Council on Aging Answers 2016 - 95

COUNCIL ON AGING - ORANGE COUNTY

Medicare Advantage Plans Comparison Chart

These charts include some of the information needed to compare the costs and benefits of the health plans available in Orange County. Plan
coverage and costs change annually. For detailed information regarding the plans and their prescription drug coverage, please contact companies
directly or call the Council on Aging-Orange County HICAP program, at (800) 434-0222, for personalized help with this critical decision.

AETNA MEDICARE
Aetna Medicare Select Plan
H0523-002
TELEPHONE NUMBERS AND
WEBSITE
PLAN TYPE
TOTAL MONTHLY PREMIUM &
ANNUAL DEDUCTIBLES
SIZE OF NETWORK
OUT OF POCKET MAXIMUM
DOCTOR/SPECIALIST VISIT

AETNA MEDICARE
Aetna Medicare Prime Plan
H0523-060

New enrollment: 888-247-1028
Current members: 800-282-5366
aetnamedicare.com
MA-PD (HMO)
$27.00 monthly premium

New enrollment: 888-247-1028
Current members: 800-282-5366
aetnamedicare.com
MA-PD (HMO)
$0 monthly premium

18001-19000 providers
$6,700 In-Network
$0/$0 each visit
Days 1-6: $264/day, Days 7-90:
$0/day. $0/day after 90 days. Unlimited
days each benefit period.

251-500 providers
$1,950 In-Network
$0/$0 each visit
$0 copay. Unlimited days each benefit
period.

ALIGNMENT HEALTH PLAN
My Choice Plan
H3815-001
New enrollment: 888-979-2247
Current members: 866-634-2247
alignmenthealthplan.com
MA-PD (HMO)
$0 monthly premium

7001-7500 providers
$3,400 In-Network
$0/$0 each visit
Days 1-10: $0/day, Days 11-45:
$100/day, Days 46-90:
INPATIENT HOSPITALIZATION
$75/day. $0/day after 90 days. 190
days each benefit period. 60 lifetime
reserve days.
Days 1-20: $0/day, Days 21Days 1-20: $0/day, Days 21Days 1-20: $40/day, Days 21SKILLED NURSING FACILITY
100: $150/day. 100 days each benefit
100: $150.00/day. 100 days each benefit 100: $50/day. 100 days each benefit
period.
period.
period.
AMBULANCE
$200 each service
$200 each service
$125 each service, waived if admitted.
20% of the cost for Part B chemotherapy 20% of cost for Part B chemotherapy
20% of cost for Part B chemotherapy
CHEMOTHERAPY DRUGS
drugs
drugs
drugs
$20
for
subluxation
manipulation
$20
for
subluxation
manipulation.
$20
$10
for subluxation manipulation
CHIROPRACTIC
for routine visit.
0-20% of cost for monitoring supplies. 0-20% of cost for monitoring supplies. $0 for monitoring supplies.
DIABETES
$0 for self- management training. $0 for $0 for self- management training. $0 for $0 for self-management training. $0 for
therapeutic shoes or inserts.
therapeutic shoes or inserts.
therapeutic shoes or inserts.
20% of cost for diagnostic radiology
$50 for diagnostic radiology services. $0 $0 for diagnostic radiology services. $0
services. $0 for diagnostic tests and
for diagnostic tests and procedures. $0 for diagnostic tests and procedures. $0
DIAGNOSTIC TESTS, LAB &
each lab service. $0 each x-ray. $50 for each lab service. $0 each x-ray. $50 for
RADIOLOGY SERVICES, AND X-RAYS procedures.
$0 each lab service. $30 each x- ray. $60 therapeutic radiology services.
therapeutic radiology services.
for therapeutic radiology services.
$75 each visit, waived if admitted
$75 each visit, waived if admitted
$75 each visit, waived if admitted
EMERGENCY ROOM VISIT
immediately.
immediately.
within 24 hours.
OUTPATIENT HOSPITAL SERVICES
$0-$264 each visit
$0 each visit
$100 each visit
OUTPATIENT REHAB SERVICES
$0 each visit
$0 each visit
$0 each visit
TRANSPORTATION
Not covered
Not covered
$0 copay
DENTAL SERVICES
$0 for limited dental
$0 for limited dental
$0 for limited dental
$0 for diagnostic exam. $0 for routine
$0 for diagnostic exam. $0 for routine
$0 for diagnostic exam. $0 for routine
hearing exam. $0 for hearing aid fitting hearing exam. $0 for hearing aid fitting hearing exam. $0 for hearing aid fitting
HEARING SERVICES
or evaluation.
or evaluation.
or evaluation.
$0 for hearing aid. Plan pays up to $500
for hearing aids.
$0 for diagnostic exam. $0 for routine
$0 for diagnostic exam. $0 for routine
$0 for diagnostic exam. $0 for routine
eye exam. $0 for eyewear after cataract eye exam. $0 for contact lenses. $0
eye exam. $0 for contact lenses. $0 for
surgery.
for eyeglasses. $0 for eyewear after
eyeglasses. $0 for eyeglass frames. $0
VISION SERVICES
cataract surgery.
for eyeglass lenses. $0 for eyewear after
Plan pays up to $150 for eyewear.
cataract surgery. Plan pays up to $75
for eyewear.

Notes

See Pages
104 and 105
for PPO's.
Each PPO
plan has an
In-Network
and an OutOf-Network
benefit list.

CONFUSED BY MEDICARE?
HICAP CAN HELP! CALL US AT 800-434-0222
HICAP is a free service to help maximize your health and drug benefits.
Council on Aging-Orange County
1971 E. 4th Street, Suite 200, Santa Ana, CA 92705 | www.coaoc.org
THE INFORMATION ON THESE CHARTS IS SUBJECT TO CHANGE. Contact the plan to verify information.

HICAPAging-Orange
is not liable for missing
or incorrect
information, but can
help with accessing the most current information via our HICAP program at 1-800-434-0222.
Council On
County
| 714-479-0107
| www.coaoc.org	
Answers Guide 2016

95


http://www.aetnamedicare.com http://www.aetnamedicare.com http://www.alignmenthealthplan.com http://www.coaoc.org

Table of Contents for the Digital Edition of Council on Aging Answers 2016

Contents
Council on Aging Answers 2016 - Intro
Council on Aging Answers 2016 - Cover1
Council on Aging Answers 2016 - Cover2
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Council on Aging Answers 2016 - Cover3
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