Council on Aging Answers 2017 - 85

COUNCIL ON AGING - SOUTHERN CALIFORNIA

Medicare Advantage Plans Comparison Chart
ANTHEM BLUE CROSS

ANTHEM BLUE CROSS

ARCADIAN
HEALTH PLAN, INC.

BLUE SHIELD OF
CALIFORNIA

Anthem MediBlue Plus
H0564-068

Anthem MediBlue
Coordination Plus
H0564-080

Humana Gold Plus
H5619-021

Humana Gold Plus
H5619-037

Blue Shield 65 Plus
H0504-015

New enrollment:
800-797-6438
Current members:
888-230-7338
anthem.com/ca/shop

New enrollment:
800-833-2364
Current Members:
800-457-4708
humana.com/medicare

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

MA-PD (HMO)

MA-PD (HMO)
Medi-Medi option offered

MA-PD (HMO)

$0 monthly premium

$36.30 monthly premium
$400 drug plan deductible

$0 monthly premium

18001-19000 providers
$6,700 In-Network
$20/$50 each visit

12001-13000 providers
$6,700 In-Network
20%/20% of cost each visit

9001-10000 providers
$2,200 In-Network
$0/$0 each visit

$16.50 monthly premium
$166 health plan deductible
$400 drug plan deductible
14001-15000 providers
$6,700 In-Network
$0/$0 each visit

$0 copay. Unlimited days each benefit
period.

Days 1-3: $480/day, Days 4-90: $0/day.
Unlimited days each benefit period.

Days 1-5: $325/day, Days 6-90: $0/day.
Unlimited days each benefit period.
Days 1-20: $0/day, Days 21-100: $160/
day. 100 days each benefit period.
$365 or 20% of cost each service
20% of cost for Part B chemotherapy
drugs
$20 for subluxation manipulation
$0 for monitoring supplies. $0 for
self-management training. $0 for
therapeutic shoes or inserts.

Days 1-60: $0/day, Days 61-90: $322/
day. $644/day after 90 days. 60 lifetime
reserve days.
Days 1-20: $0/day, Days 21-100: $161/day.
100 days each benefit period.
20% of cost each service
20% of cost for Part B chemotherapy
drugs
20% of cost for subluxation manipulation
$0 for monitoring supplies. $0 for
self-management training. $0 for
therapeutic shoes or inserts.

14001-15000 providers
$2,800 In-Network
$0/$0 each visit
$0 copay. Unlimited days each benefit
period.

Days 1-20: $0/day, Days 21-100: $164.50/
day. 100 days each benefit period.
20% of cost each service
13% of cost for Part B chemotherapy
drugs
$0 for subluxation manipulation.
0-20% of cost for monitoring supplies.
$0 for self-management training. $0 for
therapeutic shoes or inserts.
0-20% of cost for diagnostic radiology
$250 for diagnostic radiology services. 20% of cost for diagnostic radiology
$0-$40 for diagnostic radiology services. services. 0-20% of cost for diagnostic
$0-$235 for diagnostic tests and
services. 20% of cost for diagnostic tests
$0 for diagnostic tests and procedures. tests and procedures. 0-20% of cost for
procedures. $0-$15 each lab service. $65 and procedures. 20% of cost for lab
$0 for lab services. $0 each x-ray. 20% of lab services. 0- 20% of cost each x-ray.
each x-ray. 20% of cost for therapeutic services. 20% of cost each x-ray. 20% of
cost for therapeutic radiology services. 20% of cost for therapeutic radiology
radiology services.
cost for therapeutic radiology services.
services.

Days 1-20: $0/day, Days 21-100: $50/day.
100 days each benefit period.
$200 each service
20% of cost for Part B chemotherapy
drugs
$0 for subluxation manipulation
$0 for monitoring supplies.
$0 for self-management training. $0 for
therapeutic shoes or inserts.

20% of cost of Medicare- covered items

Days 1-20: $0/day, Days 21-100: $50/day.
100 days each benefit period.
$265 each service
20% of cost for Part B chemotherapy
drugs
$0 for subluxation manipulation
0-20% of cost for monitoring supplies.
$0 for self-management training. $0 for
therapeutic shoes or inserts.

$0 monthly premium

0-20% of cost of Medicare-covered items 11% of cost of Medicare-covered items

$40 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

20% of cost each visit

$325 each visit
$45 each cardiac visit.
$30-$40 each all other visits.
Not covered

20% of cost each visit

$75 each visit, waived if admitted within $75 each visit, waived if admitted within
$75 each visit
24 hours.
24 hours.
$0 each visit
20% of cost each visit
$50 each visit

20% of cost each visit

$0 each visit

0-20% of cost each visit

$0 copay

20% of cost for limited dental. $0 for
$0 for limited dental. $0 for cleaning. $0
cleaning. $0 for x-rays. $0 for oral exam. $0 for limited dental.*
for oral exam.*
Contact plan for comprehensive services.

$20 each cardiac visit.
$0 each all other visits.
Not covered

$0 for for limited dental. $0 for cleaning.
$0 for limited dental*
$0 for x-rays. $0 for oral exam.*

$50 for diagnostic exam

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 $3,000 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 $1,000 for hearing aids.

$0 for diagnostic exam. $0 for routine
hearing exam.

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

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.

$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 $200
for eyewear.

$0 for diagnostic exam. $0 for routine
eye exam. $0 for contact lenses. $0 for
eyeglasses. 20% of cost for eyewear after
cataract surgery. Plan pays up to $200
for eyewear.

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

Confused by Medicare? Call the Council on Aging - Southern California HICAP experts at (800) 434-0222
THE INFORMATION ON THESE CHARTS IS SUBJECT TO CHANGE. Contact the plan to verify information.

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

http://www.anthem.com/ca/shop http://www.anthem.com/ca/shop http://www.humana.com/medicare http://www.humana.com/medicare http://www.blueshieldcamedicare.com

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