Council on Aging Answers 2015 - 104

COUNCIL ON AGING - ORANGE COUNTY

Medicare Advantage Plans Comparison Chart
anthem blue cross
senior secure plan 1

blue shield
65 plus

blue shield
65 plus choice

brand neW day
classic care

New enrollment:
855-306-4537
Current members:
888-230-7338
anthem.com/ca/medicare

New enrollment:
800-488-8000
Current members:
800-776-4466
blueshieldca.com/medicare

New enrollment:
866-255-4795
Current members:
866-255-4795
brndhmo.com

ma-pd (hmo) medicare Advantage
plan with prescription Drug benefit.
must utilize plan physicians, providers
and hospitals.
$0 monthly premium

in-patient hospitalization

15001-16000 physicians and providers
$6,000 In-Network
$20 each visit
$50 each visit
Days 1-5: $347/day, Days 6-90: $0/day.
90 days each benefit period.

11001-12000 physicians and providers
$2,800 In-Network
$0 each visit
$0 each visit
$0 copay. Unlimited days each benefit
period.

3001-3500 physicians and providers
$2,000 In-Network
$0 each visit
$0 each visit
$0 copay. Unlimited days each benefit
period.

5001-5500 physicians and providers
$6,700 In-Network
$0 each visit
$0 each visit
$0 copay. 90 days each benefit period.

skilled nursing facility

Days 1-20: $0/day, Days 21-100: $152/
day. 100 days each benefit period.

Days 1-20: $0, Days 21-100: $75/day. 100 Days 1-20: $0/day, Days 21-100: $50/day. $0 copay. 100 days each benefit period.
days each benefit period.
100 days each benefit period.

Days 1-5: $305/day, Days 6-90, $0/day.
190-day psychiatric hospital lifetime
limit.
$40 each individual or group therapy
visit.
$0-$250 each visit
$250 each service
$65 each visit

$900 each stay. 190-day psychiatric
hospital lifetime limit.

$30 each individual or group therapy
visit.
$0 - $100 each visit
$200 each service
$65 each visit

$30 each individual or group therapy
visit.
$50 each visit
$100 each service
$65 each visit

$0 for diagnostic procedures and tests.
$40 for diagnostic radiology services.

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

$0 each x-ray
$0 each lab service.
20% of cost for therapeutic radiology
services.
20% of the cost for part b chemotherapy
drugs
$0 copay for medicare-covered benefits.

$0 each x-ray
$0 copay for lab services.
20% of cost for therapeutic radiology
services.
20% of the cost for part b chemotherapy
drugs
$0 copay for medicare-covered benefits.
$5 - $16 for oral exams. $20 up to 1
cleaning/6 mo., $5 for up to 2 fluoride
treatments. $0-$10 for up to 1 x-ray.

$0 copay to diagnose & treat eye
conditions. $10 copay for up to 1
routine exam/yr. $0 copay for eyewear
after cataract surgery. $20 for up to 1
pair of lenses/yr. $20 for up to 1 pair
of frames/2 yrs. ($75 limit/2 yrs. for
frames).

$0 copay to diagnose & treat eye
conditions. $10 for up to 1 routine
exam/yr. $0 for eyewear after cataract
surgery. $20 for up to 1 pair of lenses/yr.
$20 for up to 1 frame/2 yrs. ($90 limit/2
yrs. for frames).

telephone numbers Website

plan type
monthly health and
drug plan premium
size of netWork
out of pocket maximum
doctor visit
specialist visit

in-patient mental health
outpatient mental health
outpatient hospital services
ambulance
emergency room visit
outpatient rehab services
durable medical equipment
diagnostic tests
x-rays
lab services
part b chemotherapy drugs

dental services

$0 each individual or group therapy
visit.
$0 each visit
$65 each service
$65 each visit, waived if admitted
within 3 days.
$45 each visit cardiac
$20 each visit cardiac
$15 each visit cardiac
$0 each visit occup./cardiac
$40 each visit all others
$15 each visit all others
$10 each visit all others
20% of cost all others
20% of cost for medicare-covered items. 20% of cost for medicare-covered items. 20% of cost for medicare-covered items. 20% of cost for medicare-covered items.

$0-$220 for diagnostic procedures and
tests. $220 for diagnostic radiology
services.
$65 each x-ray
$10 each lab service.
20% of cost for therapeutic radiology
services.
20% of the cost for part b chemotherapy
drugs
$0 copay for medicare-covered benefits.
$0 copay for up to 1 cleaning/yr.
$0 copay for up to 1 oral exam/yr.
$50 copay for diagnostic exams.

hearing services

vision services

$0 copay. 190-day psychiatric hospital
lifetime limit.

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

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

$0 each x-ray
$0 copay for lab services.
20% of cost for therapeutic radiology
services.
20% of the cost for part b chemotherapy
drugs
0% - 20% of the cost for medicarecovered benefits. $0 for up to 1 oral
exam/yr., $0-$10 up to 1 cleaning/6
mo., $0-$20 up to 1 fluoride treatment/
yr., $0-$30 up to 1 x-ray/yr.
$0 copay for diagnostic exams. $0 copay $0 copay for diagnostic exams. $0 copay 20% of the cost for medicare-covered
for routine exams.
for routine exam. $0 copay for up to 1
diagnostic exams.
fitting-eval./2 yrs. $0 copay for hearing
aids ($500 limit/2 yrs. for hearing aids).
$0 copay to diagnose & treat eye
conditions. $0 for up to 1 routine exam/
yr. $0 copay for eyewear after cataract
surgery. $0 copay for up to 1 pair of
eyeglasses/2 yr., ($150 limit/2 yrs. for
glasses).

Confused by Medicare? Call the Council on Aging Orange County HICAP experts at (800) 434-0222
104

Answers Guide 2015

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INClUSION does not imply a recommendation or endorsement of COAOC is notor services by coaoc. AlwAYS be Ahelp with accessing theveRIFY INFORmATION AND via our HICAp program 1-800-434-0222.
this information at www.medicare.gov as updates are frequently made. products responsible for these changes but can vIGIlANT CONSUmeR. most current information SeeK ReFeReNCeS wHeRe AppROpRIATe.

http://www.anthem.com/ca/medicare http://www.blueshieldca.com/medicare http://www.blueshieldca.com/medicare http://www.bndhmo.com http://www.medicare.gov

Council on Aging Answers 2015

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