Council on Aging Answers 2017 - 89

COUNCIL ON AGING - SOUTHERN CALIFORNIA

Medicare Advantage Plans Comparison Chart
HEALTH NET
COMMUNITY SOLUTIONS
Health Net
Seniority Plus
Sapphire Premier
H3561-002
New enrollment:
800-977-6738
Current Members:
800-431-9007
healthnet.com/medicare
MA-PD (HMO)
Medi-Medi option offered

HEALTH NET
OF CALIFORNIA
Health Net Healthy Heart
H0562-100

HEALTH NET
OF CALIFORNIA
Health Net Gold Select
H0562-101

New enrollment:
800-977-6738
Current Members:
800-275-4737
healthnet.com/medicare

MA-PD (HMO)

$36.20 monthly premium
$170 drug plan deductible

$20 monthly premium

$0 monthly premium

13001-14000 providers
$6,700 In-Network
$0/$0 of cost each visit
90 days each benefit period. 60 lifetime
reserve days. Contact plan for more
details.
100 days each benefit period. Contact
plan for more details.
20% of cost each service
20% of cost for Part B chemotherapy
drugs

1001-1500 providers
$2,400 In-Network
$0/$0 each visit
Days 1-5: $200/day, Days 6-90: $0/day.
$0/day after 90 days. Unlimited days
each benefit period.
Days 1-20: $0/day, Days 21-100: $75/day.
100 days each benefit period.
$230 each service
20% of cost for Part B chemotherapy
drugs

1001-1500 providers
$2,800 In-Network
$0/$0 each visit

HEALTH NET OF CALIFORNIA
Health Net Seniority Plus
Sapphire
H0562-111
New enrollment:
800-977-6738
Current Members:
800-431-9007
healthnet.com/medicare
MA-PD (HMO)
Medi-Medi option offered
$36.20 monthly premium
$140 drug plan deductible

13001-14000 providers
$6,700 In-Network
$0/20% of cost each visit
90 days each benefit period. 60 lifetime
$0 copay. Unlimited days each benefit
reserve days. Contact plan for more
period.
details.
Days 1-20: $0/day, Days 21-100: $75/day. 100 days each benefit period. Contact
100 days each benefit period.
plan for more details.
$240 each service
20% of cost each service
20% of cost for Part B chemotherapy
20% of cost for Part B chemotherapy
drugs
drugs

20% of cost for subluxation manipulation $0 for subluxation manipulation

$0 for subluxation manipulation

20% of cost for monitoring supplies. $0
for self-management training. 20% of
cost for therapeutic shoes or inserts.
20% of 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.
20% of cost of Medicare- covered items
$75 each visit, waived if admitted
immediately.
20% of cost each visit

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

20% of cost each visit

$0 each visit

$0 copay
20% of cost for limited dental. $0 for
cleaning. $0 for x-rays. $0 for fluoride
treatment. $0 for oral exam. Contact plan
for comprehensive services.
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 $2,000 for hearing aids.
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. $0 for eyewear
after cataract surgery. Plan pays up to
$550 for eyewear.

Not covered

$0 copay
$0 for limited dental. $0 for cleaning.
$0 for x-rays. $0 for fluoride treatment.
$0 for oral exam. Contact plan for
comprehensive services.
$0 for diagnostic exam. $0 for routine
hearing exam. $0 for hearing aid fitting
or evaluation. Plan pays up to $1,000 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 $2,000 for hearing aids.
$0-$30 for diagnostic exam. $30 for
routine eye exam. $0 for eyewear after
cataract surgery.***

New enrollment:
800-500-7018
Current Members:
800-251-8191
ivhp.com
MA-PD (HMO)
$0 monthly premium
6501-7000 providers
$2,000 In-Network
$0/$0 each visit
$0 copay. Unlimited days each benefit
period.
Days 1-20: $0/day, Days 21-100: $50/day.
100 days each benefit period.
$195 each service
15% of cost for Part B chemotherapy
drugs

20% of cost for subluxation manipulation $0 for subluxation manipulation

20% of cost for monitoring supplies. $0
for self-management training. 20% of
cost for therapeutic shoes or inserts.
20% of cost for diagnostic radiology
$60 for diagnostic radiology services. $0 $60 for diagnostic radiology services. $0
services. 20% of cost for diagnostic tests
for diagnostic tests and procedures. $0 for diagnostic tests and procedures. $0
and procedures. $0 for lab services.
for lab services. $0 each x-ray. $60 for
for lab services. $0 each x-ray.
20% of cost each x-ray. 20% of cost for
therapeutic radiology services.
$60 for therapeutic radiology services.
therapeutic radiology services.
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
$75 each visit, waived if admitted
$75 each visit, waived if admitted
immediately.
immediately.
immediately.
$200 each visit
$0 each visit
20% of cost each visit

$0 for limited dental*

INTER VALLEY
HEALTH PLAN
Inter Valley Health Plan
Service to Seniors
H045-001

20% of cost each visit

$0 copay
20% of cost for limited dental. $0 for
cleaning. $0 for x-rays. $0 for fluoride
treatment. $0 for oral exam. Contact plan
for comprehensive services.
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 $2,000 for hearing aids.
20% of cost for diagnostic exam. $0 for
routine eye exam. $0 for contact lenses.
$25 for diagnostic exam. $10 for routine
$0 for eyeglasses. $0 for eyeglass frames.
eye exam. $0 for eyewear after cataract
$0 for eyeglass lenses. $0 for eyewear
surgery.***
after cataract surgery. Plan pays up to
$200 for eyewear.

$0 for monitoring supplies. $0 for selfmanagement training. 10% of cost for
therapeutic shoes or inserts.
$60 for diagnostic radiology services. $0
for diagnostic tests and procedures. $0
for lab services. $0 each x-ray.
$15 for therapeutic radiology services.
10% of cost of Medicare- covered items
$75 each visit, waived if admitted within
24 hours.
$0 each visit
$0 each cardiac visit.
$10 each all other visits.
Not covered
$0 for limited dental. $10 for cleaning.
$0-$10 for x-rays. $4 for oral exam.
Contact plan for comprehensive
services.*
$0 for diagnostic exam. $0 for routine
hearing exam. $0 for hearing aid fitting
or evaluation. Plan pays up to $250 for
hearing aids.
$0 for diagnostic exam. $0 for routine eye
exam. $0 for eyeglasses. $0 for eyeglass
frames. $0 for eyeglass lenses. $0 for
eyewear after cataract surgery. Plan pays
up to $175 for eyewear.

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.

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.
Council On
| 714-479-0107
Answers Guide 2017

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