Council on Aging Answers 2016 - 98

COUNCIL ON AGING - ORANGE COUNTY

Medicare Advantage Plans Comparison Chart
BLUE SHIELD OF CALIFORNIA

BRAND NEW DAY

Blue Shield 65 Plus Choice
Plan H0504-021

Classic Care
H0838-025

BRAND NEW DAY

CARE1ST HEALTH PLAN

Classic Choice for Medi-Medi Care1st AdvantageOptimum
H0838-033
Plan H5928-004

New enrollment:
800-488-8000
Current Members:
800-776-4466
blueshieldcamedicare.com

New enrollment: 866-255-4795
Current Members: 866-255-4795
brandnewdayhmo.com

New enrollment: 800-847-1222
Current Members: 800-544-0088
care1stmedicare.com

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

5001-5500 providers

1001-1500 providers

7501-8000 providers

OUT OF POCKET MAXIMUM

$2,000 In-Network

$3,400 In-Network

$6,700 In-Network

$3,400 In-Network

DOCTOR/SPECIALIST VISIT

$0/$0 each visit

20%/20% of cost each visit

$0/$0 each visit

INPATIENT HOSPITALIZATION

$0 copay. Unlimited days each benefit
period.

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

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

$0 copay. Unlimited days each benefit
period.

SKILLED NURSING FACILITY

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

$0 copay. 100 days each benefit period.

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

Days 1-20: $0/day, Days 21100: $75/day. 100 days each benefit
period.

AMBULANCE

$135 each service

$80 each service

20% of cost each service

$125 each service, waived if admitted.

CHEMOTHERAPY DRUGS

20% of cost for Part B chemotherapy
drugs

$0 copay

20% of cost for Part B chemotherapy
drugs

$0 for subluxation manipulation

20% of cost for subluxation
manipulation

$5 for subluxation manipulation

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

$0 for monitoring supplies. $0 for selfmanagement training. 20% of cost for
therapeutic shoes or inserts.

$0 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.

20% of the cost for diagnostic radiology
services. 20% of cost for diagnostic tests
and procedures. $0 for lab services.
20% of cost 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. 20% of
cost for therapeutic radiology services.

$75 each visit

$65 each visit, waived if admitted
within 3 days.

20% of cost each visit, waived if
admitted within 3 days.

$75 each visit, waived if admitted
within 1 day.

OUTPATIENT HOSPITAL SERVICES

$50 each visit

$0 each visit

20% of cost each visit

$50 each visit

OUTPATIENT REHAB SERVICES

$15 each cardiac visit.
$10 each all other visits.

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

20% of cost each visit

$10 each visit

TRANSPORTATION

$0 copay

$0 for limited dental. $20 for cleaning.
$0-$10 for x-rays. $5 for fluoride
treatment. $5-$16 for oral exam.

0-20% of cost for limited dental.
$15-$55 for cleaning. $0 for x- rays.
$0-$12 for fluoride treatment. $0 for
oral exam.

$0 for limited dental. $0 for cleaning. $0 $0 for limited dental. $0 for cleaning. $0
for x-rays. $0 for fluoride treatment. $0 for x-rays. $5 for fluoride treatment. $0
for oral exam.
for oral exam.

$0 for diagnostic exam. $0 for routine
hearing exam. $0 for hearing aid fitting
or evaluation. $0 for hearing aid. Plan
pays up to $500 for hearing aids.

20% of cost for diagnostic exam

$10 for diagnostic exam. $10 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. $10 for routine
eye exam. $20 for eyeglass frames. $20
for eyeglass lenses. $0 for eyewear after
cataract surgery. Plan pays up to $90 for
eyeglass frames.

$0 for diagnostic exam. $0 for routine
eye exam. $0 for eyeglasses. $0 for
eyewear after cataract surgery. Plan
pays up to $175 for eyeglasses.

20% of cost for diagnostic exam.
$0 for routine eye exam. $0 for
eyeglasses. $0 for eyewear after
cataract surgery. Plan pays up to $275
for eyeglasses.

$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.

TELEPHONE NUMBERS AND
WEBSITE

PLAN TYPE
TOTAL MONTHLY PREMIUM &
ANNUAL DEDUCTIBLES

CHIROPRACTIC

DIABETES

$0 for monitoring supplies.
$0 for monitoring supplies. $0 for self$0 for self-management training. $0 for management training.
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 &
RADIOLOGY SERVICES, AND X-RAYS for lab services. $0 each x-ray. 20% of
cost for therapeutic radiology services.
EMERGENCY ROOM VISIT

DENTAL SERVICES

HEARING SERVICES

VISION SERVICES

Confused by Medicare? Call the Council on Aging Orange County HICAP experts at (800) 434-0222
98

Answers Guide 2016

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

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http://www.brandnewdayhmo.com http://www.brandnewdayhmo.com http://www.care1stmedicare.com http://www.blueshieldcamedicare.com

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