|
Part C
Plans |
Type |
Premium
|
Drugs |
Doctor
|
Vision |
Dental |
| Ętna Medicare Basic Plan (HMO)
(H2112-001)
Ętna Medicare
|
Health Maintenance Organization |
$0 |
No |
Plan Doctors Only |
Covered |
Covered (for an extra cost)
|
Amerivantage Choice + Rx
(HMO-POS)
(H5896-012)
Amerigroup Community Care
|
Health Maintenance Organization with
Point of Sale option - Let's you go outside the HMO system for an
additional cost |
$0 |
Yes |
Plan Doctors Only (some exceptions) |
Covered |
Covered |
Amerivantage Choice + Rx
(HMO)
(H5896-008)
Amerigroup Community Care
|
Health Maintenance Organization |
$0 |
Yes |
Plan Doctors Only |
Covered |
Covered |
Bravo Achieve (HMO)
(H2108-30)
Bravo Health
|
Special Needs Plan only for patients
with Diabetes |
$0 |
Yes |
Plan Doctors Only |
Covered |
Covered |
Bravo Classic (HMO)
(H2108-22)
Bravo Health
|
Health Maintenance Organization |
$0 |
Yes |
Plan Doctors Only |
Covered |
Covered |
Bravo Gold (HMO)
(H2108-21)
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 |
Amerivantage Specialty + Rx
(HMO)
(H5896-007)
Amerigroup Community Care
|
Special Needs Plan for patients covered
by both Medicare and Medicaid |
$30.20 |
Yes |
Plan Doctors Only |
Covered |
Covered |
Bravo Choice (HMO)
(H2108-031)
Bravo Health
|
Health Maintenance Organization |
$31.00 |
Yes |
Plan Doctors Only |
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 |
| 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 |
| Ętna Medicare Standard Plan (HMO)
(H2112-007)
Ętna Medicare
|
Health Maintenance Organization |
$34.00 |
Yes |
Plan Doctors Only |
Covered |
Covered (for an extra cost)
|
Any, Any, Any MA Only (PFFS)
(H5820 - 029)
Universal Health Care Insurance Company Inc. |
Private Fee for Service |
$49.00 |
No |
Any Willing Doctor |
Covered |
Covered |
Any, Any, Any Gold (PFFS)
(H5820 - 011)
Universal Health Care Insurance Company Inc. |
Private Fee for Service |
$59.00 |
Yes |
Any Willing Doctor |
Covered |
Covered |
Bravo Freedom (PPO)
(H9184-002)
Bravo Health |
Local Preferred Provider Organization |
$61.00
|
Yes |
Any Doctor |
Covered |
Not Covered |
Care Improvement Plus Gold Rx
(HMO)
(H5665-002)
Care Improvement Plus
|
Special Needs Plan for patients
being treated for chronic heart failure or Diabetes mellitus |
$74.00 |
Yes |
Plan Doctors Only |
Covered |
Covered |
Any, Any, Any Platinum (PFFS)
(H5820 - 013)
Universal Health Care Insurance Company Inc. |
Private Fee for Service |
$89.00 |
Yes |
Any Willing Doctor |
Covered |
Covered |
Today's Options Value (PFFS)
(H3333 - 146)
Universal American |
Private Fee for Service |
$90.00 |
No |
Any Willing Doctor |
Covered |
Not
Covered |
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 (some exceptions |
Covered |
Covered |
Today's Options Value powered by CCRx
(PFFS)
(H3333 - 147)
Universal American |
Private Fee for Service |
$104.00 |
Yes |
Any Willing Doctor |
Covered |
Not
Covered |
| Ętna Medicare Premier Plan (HMO)
(H2112-014)
Ętna Medicare
|
Health Maintenance Organization |
$126.00 |
Yes |
Plan Doctors Only |
Covered |
Covered (for an extra cpst)
|
Today's Options Premier (PFFS)
(H3333 - 144)
Universal American |
Private Fee for Service |
$134.00 |
No |
Any Willing Doctor |
Covered |
Not
Covered |
| Ętna Medicare Standard Plan (PPO)
(H5521-036)
Ętna Medicare
|
Local Preferred Provider Organization |
$140.00 |
Yes |
Any Doctor |
Covered |
Covered (for an extra cost)
|
Today's Options Premier powered by CCRx
(PFFS)
(H3333 - 145)
Universal American |
Private Fee for Service |
$175.00 |
Yes |
Any Willing Doctor |
Covered |
Not
Covered |
| Ętna Medicare Premier Plan (PPO)
(H5521-035)
Ętna Medicare
|
Local Preferred Provider Organization |
$199.00 |
Yes |
Any Doctor |
Covered |
Covered (for an extra cost)
|
