Council on Aging Answers 2017 - 83

COUNCIL ON AGING - SOUTHERN CALIFORNIA
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-Southern California 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
IN-PATIENT HOSPITALIZATION
SKILLED NURSING FACILITY
AMBULANCE
CHEMOTHERAPY DRUGS
CHIROPRACTIC
DIABETES
DIAGNOSTIC TESTS, LAB &
RADIOLOGY SERVICES,
AND X-RAYS
DURABLE MEDICAL EQUIPMENT

AETNA MEDICARE
Aetna Medicare Prime Plan
H0523-060

New enrollment:
855-338-7027
Current members:
800-282-5366
aetnamedicare.com
MA-PD (HMO)
$27 monthly premium

New enrollment:
855-338-7027
Current members:
800-282-5366
aetnamedicare.com
MA-PD (HMO)
$0 monthly premium

New enrollment:
888-979-2247
Current members:
866-634-2247
alignmenthealthplan.com
MA-PD (HMO)
$0 monthly premium

15001-16000 providers
$5,400 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.
Days 1-20: $0/day, Days 21-100: $150/
day. 100 days each benefit period.
$200 each service
20% of the cost for Part B chemotherapy
drugs
$20 for subluxation manipulation

3001-3500 providers
$1,950 In-Network
$0/$0 each visit
$0 copay. $0/day after 90 days.
Unlimited days each benefit period.

10001-11000 providers
$3,400 In-Network
$0/$0 each visit
Days 1-3: $100/day, Days 4-90: $0/day,
$0/day after 90 days.

Days 1-20: $0/day, Days 21-100: $150/
day. 100 days each benefit period.
$200 each service
20% of cost for Part B chemotherapy
drugs
$20 for subluxation manipulation. $20
for routine visit.
0-20% of cost for monitoring supplies. 0-20% of cost for monitoring supplies.
$0 for self-management training. $0 for $0 for self-management training. $0 for
therapeutic shoes or inserts.
therapeutic shoes or inserts.
$100 for diagnostic radiology services. $50 for diagnostic radiology services. $0
$0 for diagnostic tests and procedures. for diagnostic tests and procedures. $0
$0 for lab services. $30 each x-ray. $60 for lab services. $0 each x-ray. $50 for
for therapeutic radiology services.
therapeutic radiology services.
20% of cost of Medicare- covered items 20% of cost of Medicare- covered items

Days 1-20: $0/day, Days 21-100: $30/day.
100 days each benefit period.
$125 each service, waived if admitted.
20% of cost for Part B chemotherapy
drugs
$10 for subluxation manipulation
$0 for monitoring supplies.
$0 for self-management 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.
0-20% of cost of Medicare-covered
items
$75 each visit

$75 each visit, waived if admitted
immediately.
$0-$264 each visit
$0 each visit
Not covered
$0 for limited dental*

$75 each visit, waived if admitted
immediately.
$0 each visit
$0 each visit
Not covered
$0 for limited dental*

HEARING SERVICES
(SEE NOTES FOR **)

$0 for diagnostic exam. $0 for routine
hearing exam. $0 for hearing aid fitting
or evaluation.**

$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.

$0 for diagnostic exam. $0 for routine
hearing exam. $0 for hearing aid fitting
or evaluation.

VISION SERVICES
(SEE NOTES FOR ***)

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

$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.

$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 $75
for eyewear.

EMERGENCY ROOM VISIT
OUTPATIENT HOSPITAL SERVICES
OUTPATIENT REHAB SERVICES
TRANSPORTATION
DENTAL SERVICES
(SEE NOTES FOR *)

Notes

ALIGNMENT HEALTH PLAN
My Choice Plan
H3815-001

See Pages
92 and 93
for PPO's.
Each PPO
plan has an
In-Network
and an OutOf-Network
benefit list.

$100 each visit
$0 each visit
$0 copay
$0 for limited dental

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-Southern California
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-Southern
is not liable for missingCalifornia
or incorrect information,
but can help
with accessing the most current information via our HICAP program at 1-800-434-0222.
Council On
| 714-479-0107
| www.coasc.org
Answers Guide 2017

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

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