Council on Aging Answers 2017 - 86

COUNCIL ON AGING - SOUTHERN CALIFORNIA

Medicare Advantage Plans Comparison Chart
BLUE SHIELD OF CALIFORNIA

BRAND NEW DAY

CARE1ST HEALTH PLAN

Blue Shield 65 Plus
Choice Plan
H0504-021

Classic Care
H0838-025

Classic Choice
for Medi-Medi
H0838-033

Care1st
AdvantageOptimum Plan
H5928-004

TELEPHONE NUMBERS
AND WEBSITE

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

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

PLAN TYPE

MA-PD (HMO)

TOTAL MONTHLY PREMIUM
& ANNUAL DEDUCTIBLES

$0 monthly premium

SIZE OF NETWORK
OUT OF POCKET MAXIMUM
DOCTOR/SPECIALIST VISIT

5001-5500 providers
$2,000 In-Network
$0/$0 each visit

5001-5500 providers
$3,400 In-Network
$0/$0 each visit

IN-PATIENT HOSPITALIZATION

$0 copay. Unlimited days each benefit
period.

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

SKILLED NURSING FACILITY

Days 1-20: $0/day, Days 21-100: $50/day. 100 days each benefit period. Contact
100 days each benefit period.
plan for more details.

AMBULANCE
CHEMOTHERAPY DRUGS
CHIROPRACTIC
DIABETES

DIAGNOSTIC TESTS, LAB &
RADIOLOGY SERVICES,
AND X-RAYS
DURABLE MEDICAL EQUIPMENT

$100 each service
20% of cost for Part B chemotherapy
drugs

New enrollment:
866-255-4795
Current Members:
866-255-4795
brandnewdayhmo.com
MA-PD (HMO)
Medi-Medi option offered
$36.30 monthly premium
$400 drug plan deductible

$0 monthly premium
7501-8000 providers
$3,400 In-Network
$0/$0 each visit

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

Days 1-20: $0/day, Days 21-100: $75/day.
100 days each benefit period.

$80 each service

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

20% of cost each service
20% of cost for Part B chemotherapy
$0 copay for Part B chemotherapy drugs
drugs
20% of cost for subluxation
$0 for subluxation manipulation
$0 for subluxation manipulation
manipulation
20% of cost for monitoring supplies.
$0 for monitoring supplies.
$0 for monitoring supplies. $0 for
20% of cost for self-management
$0 for self-management training. $0 for self-management training. $0 for
training. 20% of cost for therapeutic
therapeutic shoes or inserts.
therapeutic shoes or inserts.
shoes or inserts.
$0 for diagnostic radiology services. $0 $0 for diagnostic radiology services. $0 20% of the cost for diagnostic radiology
for diagnostic tests and procedures. $0 for diagnostic tests and procedures. $0 services. 20% of cost for diagnostic tests
for lab services. $0 each x-ray. 20% of
for lab services. $0 each x-ray. 20% of
and procedures. $0 for lab services.
cost for therapeutic radiology services. cost for therapeutic radiology services. 20% of cost each x-ray. 20% of cost for
therapeutic radiology services.

$150 each service, waived if admitted.
20% of cost for Part B chemotherapy
drugs

20% of cost of Medicare- covered items

20% of cost of Medicare-covered items

20% of cost of Medicare- covered items

20% of cost of Medicare- covered items
$75 each visit, waived if admitted
within 3 days.
20% of cost each visit

EMERGENCY ROOM VISIT

$75 each visit

OUTPATIENT HOSPITAL SERVICES

$0 each visit
$15 each cardiac visit.
$0 each all other visits.
Not covered

DENTAL SERVICES
(SEE NOTES FOR *)

$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$0 for limited dental. $0 for x-rays. $0
$55 for cleaning. $0 for x-rays. $0-$12
for oral exam.
for fluoride treatment. $0 for oral exam.

HEARING SERVICES
(SEE NOTES FOR **)

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

20% of cost for diagnostic exam

VISION SERVICES
(SEE NOTES FOR ***)

$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 $125
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 $250 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 $500 for eyeglasses.

TRANSPORTATION

MA-PD (HMO)

1001-1500 providers
$6,700 In-Network
20%/20% of cost each visit
90 days each benefit period. 60 lifetime
reserve days. Contact plan for more
details.

$75 each visit, waived if admitted
within 3 days.
$0 each visit
$0 each occupational or cardiac visit.
20% of cost all other visits.
$0 copay

OUTPATIENT REHAB SERVICES

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

$5 for subluxation manipulation
$0 for monitoring supplies. $0 for selfmanagement training. 20% of cost for
therapeutic shoes or inserts.
$20 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, waived if admitted.
$100 each visit

20% of cost each visit

$10 each visit

$0 copay

$0 copay
$0 for limited dental. $0 for cleaning.
$0 for x-rays. $5 for fluoride treatment.
$0 for oral exam. Contact plan for
comprehensive services.
$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. $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.

Confused by Medicare? Call the Council on Aging - Southern California HICAP experts at (800) 434-0222
86

Answers Guide 2017

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

COUNCILHICAP
ON AGING
SOUTHERN
IS Aor
501incorrect
(C)3 NONPROFIT
CORPORATION.
DISTRIBUTE
ANSWERS
FREE OFResource
COST,
WE MUST
SELL
ADVERTISING
SPACE.
WHILE
WE APPRECIATE
THEatPAID
LISTINGS IN ANSWERS, THEIR
is -not
liable CALIFORNIA
for missing
information,
butTOcan
help with
accessing
the
most
current
information
via| our
HICAP
program
Aging
and
Disability
Connection
800-510-2020
| 1-800-434-0222.
www.adrcoc.org
INCLUSION DOES NOT IMPLY A RECOMMENDATION OR ENDORSEMENT OF PRODUCTS OR SERVICES BY COASC. ALWAYS BE A VIGILANT CONSUMER. VERIFY INFORMATION AND SEEK REFERENCES WHERE APPROPRIATE.

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

Table of Contents for the Digital Edition of Council on Aging Answers 2017