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.
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.
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.
Plan | Type | Counties Served | Prem. | Part B Rebate | Drug Deduct. | Doctor Copay (per visit) | Hospital Copay | Yearly Cost (est.) | Out-of-pocket Cap | Network Size | Generics in Gap? | Rating: Out of 5 stars |
---|---|---|---|---|---|---|---|---|---|---|---|---|
AARP MedicareComplete H1045-028 Contact: 1-800-555-5757 | HMO | Pin., Hills., Pasco, Her. | $0 | $0 | $245 | Net: $0-$10, $45 Out: N/A | Net: $295 daily for 6 days Out: N/A | $4,760 | Net: $4,900 Out: N/A | 18,001-19,000 | No | 4 |
AARP MedicareComplete Choice H2228-033 | PPO | Pin., Hills., Pasco, Her. | $77 | $0 | $250 | Net: $5, $35 Out: $45-$70,$70 | Net: $275 daily for 4 days Out: 40% per stay | $5,390 | Net: $3,600 In and Out of network:$10,000 | 18,001-19,000 | No | 3.5 |
AARP MedicareComplete Choice Plan 2 R7444-003 | PPO | Pin., Hills., Pasco, Her. | $0 | $0 | $395 | Net: $15, $50 Out: $45, $70 | Net: $395 daily for 4 days Out: 40% per stay | $5,050 | Net: $6,700 In and Out of network:$10,000 | 18,001-19,000 | No | 4 |
Aetna Medicare Choice Plan H1609-028 Contact: 1-833-828-1713 | HMO- POS | Pin., Hills. | $0 | $0 | $200 | Net: $0, $45 Out: N/A, $50 | Net: $375 daily for 4 days Out: 50% per stay | $4,340 | Net: $6,700 In and Out of network:$10,000 | 7,501-8,000 | Yes | 4 |
Aetna Medicare Premier Plan H5521-033 | PPO | Pin., Hills., Pasco | $0 | $0 | $250* | Net: $10, $50 Out: $50, $50 | Net: $395 daily for 4 days Out: 50% per stay | $4,730 | Net: $6,700 In and Out of network:$10,000 | 9,001-10,000 | Yes | 4 |
Allwell Medicare H9276-006 Contact: 1-844-293-2636 | HMO | Hills. | $0 | $0 | $0 | Net: $0, $20 Out: N/A | Net: $150 daily for 5 days Out: N/A | $3,300 | Net: $4,900 Out: N/A | 1,501-2,000 | Yes | Too new to be rated |
Allwell Medicare H9276-001 | HMO | Pin. | $0 | $0 | $0 | Net: $0, $20 Out: N/A | Net: $100 daily for 6 days Out: N/A | $3,370 | Net: $5,900 Out: N/A | 2,501-3,000 | Yes | Too new to be rated |
Allwell Medicare Premier H9276-002 | HMO | Pin., Pasco, Her. | $0 | $95 | $0 | Net: $0, $35 Out: N/A | Net: $150 daily for 5 days Out: N/A | $2,830 | Net: $6,700 Out: N/A | 2,501-3,000 | No | Too new to be rated |
Allwell Medicare Premier H9276-007 | HMO | Hills. | $0 | $92 | $0 | Net: $0, $30 Out: N/A | Net: $200 daily for 6 days Out: N/A | $2,860 | Net: $6,700 Out: N/A | 1,501-2,000 | No | Too new to be rated |
BlueMedicare Choice R3332-001 Contact: 1-855-601-9465 | PPO | Pin., 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 | $5,410 | Net: $6,700 In and Out of network:$10,000 | 4,501-5,000 | Yes | 3.5 |
BlueMedicare Classic H1026-057 | HMO | Hills., Pasco, Her. | $0 | $0 | $0 | Net: $0, $40 Out: N/A | Net: $225 daily for 7 days Out: N/A | $4,300 | Net: $6,500 Out: N/A | 501-1,000 | Yes | 3.5 |
BlueMedicare Preferred H2758-006 | HMO | Pin. | $0 | $0 | $0 | Net: $0, $15 Out: N/A | Net: $120 daily for 5 days Out: N/A | $3,610 | Net: $3,400 Out: N/A | 501-1,000 | Yes | 3.5 |
BlueMedicare Preferred POS H2758-008 | HMO- POS | Pin. | $0 | $0 | $0 | Net: $0, $25 Out: $30, $45 | Net: $120 daily for 5 days Out:Coming soon** | $4,070 | Net: $4,900 Out: $8,000 | 501-1,000 | Yes | 3.5 |
BlueMedicare Select H5434-002 | PPO | Pin., Hills. | $147.80 | $0 | $305 | Net: $5, $45 Out: 40% | Net: $225 daily for 7 days Out: $200 daily for 27 days | $6,170 | Net: $5,900 In and Out of network:$10,000 | 2,501-3,000 | Yes | 3.5 |
CareFree H1019-060 Contact: 1-855-450-1352 | HMO | Pin., Hills., Pasco | $0 | $94 | $0 | Net: $0, $30 Out: N/A | Net: $195 daily for 5 days Out: N/A | $2,520 | Net: $3,400 Out: N/A | 4,501-5000 | No | 4.5 |
CareOne PLUS H1019-054 | HMO | Pin., Hills., Pasco | $0 | $0 | $0 | Net: $0, $25 Out: N/A | Net: $95 daily for 7 days Out: N/A | $3,250 | Net: $3,400 Out: N/A | 4,501-5000 | Yes | 4.5 |
Coventry Medicare Summit Plan H1609-020 Contact: 1-833-828-1713 | HMO | Pin., Hills. | $0 | $0 | $0 | Net: $0, $32 Out: N/A | Net: $195 daily for 6 days Out: N/A | $3,770 | Net: $3,400 Out: N/A | 7,001-7500 | Yes | 4 |
Freedom Medicare Plan Rx H5427-060 Contact: 1-800-401-2740 | HMO | Hills., Pasco, Her. | $0 | $0 | $0 | Net: $0, $35 Out: N/A | Net: $150 daily for 7 days Out: N/A | $4,130 | Net: $3,400 Out: N/A | 11,001-12,000 | Yes | 4 |
Freedom Medicare Plan Rx H5427-059 | HMO | Pin. | $0 | $0 | $0 | Net: $0, $30 Out: N/A | Net: $225 daily for 7 days Out: N/A | $4,150 | Net: $3,400 Out: N/A | 11,001-12,000 | Yes | 4 |
Humana Gold Plus (025) H1036-025 Contact: 1-855-795-9488 | HMO | Pin., Hills., Pasco | $0 | $0 | $0 | Net: $0, $25 Out: N/A | Net: $95 daily for 7 days Out: N/A | $3,300 | Net: $3,400 Out: N/A | 4,001-4,500 | Yes | 4.5 |
Humana Gold Plus (067) H1036-067 | HMO | Her. | $0 | $0 | $0 | Net: $0, $20 Out: N/A | Net: $75 daily for 7 days Out: N/A | $3,230 | Net: $3,400 Out: N/A | 251-500 | Yes | 4.5 |
Humana Gold Plus (265) H1036-265 | HMO | Pin., Hills., Pasco, Her. | $0 | $94 | $0 | Net: $0, $40 Out: N/A | Net: $195 daily for 5 days Out: N/A | $2,990 | Net: $6,700 Out: N/A | 5,001-5,500 | No | 4.5 |
HumanaChoice Florida (072) H5216-072 | PPO | Pin., Hills., Pasco, Her. | $0 | $0 | $150 | Net: $10, $40 Out: $65, $65 | Net: $360 daily for 5 days Out: $495 daily for 27 days | $4,800 | Net: $6,700 In and Out of network: $10,000 | 14,001-15000 | No | 4 |
HumanaChoice (005) R5826-005 | PPO | Pin., Hills., Pasco, Her. | $98 | $0 | $100* | Net: $5, $40 Out: $45, $45 | Net: $225 daily for 7 days Out: 40% per stay | $5,710 | Net: $6,700 In and Out of network: $10,000 | 20,000 and above | No | 3.5 |
HumanaChoice (074) R5826-074 | PPO | Pin., Hills., Pasco, Her. | $0 | $0 | $405* | Net: $20, $50 Out: $60, $60 | Net: $450 daily for 4 days Out: $495 daily for 27 days | $5,160 | Net: $6,700 In and Out of network: $10,000 | 20,000 and above | No | 3.5 |
Optimum Gold Plus Plan H5594-032 Contact: 1-866-245-5360 | HMO | Her. | $0 | $104.90 | $0 | Net: $0, $20 Out: N/A | Net: $150 daily for 7 days Out: N/A | $2,550 | Net: $3,400 Out: N/A | 10,001-11,000 | Yes | 5 |
Optimum Gold Rewards Plan H5594-001 | HMO | Pin., Hills., Pasco, Her. | $0 | $90 | $0 | Net: $0, $40 Out: N/A | Net: $195 daily for 6 days Out: N/A | $3,040 | Net: $3,400 Out: N/A | 10,001-11000 | Yes | 5 |
Optimum Platinum Plan H5594-002 | HMO | Pin., Hills., Pasco, Her. | $0 | $0 | $0 | Net: $0, $5 Out: N/A | Net: $0 Out: N/A | $3,470 | Net: $3,400 Out: N/A | 10,001-11,000 | Yes | 5 |
Simply More H5471-052 Contact: 1-888-577-0212 | HMO | Pin., Hills., Pasco, Her. | $0 | $0 | $0 | Net: $0, $10 Out: N/A | Net: $50 daily for 8 days Out: N/A | $2,750 | Net: $6,700 Out: N/A | 6,501-7,000 | Yes | 4 |
Ultimate Elite H2962-003 Contact: 1-855-858-7526 | HMO | Pasco | $0 | $105 | $0 | Net: $0, $20 Out: N/A | Net: $90 daily for 5 days Out: N/A | $2,040 | Net: $3,400 Out: N/A | 501-1,000 | Yes | 3.5 |
Ultimate Premier H2962-001 | HMO | Her. | $0 | $105 | $0 | Net: $0, $20 Out: N/A | Net: $90 daily for 5 days Out: N/A | $2,040 | Net: $3,400 Out: N/A | 501-1,000 | Yes | 3.5 |
Ultimate Premier Plus H2962-002 | HMO | Pasco, Her. | $0 | $0 | $0 | Net: $0, $0 Out: N/A | Net: $0 Out: N/A | $2,880 | Net: $3,400 Out: N/A | 501-1,000 | Yes | 3.5 |
WellCare Dividend H1032-032 Contact: 1-866-484-1451 | HMO | Pin., Hills., Her. | $0 | $80 | $0 | Net: $0, $25 Out: N/A | Net: $150 daily for 5 days Out: N/A | $3,700 | Net: $6,700 Out: N/A | 4,501-5,000 | No | 4 |
WellCare Dividend H1032-187 | HMO | Pasco | $0 | $80 | $0 | Net: $0, $35 Out: N/A | Net: $250 daily for 6 days Out: N/A | $3,920 | Net: $6,700 Out: N/A | 13,001-14,000 | No | 4 |
WellCare Essential H1032-174 | HMO- POS | Pin., Hills., Pasco, Her. | $0 | $0 | $0 | Net: $0, $20 Out: 45% | Net: $100 daily for 6 days Out: 45% per stay | $4,270 | Net: $6,700 In and Out of network:$6,700 | 8,001-8,500 | No | 4 |
WellCare Premier H5199-001 | PPO | Pasco, Her. | $0 | $0 | $250 | Net: $5, $45 Out: 50% | Net: $300 daily for 5 days Out: 40% for 150 days | $5,340 | Net: $6,700 In and Out of network:$10,000 | 4,501-5,000 | No | Too 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