $20
Out: N/A
Net: $150 daily for 5 days
Out: N/A
$3,300Net: $4,900
Out: N/A
1,501-2,000YesToo new to be rated
Allwell Medicare
H9276-001
HMOPin.$0$0$0Net: $0, $20
Out: N/A
Net: $100 daily for 6 days
Out: N/A
$3,370Net: $5,900
Out: N/A
2,501-3,000YesToo new to be rated
Allwell Medicare Premier
H9276-002
HMOPin., Pasco, Her.$0$95$0Net: $0, $35
Out: N/A
Net: $150 daily for 5 days
Out: N/A
$2,830Net: $6,700
Out: N/A
2,501-3,000NoToo new to be rated
Allwell Medicare Premier
H9276-007
HMOHills.$0$92$0Net: $0, $30
Out: N/A
Net: $200 daily for 6 days
Out: N/A
$2,860Net: $6,700
Out: N/A
1,501-2,000NoToo new to be rated
BlueMedicare Choice R3332-001
Contact: 1-855-601-9465
PPOPin., Hills. Pasco, Her.$41$0$260*Net: $10, $45
Out: 50% per visit
Net: $295 daily for 5 days
Out: $495 daily for 27 days
$5,410Net: $6,700
In and Out of network:$10,000
4,501-5,000Yes3.5
BlueMedicare Classic
H1026-057
HMOHills., Pasco, Her.$0$0$0Net: $0, $40
Out: N/A
Net: $225 daily for 7 days
Out: N/A
$4,300Net: $6,500
Out: N/A
501-1,000Yes3.5
BlueMedicare Preferred
H2758-006
HMOPin.$0$0$0Net: $0, $15
Out: N/A
Net: $120 daily for 5 days
Out: N/A
$3,610Net: $3,400
Out: N/A
501-1,000Yes3.5
BlueMedicare Preferred POS
H2758-008
HMO- POSPin.$0$0$0Net: $0, $25
Out: $30, $45
Net: $120 daily for 5 days
Out:Coming soon**
$4,070Net: $4,900
Out: $8,000
501-1,000Yes3.5
BlueMedicare Select
H5434-002
PPOPin., Hills.$147.80$0$305Net: $5, $45
Out: 40%
Net: $225 daily for 7 days
Out: $200 daily for 27 days
$6,170Net: $5,900
In and Out of network:$10,000
2,501-3,000Yes3.5
CareFree
H1019-060
Contact: 1-855-450-1352
HMOPin., Hills., Pasco$0$94$0Net: $0, $30
Out: N/A
Net: $195 daily for 5 days
Out: N/A
$2,520Net: $3,400
Out: N/A
4,501-5000No4.5
CareOne PLUS
H1019-054
HMOPin., Hills., Pasco$0$0$0Net: $0, $25
Out: N/A
Net: $95 daily for 7 days
Out: N/A
$3,250Net: $3,400
Out: N/A
4,501-5000Yes4.5
Coventry Medicare Summit Plan
H1609-020
Contact: 1-833-828-1713
HMOPin., Hills.$0$0$0Net: $0, $32
Out: N/A
Net: $195 daily for 6 days
Out: N/A
$3,770Net: $3,400
Out: N/A
7,001-7500Yes4
Freedom Medicare Plan Rx
H5427-060
Contact: 1-800-401-2740
HMOHills., Pasco, Her.$0$0$0Net: $0, $35
Out: N/A
Net: $150 daily for 7 days
Out: N/A
$4,130Net: $3,400
Out: N/A
11,001-12,000Yes4
Freedom Medicare Plan Rx
H5427-059
HMOPin.$0$0$0Net: $0, $30
Out: N/A
Net: $225 daily for 7 days
Out: N/A
$4,150Net: $3,400
Out: N/A
11,001-12,000Yes4
Humana Gold Plus (025)
H1036-025
Contact: 1-855-795-9488
HMOPin., Hills., Pasco$0$0$0Net: $0, $25
Out: N/A
Net: $95 daily for 7 days
Out: N/A
$3,300Net: $3,400
Out: N/A
4,001-4,500Yes4.5
Humana Gold Plus (067)
H1036-067
HMOHer.$0$0$0Net: $0, $20
Out: N/A
Net: $75 daily for 7 days
Out: N/A
$3,230Net: $3,400
Out: N/A
251-500Yes4.5
Humana Gold Plus (265)
H1036-265
HMOPin., Hills., Pasco, Her.$0$94$0Net: $0, $40
Out: N/A
Net: $195 daily for 5 days
Out: N/A
$2,990Net: $6,700
Out: N/A
5,001-5,500No4.5
HumanaChoice Florida (072)
H5216-072
PPOPin., Hills., Pasco, Her.$0$0$150Net: $10, $40
Out: $65, $65
Net: $360 daily for 5 days
Out: $495 daily for 27 days
$4,800Net: $6,700
In and Out of network: $10,000
14,001-15000No4
HumanaChoice
(005)
R5826-005
PPOPin., Hills., Pasco, Her.$98$0$100*Net: $5, $40
Out: $45, $45
Net: $225 daily for 7 days
Out: 40% per stay
$5,710Net: $6,700
In and Out of network: $10,000
20,000 and aboveNo3.5
HumanaChoice
(074)
R5826-074
PPOPin., Hills., Pasco, Her.$0$0$405*Net: $20, $50
Out: $60, $60
Net: $450 daily for 4 days
Out: $495 daily for 27 days
$5,160Net: $6,700
In and Out of network: $10,000
20,000 and aboveNo3.5
Optimum Gold Plus Plan
H5594-032
Contact: 1-866-245-5360
HMOHer.$0$104.90$0Net: $0, $20
Out: N/A
Net: $150 daily for 7 days
Out: N/A
$2,550Net: $3,400
Out: N/A
10,001-11,000Yes5
Optimum Gold Rewards Plan
H5594-001
HMOPin., Hills., Pasco, Her.$0$90$0Net: $0, $40
Out: N/A
Net: $195 daily for 6 days
Out: N/A
$3,040Net: $3,400
Out: N/A
10,001-11000Yes5
Optimum Platinum Plan
H5594-002
HMOPin., Hills., Pasco, Her.$0$0$0Net: $0, $5
Out: N/A
Net: $0
Out: N/A
$3,470Net: $3,400
Out: N/A
10,001-11,000Yes5
Simply More
H5471-052
Contact: 1-888-577-0212
HMOPin., Hills., Pasco, Her.$0$0$0Net: $0, $10
Out: N/A
Net: $50 daily for 8 days
Out: N/A
$2,750Net: $6,700
Out: N/A
6,501-7,000Yes4
Ultimate Elite
H2962-003
Contact: 1-855-858-7526
HMOPasco$0$105$0Net: $0, $20
Out: N/A
Net: $90 daily for 5 days
Out: N/A
$2,040Net: $3,400
Out: N/A
501-1,000Yes3.5
Ultimate Premier
H2962-001
HMOHer.$0$105$0Net: $0, $20
Out: N/A
Net: $90 daily for 5 days
Out: N/A
$2,040Net: $3,400
Out: N/A
501-1,000Yes3.5
Ultimate Premier Plus
H2962-002
HMOPasco, Her.$0$0$0Net: $0, $0
Out: N/A
Net: $0
Out: N/A
$2,880Net: $3,400
Out: N/A
501-1,000Yes3.5
WellCare Dividend
H1032-032
Contact: 1-866-484-1451
HMOPin., Hills., Her.$0$80$0Net: $0, $25
Out: N/A
Net: $150 daily for 5 days
Out: N/A
$3,700Net: $6,700
Out: N/A
4,501-5,000No4
WellCare Dividend
H1032-187
HMOPasco$0$80$0Net: $0, $35
Out: N/A
Net: $250 daily for 6 days
Out: N/A
$3,920Net: $6,700
Out: N/A
13,001-14,000No4
WellCare Essential
H1032-174
HMO- POSPin.,
Hills., Pasco, Her.
$0$0$0Net: $0, $20
Out: 45%
Net: $100 daily for 6 days
Out: 45% per stay
$4,270Net: $6,700
In and Out of network:$6,700
8,001-8,500No4
WellCare Premier
H5199-001
PPOPasco, Her.$0$0$250Net: $5, $45
Out: 50%
Net: $300 daily for 5 days
Out: 40% for 150 days
$5,340Net: $6,700
In and Out of network:$10,000
4,501-5,000NoToo new to be rated

* This plan’s deductible only applies to out-of-network services.

** Information was not available at press time. Call Florida Blue toll-free at 1-855-601-9465 for details.

Source: Centers for Medicare & Medicaid Services