Council on Aging Answers 2016 - 100

COUNCIL ON AGING - ORANGE COUNTY

Medicare Advantage Plans Comparison Chart
CENTRAL HEALTH
MEDICARE PLAN

EASY CHOICE HEALTH PLAN

GOLDEN STATE

Central Health Premier Plan
H5649-004

Easy Choice Plus Plan
H5087-002

Easy Choice Best Plan
H5087-005

Golden State Medicare
Health Plan, Golden
H2241-006

TELEPHONE NUMBERS AND
WEBSITE

New enrollment: 866-314-2427
Current Members: 866-314-2427
centralhealthplan.com

New enrollment: 866-999-3945
Current Members: 866-999-3945
easychoicehealthplan.com

New enrollment: 877-541-4111
Current Members: 877-541-4111
gsmhp.com

PLAN TYPE

MA-PD (HMO)
Medi-Medi option

MA-PD (HMO)

TOTAL MONTHLY PREMIUM &
ANNUAL DEDUCTIBLES

$31.00 monthly premium health plan
deduct.: unavail.
$360 drug plan deductible

$12.00 monthly premium
$360 drug plan deductible

$0 monthly premium

SIZE OF NETWORK

4501-5000 providers

10001-11000 providers

20000 and above providers

4501-5000 providers

OUT OF POCKET MAXIMUM

$6,700 In-Network

$3,400 In-Network

DOCTOR/SPECIALIST VISIT

20%/20% of cost each visit

$0/20% of cost each visit

$0/$12 each visit

$0/$0 each visit

INPATIENT HOSPITALIZATION

Days 1-90: costs unavailable.
$0/day after 90 days. Unlimited days
each benefit period.

Days 1-3: $500/day, Days 4-90:
$0/day. $0/day after 90 days. Unlimited
days each benefit period.

Days 1-5: $125/day, Days 6-90:
$0/day. $0/day after 90 days. Unlimited
days each benefit period.

$0 copay. Unlimited days each benefit
period.

SKILLED NURSING FACILITY

100 days each benefit period. Contact
plan for more details.

Days 1-20: $0/day, Days 21100: $160/day. 100 days each benefit
period.

Days 1 -20: $0/day, Days 21100: $50/day. 100 days each benefit
period.

Days 1-20: $0/day, Days 21100: $50/day. 100 days covered each
benefit period.

AMBULANCE

20% of cost each service

$200 each service

$60 each service

CHEMOTHERAPY DRUGS

20% of cost for Part B chemotherapy
drugs

CHIROPRACTIC

$0 for subluxation manipulation

20% of cost for subluxation manipulation $12 for subluxation manipulation

DIABETES

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

20% of cost for diagnostic radiology
services. 20% of cost for diagnostic tests
and procedures. 20% of cost for lab
DIAGNOSTIC TESTS, LAB &
RADIOLOGY SERVICES, AND X-RAYS services. 20% of cost each x-ray.
20% of cost for therapeutic radiology
services.

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

$0 for subluxation manipulation

$0 for monitoring supplies.
$0 for monitoring supplies. $0 for self$0 for self-management training. 20% of management training.
cost for therapeutic shoes or inserts.
$0 for therapeutic shoes or inserts.
$50 for diagnostic radiology services. $0
for diagnostic tests and procedures. $0
for lab services. $0 each x-ray. 20% of
cost for therapeutic radiology services.

$0 for diagnostic radiology services. $0
for diagnostic tests and procedures. $0
for lab services. $0 each x-ray. $0 for
therapeutic radiology services.

EMERGENCY ROOM VISIT

20% of cost each visit, waived if admitted 20% of cost each visit, waived if admitted $75 each visit, waived if admitted within $65 each visit, waived if admitted within
within 24 hours.
within 24 hours.
24 hours.
24 hours.

OUTPATIENT HOSPITAL SERVICES

20% of cost each visit

$0-$50 each visit

$0 each visit

OUTPATIENT REHAB SERVICES

20% each occupational or cardiac visit.
$0 each all other visits.

20% of cost each visit

$12 each visit

$0 each visit

TRANSPORTATION

$0 copay

$0 for limited dental. $0 for cleaning. $0 20% of cost for limited dental.
for x-rays. $0 for fluoride treatment. $0 $0 for cleaning. $0 for x-rays. $0 for
for oral exam.
fluoride treatment. $0 for oral exam.
Plan pays $1,500 for most services.

$12 for limited dental. $10-$55 for
cleaning. $0-$30 for x-rays.
$9-$20 for fluoride treatment.
$0-$40 for oral exam. Plan pays
$1,000 for most services.

$0 for limited dental. $8 for cleaning. $8
for x-rays. $8 for fluoride treatment. $8
for oral exam.

HEARING SERVICES

20% of cost for diagnostic exam.
$0 for routine hearing exam. $0 for
hearing aid fitting or evaluation. $0 for
hearing aid.
Plan pays up to $2,000 for hearing aids.

20% of cost for diagnostic exam.
$0 for routine hearing exam. $0 for
hearing aid fitting or evaluation. $0 for
hearing aid.
Plan pays up to $350 for hearing aids.

$12 for diagnostic exam. $0 for routine
hearing exam. $0 for hearing aid fitting
or evaluation.
$0 for hearing aid. Plan pays up to $350
for hearing aids.

$0 for diagnostic exam. $0 for routine
hearing exam. $0 for hearing aid fitting
or evaluation.
$0 for hearing aid. Plan pays up to $400
for hearing aids.

VISION SERVICES

20% of cost for diagnostic exam.
$0 for routine eye exam. $0 for contact
lenses. $0 for eyeglasses. $0 for eyeglass
frames. $0 for eyeglass lenses.
20% of cost for eyewear after cataract
surgery. Plan pays up to $300 for
eyewear.

20% of cost for diagnostic exam.
$0 for routine eye exam. $0 for contact
lenses. $0 for eyeglasses. $0 for eyeglass
frames. $0 for eyeglass lenses.
$0 for eyewear after cataract surgery.
Plan pays up to $100 for eyewear.

$0-$12 for diagnostic exam.
$0 for routine eye exam. $0 for contact
lenses. $0 for eyeglasses. $0 for eyeglass
frames. $0 for eyeglass lenses.
$0 for eyewear after cataract surgery.
Plan pays up to $100 for eyewear.

$0 for diagnostic exam. $0 for routine
eye exam. $0 for contact lenses. $0 for
eyeglasses. $0 for eyewear after cataract
surgery.
Plan pays up to $150 for eyewear.

DENTAL SERVICES

Confused by Medicare? Call the Council on Aging Orange County HICAP experts at (800) 434-0222
100

Answers Guide 2016

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

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http://www.centralhealthplan.com http://www.easychoicehealthplan.com http://www.easychoicehealthplan.com http://www.gsmhp.com

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