Council on Aging Answers 2017 - 90

COUNCIL ON AGING - SOUTHERN CALIFORNIA

Medicare Advantage Plans Comparison Chart
INTER VALLEY HEALTH PLAN INTER VALLEY HEALTH PLAN
Inter Valley Health Plan
Inter Valley Health Plan
Value Preferred Choice
OC Preferred
H0545-014
H0545-013

KAISER PERMANENTE

Kaiser Permanente
Senior Advantage
L.A., Orange Co.
H0524-003

SCAN HEALTH PLAN
SCAN Classic
H5425-007

TELEPHONE NUMBERS
AND WEBSITE

New enrollment:
800-500-7018
Current Members:
800-251-8191
ivhp.com

New enrollment:
800-500-7018
Current Members:
800-251-8191
ivhp.com

New enrollment:
800-777-1238
Current Members:
800-443-0815
kp.org/medicare

New enrollment:
800-915-7226
Current Members:
800-559-3500
scanhealthplan.com

PLAN TYPE

MA-PD (HMO)

MA-PD (HMO)
Medi-Medi option offered

MA-PD (HMO)

MA-PD (HMO)

TOTAL MONTHLY PREMIUM
& ANNUAL DEDUCTIBLES

$0 monthly premium

$36.20 monthly premium
$400 drug plan deductible

$0 monthly premium

$0 monthly premium

SIZE OF NETWORK
OUT OF POCKET MAXIMUM
DOCTOR/SPECIALIST VISIT

6501-7000 providers
$2,000 In-Network
$0/$0 each visit

6001-6500 providers
$5,900 In-Network
20%/20% of cost each visit

6001-6500 providers
$4,400 In-Network
$10/$10 each visit

4001-4500 providers
$2,900 In-Network
$0/$0 each visit

IN-PATIENT HOSPITALIZATION

$0 copay. Unlimited days each benefit
period.

Contact plan for details.

Days 1-7: $240/day, Days 8-90: $0/day.
$0/day after 90 days. Unlimited days
each benefit period.

$0 copay. Unlimited days each benefit
period.

SKILLED NURSING FACILITY

Days 1-20: $0/day, Days 21-100: $50/day. Days 1-20: $0/day, Days 21-100: $161/day. Days 1-20: $0/day, Days 21-100: $50/day. Days 1-20: $0/day, Days 21-100: $50/day.
100 days each benefit period.
100 days each benefit period.
100 days each benefit period.
100 days each benefit period.

AMBULANCE

$165 each service

20% of cost each service

$200 each service

$175 each service

CHEMOTHERAPY DRUGS

20% of cost for Part B chemotherapy
drugs

20% of cost for Part B chemotherapy
drugs

$0-$45 copay for Part B chemotherapy
drugs

20% of cost for Part B chemotherapy
drugs

CHIROPRACTIC

$0 for subluxation manipulation

$0 for subluxation manipulation

$10 for subluxation manipulation

$0 for subluxation manipulation

DIABETES

$0 for monitoring supplies. $0 for selfmanagement training. 10% of cost for
therapeutic shoes or inserts.

20% of cost for monitoring supplies

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

$0 for monitoring supplies. $0 for selfmanagement training. $0 for therapeutic
shoes or inserts.

DIAGNOSTIC TESTS, LAB &
RADIOLOGY SERVICES,
AND X-RAYS

20% of cost for diagnostic radiology
$60 for diagnostic radiology services. $0
services. 20% of cost for diagnostic tests
for diagnostic tests and procedures. $0
and procedures. 20% of cost for lab
for lab services. $0 each x-ray.
services. 20% of cost each x-ray.
$15 for therapeutic radiology services.

$155 for diagnostic radiology services.
$30 for diagnostic tests and procedures.
$30 each lab service. $40 each x-ray. $0
for therapeutic radiology services.

$50 for diagnostic radiology services. $0
for diagnostic tests and procedures. $0
for lab services. $0 each x-ray. $50 for
therapeutic radiology services.

DURABLE MEDICAL EQUIPMENT

10% of cost of Medicare- covered items

20% of cost of Medicare- covered items

0-20% of cost of Medicare-covered items

EMERGENCY ROOM VISIT
OUTPATIENT HOSPITAL SERVICES
OUTPATIENT REHAB SERVICES
TRANSPORTATION

20% of cost of Medicare- covered items

$75 each visit, waived if admitted within
$75 each visit
24 hours.
$0 each visit
Contact plan for details.
$0 each cardiac visit.
$10 each all other visits.
Not covered

$210 each visit

$75 each visit, waived if admitted
immediately.
$0-$75 each visit

20% of cost each visit

$10 each visit

$0 each visit

$0 copay

Not covered

$0 copay

Not covered*

$0 for limited dental

$10 for diagnostic exam. $10 for routine
hearing 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 $699-$999 for hearing aids.

$75 each visit

DENTAL SERVICES
(SEE NOTES FOR *)

Not covered

$0 for cleaning. $0 for x-rays. $0 for
oral exam.

HEARING SERVICES
(SEE NOTES FOR **)

$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 routine hearing exam. Plan pays
up to $1,500 for hearing aids.

VISION SERVICES
(SEE NOTES FOR ***)

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

$0 for diagnostic exam. $0 for routine
$10 for diagnostic exam. $10 for
eye exam. $30 for contact lenses. $30 for
routine eye exam. $0 for eyewear after
eyeglasses. $30 for eyeglass lenses. $0 for
cataract surgery. Plan pays up to $40 for
eyewear after cataract surgery. Plan pays
eyewear.***
up to $175 for contacts or frames.

Confused by Medicare? Call the Council on Aging - Southern California HICAP experts at (800) 434-0222
90

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
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WE MUST
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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.ivhp.com http://www.ivhp.com http://www.kp.org/medicare http://www.scanhealthplan.com

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

Contents
Council on Aging Answers 2017 - Intro
Council on Aging Answers 2017 - Cover1
Council on Aging Answers 2017 - Cover2
Council on Aging Answers 2017 - 1
Council on Aging Answers 2017 - Contents
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Council on Aging Answers 2017 - 3a
Council on Aging Answers 2017 - 3b
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Council on Aging Answers 2017 - Cover3
Council on Aging Answers 2017 - Cover4
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