|
Part C
Plans |
Type |
Premium
|
Drugs |
Doctor
|
Vision |
Dental |
Bravo Classic
(HMO)
(H2108-028)
Bravo Health |
Health Maintenance Organization
|
$0
|
Yes |
Plan doctors only |
Covered |
Covered |
Bravo Achieve
(HMO)
(H2108-029)
Bravo Health
|
Special Needs Plan only for patients
with Diabetes mellitus
|
$0 |
Yes |
Plan doctors only |
Covered |
Covered |
Bravo Gold
(HMO)
(H2108-021)
Bravo Health
|
Health Maintenance Organization
|
$0 |
No |
Plan doctors only |
Covered |
Covered |
Bravo Select
(HMO)
(H2108-001)
Bravo Health
|
Special Needs Plan for patients covered
by both Medicare and Medicaid |
$29.40 |
Yes |
Plan doctors only |
Covered |
Covered |
Evercare Plan DP
(PPO)
(H2111-008)
Evercare® by UnitedHealthcare
|
Special Needs Plan for patients covered
by both Medicare and Medicaid |
$31.50 |
Yes |
Any doctor |
Covered |
Covered |
Evercare Plan IP
(PPO)
(H2111-001)
Evercare® by UnitedHealthcare
|
Special Needs Plan for patients who
require a nursing home or the same amount of care as someone in a
nursing home |
$33.70 |
Yes |
Any doctor |
Covered |
Covered |
Bravo Traditions
(HMO)
(H2108-020)
Bravo Health
|
Special Needs Plan for patients who
require a nursing home or the same amount of care as someone in a
nursing home |
$33.70 |
Yes |
Plan doctors only |
Covered |
Covered |
| Ętna Medicare Standard Plan (HMO)
(H0901-004)
Ętna Medicare
|
Health Maintenance Organization |
$34.00 |
Yes |
Plan doctors only |
Covered |
Covered (for an extra cost) |
Bravo Freedom
(PPO)
(H9184-001)
Bravo Health
|
Local Preferred Provider Organization |
$41.00 |
Yes |
Any doctor |
Covered |
Not Covered |
Security Choice Classic
(PFFS)
(H0540-088)
Unicare Life & Health Insurance Company
|
Private Fee For Service |
$55.00 |
No |
Any willing doctor |
Covered |
Not Covered |
Security Choice Plus
(PFFS)
(H0540-089)
Unicare Life & Health Insurance Company
|
Private Fee For Service |
$56.00 |
Yes |
Any willing doctor |
Covered |
Not Covered |
Ętna Medicare Premier Plan
(HMO)
(H0901-007)
Ętna Medicare
|
Health Maintenance Organization |
$69.00 |
Yes |
Plan doctors only |
Covered |
Covered (for an exra fee) |
Bravo Premier Plus
(HMO-POS)
(H2108-026)
Bravo Health
|
Health Maintenance Organization with
Point of Sale option - Let's you go outside the HMO system for an
additional cost |
$91.00 |
Yes |
Plan doctors only - with some
exceptions |
Covered |
Covered |
Bravo Liberty II Rx
(PFFS)
(H6421-012)
Bravo Health
|
Private Fee For Service |
$115.00 |
Yes |
Any willing doctor |
Not Covered |
Not Covered |
Ętna Medicare Premier Plan
(PPO)
(H5521-015)
Ętna Medicare
|
Local Preferred Provider Organization |
$169.00 |
Yes |
Any doctor |
Covered |
Covered (for an exra fee) |