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2016 Medicare Advantage Plan Benefit Details for the HumanaChoice R5826-011 (Regional PPO)
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2016 Medicare Advantage Plan Details
Medicare Plan Name:HumanaChoice R5826-011 (Regional PPO)
Location:Simpson, Mississippi     Click to see other locations
Plan ID:R5826 - 011 - 0     Click to see other plans
Member Services:1-800-457-4708 TTY users 711
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the HumanaChoice R5826-011 (Regional PPO) benefit details
— Medicare Plan Features —
Monthly Premium:$79.00 (see Plan Premium Details below)
Annual Deductible:$360
Annual Initial Coverage Limit (ICL):$3,310
Health Plan Type:Regional PPO
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$6,700
Additional Gap Coverage?Yes, some additional gap coverage.
Total Number of Formulary Drugs:3,884 drugsBrowse the HumanaChoice R5826-011 (Regional PPO) Formulary
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. 
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
• Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:		$6.00$15.00$47.00$99.0025%
• Number of Drugs per
  Tier:		2477788411431587
Plan's Pharmacy Search:http://www.humana.com/Medicare/medicare_prescription_drugs
Plan Offers Mail Order?Yes
Number of Members enrolled in this plan in Simpson, Mississippi:171 members
Number of Members enrolled in this plan in Mississippi:12,282 members
Number of Members enrolled in this plan in (R5826 - 011):22,738 members
Plan’s Summary Star Rating: 3.5 out of 5 Stars.
• Customer Service Rating: 5 out of 5 Stars.
• Member Experience Rating: 4 out of 5 Stars.
• Drug Cost Accuracy Rating: 4 out of 5 Stars.
— Plan Premium Details —
The Monthly Premium is Split as Follows: ❔
Total
Premium		Part C
Premium		Part D Base
Premium		Part D Supplemental
Premium
$79.00$36.30$42.70$0.00
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔100%
Subsidy		75%
Subsidy		50%
Subsidy		25%
Subsidy
Monthly Part D Premium with LIS:$12.90$20.40$27.80$35.30
Total Monthly Premium with LIS (Parts C & D):$49.20$56.70$64.10$71.60
— Plan Health Benefits —
** Cost **
Monthly premium, deductible, and limits on how much you pay for covered services
$79 per month. In addition you must keep paying your Medicare Part B premium.
This plan has deductibles for some hospital and medical services and Part D prescription drugs.
$500 per year for out-of-network services.
$360 per year for Part D prescription drugs except for drugs listed on Tier 1 Tier 2 and Tier 3 which are excluded from the deductible.
Yes. Like all Medicare health plans our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.
Your yearly limit(s) in this plan:
  • $6 700 for services you receive from in-network providers.
  • $6 700 for services you receive from any provider. Your limit for services received from in-network providers will count toward this limit.
If you reach the limit on out-of-pocket costs you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.

Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.
Our plan has a coverage limit every year for certain benefits from any provider. Contact us for services that apply.
** Doctor and Hospital Choice **
Acupuncture
Not covered
** Extra Benefits **
Inpatient mental health care
For inpatient mental health care see the "Mental Health Care" section.
Outpatient prescription drugs
For Part B drugs such as chemotherapy drugs1:
  • In-network:  20% of the cost
  • Out-of-network:  20-25% of the cost depending on the drug
Other Part B drugs1:
  • In-network:  20% of the cost
  • Out-of-network:  20-25% of the cost depending on the drug
After you pay your yearly deductible you pay the following until your total yearly drug costs reach $3 310. Total yearly drug costs are the total drug costs paid by both you and our Part D plan.
You may get your drugs at network retail pharmacies and mail order pharmacies.
Standard Retail Cost-Sharing
TierOne-month supplyThree-month supply
Tier 1 (Preferred Generic)$6 copay$18 copay
Tier 2 (Generic)$15 copay$45 copay
Tier 3 (Preferred Brand)$47 copay$141 copay
Tier 4 (Non-Preferred Brand)$99 copay$297 copay
Tier 5 (Specialty Tier)25% of the costNot Offered
Standard Mail Order Cost-Sharing
TierOne-month supplyThree-month supply
Tier 1 (Preferred Generic)$6 copay$18 copay
Tier 2 (Generic)$15 copay$45 copay
Tier 3 (Preferred Brand)$47 copay$141 copay
Tier 4 (Non-Preferred Brand)$99 copay$297 copay
Tier 5 (Specialty Tier)25% of the costNot Offered
Preferred Mail Order Cost-Sharing
TierOne-month supplyThree-month supply
Tier 1 (Preferred Generic)$6 copay$0
Tier 2 (Generic)$15 copay$0
Tier 3 (Preferred Brand)$47 copay$131 copay
Tier 4 (Non-Preferred Brand)$99 copay$287 copay
Tier 5 (Specialty Tier)25% of the costNot Offered
If you reside in a long-term care facility you pay the same as at a retail pharmacy.
You may get drugs from an out-of-network pharmacy but may pay more than you pay at an in-network pharmacy.
Most Medicare drug plans have a coverage gap (also called the "donut hole"). This means that there's a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $3 310.

After you enter the coverage gap you pay 45% of the plan's cost for covered brand name drugs and 58% of the plan's cost for covered generic drugs until your costs total $4 850 which is the end of the coverage gap. Not everyone will enter the coverage gap.

Under this plan you may pay even less for the brand and generic drugs on the formulary. Your cost varies by tier. You will need to use your formulary to locate your drug's tier. See the chart that follows to find out how much it will cost you.
Standard Retail Cost-Sharing
TierDrugs CoveredOne-month supplyThree-month supply
Tier 1 (Preferred Generic)Some$6 copay$18 copay
Tier 2 (Generic)Some$15 copay$45 copay
Tier 3 (Preferred Brand)Some$47 copay$141 copay
Tier 4 (Non-Preferred Brand)Some$99 copay$297 copay
Tier 5 (Specialty Tier)Some25% of the costNot Offered
Standard Mail Order Cost-Sharing
TierDrugs CoveredOne-month supplyThree-month supply
Tier 1 (Preferred Generic)Some$6 copay$18 copay
Tier 2 (Generic)Some$15 copay$45 copay
Tier 3 (Preferred Brand)Some$47 copay$141 copay
Tier 4 (Non-Preferred Brand)Some$99 copay$297 copay
Tier 5 (Specialty Tier)Some25% of the costNot Offered
Preferred Mail Order Cost-Sharing
TierDrugs CoveredOne-month supplyThree-month supply
Tier 1 (Preferred Generic)Some$6 copay$0
Tier 2 (Generic)Some$15 copay$0
Tier 3 (Preferred Brand)Some$47 copay$131 copay
Tier 4 (Non-Preferred Brand)Some$99 copay$287 copay
Tier 5 (Specialty Tier)Some25% of the costNot Offered
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $4 850 you pay the greater of:
  • 5% of the cost or
  • $2.95 copay for generic (including brand drugs treated as generic) and a $7.40 copayment for all other drugs.
** Important Information **
Monthly premium, deductible, and limits on how much you pay for covered services
$79 per month. In addition you must keep paying your Medicare Part B premium.
This plan has deductibles for some hospital and medical services and Part D prescription drugs.
$500 per year for out-of-network services.
$360 per year for Part D prescription drugs except for drugs listed on Tier 1 Tier 2 and Tier 3 which are excluded from the deductible.
Yes. Like all Medicare health plans our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.
Your yearly limit(s) in this plan:
  • $6 700 for services you receive from in-network providers.
  • $6 700 for services you receive from any provider. Your limit for services received from in-network providers will count toward this limit.
If you reach the limit on out-of-pocket costs you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.

Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.
Our plan has a coverage limit every year for certain benefits from any provider. Contact us for services that apply.
** Outpatient Care and Services **
Acupuncture
Not covered
Ambulance
  • In-network:  $300 copay
  • Out-of-network:  $300 copay
Chiropractic care
Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position):
  • In-network:  $20 copay
  • Out-of-network:  $20 copay
Dental services
Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):
  • In-network:  $45 copay
  • Out-of-network:  $40-60 copay depending on the service
Preventive dental services:
  • Cleaning (for up to 2 every year):
    • In-network:  You pay nothing
    • Out-of-network:  50-55% of the cost depending on the service
  • Dental x-ray(s) (for up to 4):
    • In-network:  You pay nothing
    • Out-of-network:  50-55% of the cost depending on the service
  • Fluoride treatment (for up to 2 every year):
    • In-network:  You pay nothing
    • Out-of-network:  50-55% of the cost depending on the service
  • Oral exam (for up to 2 every year):
    • In-network:  You pay nothing
    • Out-of-network:  50-55% of the cost depending on the service
    Diabetes supplies and services
    Diabetes monitoring supplies:
    • In-network:  0-20% of the cost depending on the supply
    • Out-of-network:  20-25% of the cost depending on the supply
    Diabetes self-management training:
    • In-network:  You pay nothing
    • Out-of-network:  You pay nothing
    Therapeutic shoes or inserts:
    • In-network:  $10 copay
    • Out-of-network:  20-25% of the cost depending on the supply
    Diagnostic tests, lab and radiology services, and x-rays (Costs for these services may be different if received in an outpatient surgery setting)
    Diagnostic radiology services (such as MRIs CT scans):
    • In-network:  $0-225 copay depending on the service
    • Out-of-network:  $0-225 copay depending on the service
    Diagnostic tests and procedures:
    • In-network:  $0-100 copay depending on the service
    • Out-of-network:  $0-100 copay depending on the service
    Lab services:
    • In-network:  $0-50 copay depending on the service
    • Out-of-network:  $0-100 copay depending on the service
    Outpatient x-rays:
    • In-network:  $0-60 copay depending on the service
    • Out-of-network:  $0-60 copay depending on the service
    Therapeutic radiology services (such as radiation treatment for cancer):
    • In-network:  $45-60 copay depending on the service
    • Out-of-network:  $40-60 copay depending on the service
    Doctor's office visits
    Primary care physician visit:
    • In-network:  $15 copay
    • Out-of-network:  $15 copay
    Specialist visit:
    • In-network:  $15-45 copay depending on the service
    • Out-of-network:  $15-45 copay depending on the service
    Durable medical equipment (wheelchairs, oxygen, etc.)
    • In-network:  20% of the cost
    • Out-of-network:  20-25% of the cost depending on the equipment
    If you go to a preferred vendor your cost may be less. Contact us for a list of preferred vendors.
    Emergency care
    $75 copay
    If you are admitted to the hospital within 24 hours you do not have to pay your share of the cost for emergency care. See the "Inpatient Hospital Care" section for other costs.
    Foot care (podiatry services)
    Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:
    • In-network:  $45 copay
    • Out-of-network:  $40-60 copay depending on the service
    Hearing services
    Exam to diagnose and treat hearing and balance issues:
    • In-network:  $45 copay
    • Out-of-network:  $40-60 copay depending on the service
    Routine hearing exam (for up to 1 every year):
    • In-network:  You pay nothing
    • Out-of-network:  20-25% of the cost depending on the service
    Hearing aid fitting/evaluation (for up to 1 every year):
    • In-network:  You pay nothing
    • Out-of-network:  20-25% of the cost depending on the service
    Hearing aid:
    • In-network:  You pay nothing
    • Out-of-network:  20-25% of the cost for each hearing aid depending on the type
    Our plan pays up to $1 000 every three years for hearing aids from any provider.
    Home health care
    • In-network:  You pay nothing
    • Out-of-network:  You pay nothing
    Mental health care
    Inpatient visit:
    Our plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. The inpatient hospital care limit does not apply to inpatient mental services provided in a general hospital.
    Our plan covers 90 days for an inpatient hospital stay.
    Our plan also covers 60 "lifetime reserve days." These are "extra" days that we cover. If your hospital stay is longer than 90 days you can use these extra days. But once you have used up these extra 60 days your inpatient hospital coverage will be limited to 90 days.
    • In-network:  
      • $275 copay per day for days 1 through 5
      • You pay nothing per day for days 6 through 90
        • Out-of-network:  
          • $275 copay per day for days 1 through 5
          • You pay nothing per day for days 6 through 90
            • Outpatient group therapy visit:
            • In-network:  $40 copay
            • Out-of-network:  $40 copay
            Outpatient individual therapy visit:
            • In-network:  $40 copay
            • Out-of-network:  $40 copay
            Outpatient rehabilitation
            Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks):
            • In-network:  $15 copay
            • Out-of-network:  $15 copay
            Occupational therapy visit:
            • In-network:  $15 copay
            • Out-of-network:  $15 copay
            Physical therapy and speech and language therapy visit:
            • In-network:  $15 copay
            • Out-of-network:  $15 copay
            Outpatient substance abuse
            Group therapy visit:
            • In-network:  $40-45 copay depending on the service
            • Out-of-network:  $40-60 copay depending on the service
            Individual therapy visit:
            • In-network:  $40-45 copay depending on the service
            • Out-of-network:  $40-60 copay depending on the service
            Outpatient surgery
            Ambulatory surgical center:
            • In-network:  $225 copay
            • Out-of-network:  $225 copay
            Outpatient hospital:
            • In-network:  $275 copay
            • Out-of-network:  $275 copay
            Over-the-counter items
            Please visit our website to see our list of covered over-the-counter items.
            Prosthetic devices (braces, artificial limbs, etc.)
            Prosthetic devices:
            • In-network:  20% of the cost
            • Out-of-network:  20-25% of the cost depending on the device
            Related medical supplies:
            • In-network:  20% of the cost
            • Out-of-network:  20-25% of the cost depending on the supply
            Renal dialysis
            • In-network:  20% of the cost
            • Out-of-network:  20-25% of the cost depending on the service
            Transportation
            Not covered
            Urgently needed services
            $15-45 copay depending on the service
            Vision services
            Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):
            • In-network:  $0-45 copay depending on the service
            • Out-of-network:  $0-100 copay depending on the service
            Routine eye exam (for up to 1 every year):
            • In-network:  You pay nothing
            • Out-of-network:  You pay nothing
            Our plan pays up to $40 every year for routine eye exams from any provider.
            Eyeglasses or contact lenses after cataract surgery:
            • In-network:  You pay nothing
            • Out-of-network:  You pay nothing
            ** Hospice **
            Hospice
            You pay nothing for hospice care from a Medicare-certified hospice. You may have to pay part of the cost for drugs and respite care.
            ** Preventive Care **
            Preventive care
            • In-network:  You pay nothing
            • Out-of-network:  You pay nothing
            Our plan covers many preventive services including:
            • Abdominal aortic aneurysm screening
            • Alcohol misuse counseling
            • Bone mass measurement
            • Breast cancer screening (mammogram)
            • Cardiovascular disease (behavioral therapy)
            • Cardiovascular screenings
            • Cervical and vaginal cancer screening
            • Colorectal cancer screenings (Colonoscopy Fecal occult blood test Flexible sigmoidoscopy)
            • Depression screening
            • Diabetes screenings
            • HIV screening
            • Medical nutrition therapy services
            • Obesity screening and counseling
            • Prostate cancer screenings (PSA)
            • Sexually transmitted infections screening and counseling
            • Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease)
            • Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
            • "Welcome to Medicare" preventive visit (one-time)
            • Yearly "Wellness" visit
            Any additional preventive services approved by Medicare during the contract year will be covered.
            ** Inpatient Care **
            Inpatient hospital care
            Our plan covers an unlimited number of days for an inpatient hospital stay.
            • In-network:  
              • $275 copay per day for days 1 through 7
              • You pay nothing per day for days 8 through 90
              • You pay nothing per day for days 91 and beyond
                • Out-of-network:  
                  • $275 copay per day for days 1 through 7
                  • You pay nothing per day for days 8 through 90
                    • Inpatient mental health care
                    For inpatient mental health care see the "Mental Health Care" section.
                    Skilled Nursing Facility (SNF)
                    Our plan covers up to 100 days in a SNF.
                    • In-network:  
                      • You pay nothing per day for days 1 through 20
                      • $160 copay per day for days 21 through 100
                        • Out-of-network:  
                          • You pay nothing per day for days 1 through 20
                          • $160 copay per day for days 21 through 100
                            • Outpatient prescription drugs
                            For Part B drugs such as chemotherapy drugs1:
                            • In-network:  20% of the cost
                            • Out-of-network:  20-25% of the cost depending on the drug
                            Other Part B drugs1:
                            • In-network:  20% of the cost
                            • Out-of-network:  20-25% of the cost depending on the drug
                            After you pay your yearly deductible you pay the following until your total yearly drug costs reach $3 310. Total yearly drug costs are the total drug costs paid by both you and our Part D plan.
                            You may get your drugs at network retail pharmacies and mail order pharmacies.
                            Standard Retail Cost-Sharing
                            TierOne-month supplyThree-month supply
                            Tier 1 (Preferred Generic)$6 copay$18 copay
                            Tier 2 (Generic)$15 copay$45 copay
                            Tier 3 (Preferred Brand)$47 copay$141 copay
                            Tier 4 (Non-Preferred Brand)$99 copay$297 copay
                            Tier 5 (Specialty Tier)25% of the costNot Offered
                            Standard Mail Order Cost-Sharing
                            TierOne-month supplyThree-month supply
                            Tier 1 (Preferred Generic)$6 copay$18 copay
                            Tier 2 (Generic)$15 copay$45 copay
                            Tier 3 (Preferred Brand)$47 copay$141 copay
                            Tier 4 (Non-Preferred Brand)$99 copay$297 copay
                            Tier 5 (Specialty Tier)25% of the costNot Offered
                            Preferred Mail Order Cost-Sharing
                            TierOne-month supplyThree-month supply
                            Tier 1 (Preferred Generic)$6 copay$0
                            Tier 2 (Generic)$15 copay$0
                            Tier 3 (Preferred Brand)$47 copay$131 copay
                            Tier 4 (Non-Preferred Brand)$99 copay$287 copay
                            Tier 5 (Specialty Tier)25% of the costNot Offered
                            If you reside in a long-term care facility you pay the same as at a retail pharmacy.
                            You may get drugs from an out-of-network pharmacy but may pay more than you pay at an in-network pharmacy.
                            Most Medicare drug plans have a coverage gap (also called the "donut hole"). This means that there's a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $3 310.

                            After you enter the coverage gap you pay 45% of the plan's cost for covered brand name drugs and 58% of the plan's cost for covered generic drugs until your costs total $4 850 which is the end of the coverage gap. Not everyone will enter the coverage gap.

                            Under this plan you may pay even less for the brand and generic drugs on the formulary. Your cost varies by tier. You will need to use your formulary to locate your drug's tier. See the chart that follows to find out how much it will cost you.
                            Standard Retail Cost-Sharing
                            TierDrugs CoveredOne-month supplyThree-month supply
                            Tier 1 (Preferred Generic)Some$6 copay$18 copay
                            Tier 2 (Generic)Some$15 copay$45 copay
                            Tier 3 (Preferred Brand)Some$47 copay$141 copay
                            Tier 4 (Non-Preferred Brand)Some$99 copay$297 copay
                            Tier 5 (Specialty Tier)Some25% of the costNot Offered
                            Standard Mail Order Cost-Sharing
                            TierDrugs CoveredOne-month supplyThree-month supply
                            Tier 1 (Preferred Generic)Some$6 copay$18 copay
                            Tier 2 (Generic)Some$15 copay$45 copay
                            Tier 3 (Preferred Brand)Some$47 copay$141 copay
                            Tier 4 (Non-Preferred Brand)Some$99 copay$297 copay
                            Tier 5 (Specialty Tier)Some25% of the costNot Offered
                            Preferred Mail Order Cost-Sharing
                            TierDrugs CoveredOne-month supplyThree-month supply
                            Tier 1 (Preferred Generic)Some$6 copay$0
                            Tier 2 (Generic)Some$15 copay$0
                            Tier 3 (Preferred Brand)Some$47 copay$131 copay
                            Tier 4 (Non-Preferred Brand)Some$99 copay$287 copay
                            Tier 5 (Specialty Tier)Some25% of the costNot Offered
                            After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $4 850 you pay the greater of:
                            • 5% of the cost or
                            • $2.95 copay for generic (including brand drugs treated as generic) and a $7.40 copayment for all other drugs.
                            ** Outpatient Care **
                            Diabetes supplies and services
                            Diabetes monitoring supplies:
                            • In-network:  0-20% of the cost depending on the supply
                            • Out-of-network:  20-25% of the cost depending on the supply
                            Diabetes self-management training:
                            • In-network:  You pay nothing
                            • Out-of-network:  You pay nothing
                            Therapeutic shoes or inserts:
                            • In-network:  $10 copay
                            • Out-of-network:  20-25% of the cost depending on the supply
                            Foot care (podiatry services)
                            Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:
                            • In-network:  $45 copay
                            • Out-of-network:  $40-60 copay depending on the service
                            Hearing services
                            Exam to diagnose and treat hearing and balance issues:
                            • In-network:  $45 copay
                            • Out-of-network:  $40-60 copay depending on the service
                            Routine hearing exam (for up to 1 every year):
                            • In-network:  You pay nothing
                            • Out-of-network:  20-25% of the cost depending on the service
                            Hearing aid fitting/evaluation (for up to 1 every year):
                            • In-network:  You pay nothing
                            • Out-of-network:  20-25% of the cost depending on the service
                            Hearing aid:
                            • In-network:  You pay nothing
                            • Out-of-network:  20-25% of the cost for each hearing aid depending on the type
                            Our plan pays up to $1 000 every three years for hearing aids from any provider.
                            ** Outpatient Medical Services and Supplies **
                            Outpatient substance abuse
                            Group therapy visit:
                            • In-network:  $40-45 copay depending on the service
                            • Out-of-network:  $40-60 copay depending on the service
                            Individual therapy visit:
                            • In-network:  $40-45 copay depending on the service
                            • Out-of-network:  $40-60 copay depending on the service
                            Prosthetic devices (braces, artificial limbs, etc.)
                            Prosthetic devices:
                            • In-network:  20% of the cost
                            • Out-of-network:  20-25% of the cost depending on the device
                            Related medical supplies:
                            • In-network:  20% of the cost
                            • Out-of-network:  20-25% of the cost depending on the supply
                            ** Additional Benefits **
                            Inpatient mental health care
                            For inpatient mental health care see the "Mental Health Care" section.




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                            • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
                            • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
                            • Limitations, copayments, and restrictions may apply.
                            • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
                              Statement required by Medicare:
                              "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
                            • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
                            • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
                            • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
                            • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
                            • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
                            • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
                            • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
                            • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
                            • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
                            • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
                            • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
                            • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
                            • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
                            • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
                            • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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