Council on Aging Answers 2016 - 96

COUNCIL ON AGING - ORANGE COUNTY

Medicare Advantage Plans Comparison Chart
ALIGNMENT HEALTH PLAN

ALIGNMENT HEALTH PLAN

ANTHEM BLUE CROSS

Platinum Plan
H3815-008

CalPlus Plan
H3815-009

Anthem MediBlue Select
H0564-063

Anthem MediBlue Plus
H0564-068

New enrollment: 888-979-2247
Current members: 866-634-2247
alignmenthealthplan.com

New enrollment: 800-963-8008
Current members: 888-230-7338
anthem.com/ca/shop

MA-PD (HMO)

MA-PD (HMO)
Medi-Medi option

MA-PD (HMO)

$0 monthly premium

$31.00 monthly premium
$360 drug plan deductible

$0 monthly premium

SIZE OF NETWORK

3501-4000 providers

9001-10000 providers

18001-19000 providers

OUT OF POCKET MAXIMUM

$3,400 In-Network

$6,700 In-Network

DOCTOR/SPECIALIST VISIT

$0/$0 each visit

20%/20% of cost each visit

$0/$0 each visit

$20/$50 each visit

INPATIENT HOSPITALIZATION

$0 copay. Unlimited days each benefit
period.

90 days each benefit period. 60 lifetime
reserve days. Contact plan for more
details.

$0 copay. 90 days each benefit period.
60 lifetime reserve days.

Days 1-5: $340/day, Days 6-90:
$0/day. 90 days each benefit period. 60
lifetime reserve days.

SKILLED NURSING FACILITY

Days 1-20: $40/day, Days 21100: $50/day. 100 days each benefit
period.

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

Days 1-20: $0/day, Days 21100: $145/day. 100 days each benefit
period.

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

AMBULANCE

$125 each service, waived if admitted.

20% of cost each service

$275 each service

$365 or 20% of cost each service

CHEMOTHERAPY DRUGS

20% of cost for Part B chemotherapy
drugs

$10 for subluxation manipulation

20% of cost for subluxation
manipulation

$0 for subluxation manipulation

$20 for subluxation manipulation

TELEPHONE NUMBERS AND
WEBSITE
PLAN TYPE
TOTAL MONTHLY PREMIUM &
ANNUAL DEDUCTIBLES

CHIROPRACTIC
DIABETES

$0 for monitoring supplies.
$0 for monitoring supplies.
$0 for monitoring supplies. $0 for self$0 for self-management training. $0 for $0 for self-management training. $0 for management training.
therapeutic shoes or inserts.
therapeutic shoes or inserts.
$0 for therapeutic shoes or inserts.

$0 for diagnostic radiology services. $0
for diagnostic tests and procedures. $0
DIAGNOSTIC TESTS, LAB &
each lab service. $0 each x-ray. $50 for
RADIOLOGY SERVICES, AND X-RAYS therapeutic radiology services.

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

$0 for monitoring supplies. $0 for selfmanagement training.
$0 for therapeutic shoes or inserts.

$85 for diagnostic radiology services. $0
for diagnostic tests and procedures. $0
each lab service. $0 each x-ray. 20% of
cost for therapeutic radiology services.

$250 for diagnostic radiology services.
$0-$235 for diagnostic tests and
procedures. $15 each lab service. $65
each x-ray. 20% of cost for therapeutic
radiology services.

EMERGENCY ROOM VISIT

$75 each visit, waived if admitted within 20% of cost each visit, waived if
24 hours.
admitted within 3 days.

$75 each visit

OUTPATIENT HOSPITAL SERVICES

$100 each visit

20% of cost each visit

$0-$50 each visit

$0-$300 each visit

$0 each visit

20% of cost each visit

$0 each visit

$45 each cardiac visit.
$40 each all other visits.

TRANSPORTATION

$0 copay

Not covered

DENTAL SERVICES

$0-$425 for limited dental. $0 for
cleaning. $0-$30 for x-rays.
$0-$20 for fluoride treatment.
$0 for oral exam.

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

HEARING SERVICES

$0 for diagnostic exam. $0 for routine
hearing exam. $0 for hearing aid fitting
or evaluation.
$0 for hearing aid. Plan pays up to
$1,000 for hearing aids.

$0 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 $200
for eyewear.

$0 for diagnostic exam. $0 for routine
$0 for diagnostic exam. $0 for routine
eye exam. $0 for contact lenses. $0 for eye exam. $0 for eyewear after cataract
eyeglasses. $0 for eyeglass frames. $0
surgery.
for eyeglass lenses. $0 for eyewear after
cataract surgery. Plan pays up to $200
for eyewear.

OUTPATIENT REHAB SERVICES

VISION SERVICES

$50 for diagnostic exam

$0 for diagnostic exam. $0 for routine
eye exam. $0 for eyewear after cataract
surgery.

Confused by Medicare? Call the Council on Aging Orange County HICAP experts at (800) 434-0222
96

Answers Guide 2016

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

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http://www.alignmenthealthplan.com http://www.alignmenthealthplan.com http://www.anthem.com/ca/shop http://www.anthem.com/ca/shop

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