Council on Aging Answers 2017 - 93

COUNCIL ON AGING - SOUTHERN CALIFORNIA

Medicare Advantage Plans Comparison Chart
AETNA MEDICARE

ANTHEM BLUE CROSS

Aetna Medicare
Choice Plan
Out-of-Network
H5521-056

Anthem MediBlue Access
In-Network
H8552-020

Anthem MediBlue Access
Out-of-Network
H8552-020

New enrollment:
855-338-7027
Current Members:
800-282-5366
aetnamedicare.com

New enrollment:
844-364-2129
Current members:
877-811-3107
anthem.com/ca/shop

MA-PD (PPO)

$107 monthly premium
$750 health plan deductible

$150 monthly premium
$1,250 health plan deductible
$230 drug plan deductible

5501-6000 providers

20000 and above providers

$6,700 In-Network
$10,000 In&Out

40%/40% of cost each visit

$10/$30 each visit

$35/$50 each visit

40% of cost per stay. Unlimited days each benefit Days 1-7: $175/day, Days 8-90: $0/day. Unlimited 40% of cost per stay. Unlimited days each benefit
period.
days each benefit period.
period.
40% of cost per stay. 100 days each benefit
period.

Days 1-20: $0/day, Days 21-100: $80/day. 100 days 15% of cost per stay. 100 days each benefit
each benefit period.
period.

$300 each service

$325 each service

40% of cost for Part B
chemotherapy drugs

20% of cost for Part B chemotherapy drugs

40% of cost for subluxation manipulation

$20 for subluxation manipulation

$50 for subluxation manipulation

20% of cost for monitoring supplies. 40% of cost $0 for monitoring supplies. $0 for selffor self-management training. 20% of cost for
management training. $0 for therapeutic shoes
therapeutic shoes or inserts.
or inserts.

30% of cost for monitoring supplies. 40% of cost
for self-management training. 30% of cost for
therapeutic shoes or inserts.

40% of cost for diagnostic radiology services.
40% of cost for diagnostic tests and procedures.
40% of cost for lab services. 40% of cost each
x-ray. 40% of cost for therapeutic radiology
services.

$100 for diagnostic radiology services. $0-$100
for diagnostic tests and procedures. $0-$10
each lab service. $25 each x-ray. 20% of cost for
therapeutic radiology services.

50% of cost for diagnostic radiology services. 50%
of cost for diagnostic tests and procedures. 50%
of cost for lab services. 50% of cost each x-ray.
50% of cost for therapeutic radiology services.

40% of cost of Medicare- covered items

20% of cost of Medicare- covered items

30% of cost of Medicare- covered items

$75 each visit, waived if admitted immediately.

$75 each visit

40% of cost each visit

$175 each visit

40% of cost each visit

40% of cost for each visit

$50 each cardiac visit.
$25 each all other visits.

40% of cost each cardiac visit.
$50 each all other visits.

Not covered

40% of cost for limited dental

$0 for limited dental. $0 for cleaning. $0 for oral
exam.*

$0 for limited dental. 20% of cost for cleaning.
20% of cost for oral exam.*

40% of cost for diagnostic exam. 40% of cost for
routine hearing exam. 40% of cost for hearing aid $35 for diagnostic exam
fitting or evaluation.
40% of cost for diagnostic exam. 40% of cost for
routine eye exam. 40% of cost for eyewear after
cataract surgery.

$0 for diagnostic exam. $0 for routine eye exam.
$0 for eyewear after cataract surgery. Plan
pays up to $69 for routine eye exams from any
provider.***

40% of cost for diagnostic exam
$0 for diagnostic exam. $0 for routine eye exam.
$0 for eyewear after cataract surgery. Plan
pays up to $69 for routine eye exams from any
provider.***

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THE INFORMATION ON THESE CHARTS IS SUBJECT TO CHANGE. Contact the plan to verify information.

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California
| 714-479-0107
| www.coasc.org
Answers Guide 2017
HICAPAging-Southern
is not
liable
for ISmissing
orTOincorrect
information,
with
accessing
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information
via our
HICAP
1-800-434-0222.
THE INFORMATION
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SUBJECT
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information isbut
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date ofprogram
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http://www.aetnamedicare.com http://www.anthem.com/ca/shop http://www.anthem.com/ca/shop http://www.coasc.org

Table of Contents for the Digital Edition of Council on Aging Answers 2017