Medicare Advantage

Medicare Advantage Plans – 2019

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There’s a lot to consider when you’re ready to enroll in Medicare, whether it’s deciding on which Medigap supplemental policy to add to original Medicare or signing up for Medicare Advantage, the private portion of Medicare that covers added benefits and services. There’s no one-size-fits-all solution to the process, and we believe that speaking with a licensed Medicare insurance specialist yields the best results.

We’re not going to sugar-coat things. Picking a Medicare plan isn’t black and white. So many factors go into your perfect health plan — what it costs, how much you’ll use it, extra benefits and features that you didn’t even consider — that this process can feel like one big headache. We get it (we really do!) because we do this for a living. We help people like you make sense of the options and find the right coverage for your needs.

Because Medicare Advantage plans differ so much based on where you live and who’s selling them, it’s impossible to give you an “average” for what you might pay or what the plan might look like for you. Plus, some companies let you add “riders” (extra features) to their basic plans, which makes the whole process that much more daunting. (Did we mention that this is tough?)

Nevertheless, from time to time we get requests for an analysis of different Medicare Advantage plans. How do they stack up? What should you be looking for? What can you expect as you start shopping for health insurance in retirement? Well, we can’t give you a detailed analysis that crunches all the numbers — after all, there are about 3,700 total Medicare Advantage plans available in 2019 — but we can take a look at a handful to give you a better idea of what you need to consider as you shop for Medicare Advantage for next year.

Below, we’ve highlighted four companies: Humana, AARP (United Healthcare), Aetna and Blue Cross Blue Shield. In each company, we’ve chosen to shine a spotlight on a specific city just to give you real numbers and coverage information, which we got straight from each company’s own website.

(After browsing the information, you’ll probably have questions. Let us answer them! We’re Medicare experts, and we stay up to date on Medicare facts and info so we can help consumers make better choices about their health insurance. It’s what we do.)

Now, without further ado, here’s a handy overview of some Medicare Advantage plan options available in 2019.

Humana Medicare – 53051 – Meomonee Falls, Wisconsin

Humana offers a wide range of insurance products, one of their most prominent being Medicare Advantage. Founded in Kentucky in 1961, the company consistently ranks on lists of top employers in the country, and its commitment to corporate social responsibility sets it apart from industry leaders. In Meomonee Falls, Wisconsin, there are nine Medicare Advantage plans available. We’ve highlighted a few in this section.

Humana Gold Plus HMO (H6622-034)

The Humana Gold Plus HMO plan covers everything that original Medicare covers, plus some added benefits. Many annual preventive screenings are free, and prescription drugs are covered at no additional premium. You can also use any doctor approved by Medicare that accepts Humana without the need for a referral to see specialists. As an HMO plan, there is no coverage for out-of-network providers and services except in cases of urgent or emergency needs. But the plan also doesn’t charge a monthly premium or medical deductible. Primary care physician visits have no copay (specialists cost $45 per visit). There’s no deductible for hospital visits. Your maximum annual out-of-pocket expense is $4,500 for covered benefits.

Humana plans also include extra benefits. The Gold Plus HMO, for instance, covers routine transportation, fitness benefits through Silver Sneakers, and an allowance for over-the-counter drugs and supplies. Note that while there’s no monthly cost for prescription benefits, there is a $300 drug deductible with this plan.

HumanaChoice PPO (H5216-001)

The HumanaChoice PPO gives you a bit more freedom to choose providers than the HMO plan, but you should note that non-network care will likely cost much more than care you get from an in-network provider. Under this plan, you’ll gain all the same benefits as original Medicare along with added features and coverage. Primary doctors require a $10 copay while specialists cost $40 per visit. There’s no medical deductible, but there is a prescription drug deductible of $325 for the year for tiers 4 and 5. You’ll pay about $79 a month for HumanaChoice PPO. This plan also includes an out-of-pocket cap on covered expenses for the year, but it’s the maximum amount of $6,700.

Along with prescription drug coverage, this plan includes added benefits that make it a more robust option than your standard Medicare Advantage plan. Routine vision and dental benefits are included, as is access to the Silver Sneakers fitness program and a benefit for over-the-counter drugs and supplies.

Humana Gold Choice PFFS (H8145-006)

Humana Gold Choice PFFS covers many of the same benefits as all Humana Medicare Advantage plans in 2019, including everything that original Medicare covers along with added features and services. With this plan, the monthly premium is about $94, and there’s a $200 medical deductible whether you get care from an in-network or out-of-network provider (for services not covered under original Medicare). Primary doctors require a $20 copay while specialists will cost $50 per visit. This plan and the other two outlined above require a $25 copay for visits to an urgent care center and a $90 copay for emergency room visits. There’s also an out-of-pocket cap in place for covered services of $6,700.

Humana’s plans come with different types of added benefits. The Gold Choice PFFS covers routine dental, hearing and vision services and gives you access to the Silver Sneakers fitness program as well as an allotment for over-the-counter drugs and supplies. Prescription drugs are also covered. Costs for these depend on where you get the prescription filled, the supply amount and which tier the drug is on.

Humana Medicare Advantage Plans 2019 (Meomonee Falls, WI)
Gold Plus HMO HumanaChoice PPO Gold Choice PFFS
Monthly cost $0 $79 $94
Deductible $0 $0 $200
Doctor copays $0 primary doctor

$45 specialist

$10 primary doctor

$40 specialist

$20 primary doctor

$50 specialist

Urgent care $25 copay $25 copay (in-network) $25 copay
Emergency care $90 copay $90 copay (in-network) $90 copay
Inpatient hospital stays $350 for days 1 to 5, then nothing for days 6 to 90 $295 for days 1 to 6, then nothing for days 7 to 90 $279 for days 1 to 7, then $0 for days 8 to 90
Rx deductible $300 for tiers 4 and 5 $325 for tiers 4 and 5 $415 for tiers 3, 4 and 5
Rx copays Ranges from $6 copay for preferred tier 1 generics (preferred retail, 30-day supply) to 27% of the cost of tier 5 specialty drugs Ranges from $6 copay for preferred tier 1 generics (preferred retail, 30-day supply) to 26% of the cost of tier 5 specialty drugs Ranges from $6 copay for preferred tier 1 generics (preferred retail, 30-day supply) to 25% of the cost of tier 5 specialty drugs
Medical out-of-pocket cap $4,500 (in-network) $6,700 (in-network) $6,700 (in-network)
Extra benefits Routine dental, hearing and vision as well as routine transportation, Silver Sneakers fitness program and over-the-counter items Routine dental and vision as well as Silver Sneakers fitness program and over-the-counter items Routine dental, hearing and vision as well as Silver Sneakers fitness program and over-the-counter items
Overall rating from the CMS 4 stars 4 stars 3.5 stars

AARP – 55105 – St. Paul, Minnesota

AARP was founded in 1958 by Dr. Ethel Percy Andrus, a retired high school principal. Initially known as the National Retired Teachers Association, the organization has grown to include a much wider membership. Today, the organization has a mission to empower people so that they can choose how to live as they age. AARP offers Medicare Advantage Plans in the St. Paul area through United Healthcare. There are three Medicare Advantage plans available in the area.

AARP Medicare Complete Headwaters PPO

The AARP Medicare Complete Headwaters PPO has a monthly copay of $24. Primary care office visits require a $20 copay, and you’ll pay $50 per visit to see specialists, which does not require a referral from your primary doctor. There’s no annual deductible, and your out-of-pocket cap for the year (for in-network care) is $6,700. Inpatient hospital care costs $450 for days 1 through 4 with no copay for days 5 through 90. Skilled nursing facility costs are included.

This plan does include prescription drug coverage, and you won’t need to meet a deductible for drugs on tiers 1 and 2. For tiers 3, 4 and 5, there’s a $395 annual deductible. You’ll also have benefits for extra services, such as membership to a participating fitness center and coverage for some over-the-counter items. Eyewear isn’t included in this plan, but you will have coverage for an eye exam with no copay. Dental is not included.

AARP MedicareComplete Lakeshore PPO

The AARP Medicare Complete Lakeshore PPO costs $58 a month. Primary care physicians have a $15 copay ($45 for specialists), and you don’t need a referral to see a specialist. Routine physicals are included without cost sharing. There’s no annual deductible, and the maximum you’ll pay for in-network services is $4,900 for the year. Inpatient hospital stays require a daily copay of $350 for days 1 through 4 with no copay for days 5 to 90. Skilled nursing facility costs are also covered.

Costs for other services vary. Lab services require a $10 copay, but all preventive care is included at no added out-of-pocket cost. The Lakeshore plan includes coverage for things like fitness memberships, over-the-counter items and video doctor visits, along with preventive dental care.

Prescription drugs are covered under this plan with a $0 deductible for tiers 1 and 2 (and a $295 deductible for tiers 3, 4 and 5). Costs for specific drugs will vary based on the supply, where you buy it from and the kind of medication (tier) you’re taking.

UnitedHealthcare Sync PPO

The monthly premium for the UnitedHealthcare Sync PPO plan is $54. Primary care visits have a $15 copay while specialists have a $50 copay. Routine physicals are free, and there’s no annual deductible for medical services. The maximum you’ll pay for in-network services for the year is $5,900. Inpatient hospital stays require a $400 copay per day for days 1 through 4, but there’s no copay for days 5 through 90. Skilled nursing facility costs are also covered.

Costs for other treatments and services depend on type. Outpatient X-rays, for instance, require a $14 copay while air ambulance rides require a $250 copay whether you use an in-network provider or not. You’ll have a 20 percent copay for diagnostic testing other than radiology, and there’s $0 copay for home healthcare. This plan includes coverage for preventive and comprehensive dental services.

AARP Medicare Advantage Plans 2019 (St. Paul, MN)
Medicare Complete

Headwaters PPO

Medicare Complete

Lakeshore PPO

United Healthcare Sync PPO
Monthly cost $24 $58 $54
Deductible $0 $0 $0
Doctor copays $20 primary doctor

$50 specialist

$15 primary doctor

$45 specialist

$15 primary doctor

$50 specialist

Urgent care $30 to $40 copay $30 to $40 copay $30 to $40 copay
Emergency care $90 copay $90 copay $90 copay
Inpatient hospital stays $450 for days 1 to 4, then nothing for days 5 to 90 $350 for days 1 to 5, then nothing for days 6 to 90 $400 for days 1 to 4, then $0 for days 5 to 90
Rx deductible $0 for tiers 1 and 2

$395 for tiers 3, 4 and 5

$0 for tiers 1 and 2

$295 for tiers 3, 4 and 5

$0 for tiers 1 and 2

$295 for tiers 3, 4 and 5

Rx copays Ranges from $3 copay for preferred tier 1 generics (preferred retail, 30-day supply) to 25% of the cost of tier 5 specialty drugs Ranges from $3 copay for preferred tier 1 generics (preferred retail, 30-day supply) to 27% of the cost of tier 5 specialty drugs Ranges from $3 copay for preferred tier 1 generics (preferred retail, 30-day supply) to 27% of the cost of tier 5 specialty drugs
Medical out-of-pocket cap $6,700 (in-network) $4,900 (in-network) $5,900 (in-network)
Extra benefits Routine hearing and over-the-counter benefits as well as fitness benefits, video doctor visits, caregiver support, a nurse hotline and travel coverage Dental, vision and hearing as well as fitness and over-the-counter benefits, video doctor visits, caregiver support, a nurse hotline and travel coverage Dental, vision and hearing as well as fitness benefits (including a Fitbit), video doctor visits, caregiver support, a nurse hotline and travel coverage
Overall rating from the CMS N/A (too new to be rated) N/A (too new to be rated) N/A (too new to be rated)

 

Aetna\Coventry Medicare Advantage Plans – 90001 – Los Angeles, CA

Aetna was founded in 1853 in Hartford, Connecticut, and has been providing insurance to consumers in the United States for over 160 years. In 2013, Aetna acquired Coventry Health Care, increasing the number of Medicare Advantage plans available throughout the country. In California, consumers can choose from three Aetna Medicare Advantage plans: Aetna Medicare Choice Plan (PPO), Aetna Medicare Prime Plan (HMO) and Aetna Medicare Select Plan (HMO)

Aetna Medicare Choice Plan (PPO)

Under the Aetna Medicare Choice Plan, if you are between the ages of 65 and 69 in fair health, the monthly premium is $73, and you can expect to pay approximately $3,738 per year for medical costs, including premiums. There is no deductible if you remain in the network, but if you go outside the network you’ll have to meet a $750 deductible before benefits start. There’s an annual cap on your out-of-pocket costs with this plan of $6,700 (for in-network services). In-network primary care physician copays are $5 and 40 percent outside the network. Specialists are $40 in-network and 40 percent outside the network. Inpatient hospital stays cost $220 per day for the first four days. After that, you won’t have to pay a copay for inpatient stays.

Alternative therapies, meals, transportation and over-the-counter medications are not covered under this plan, but you do get prescription drug benefits. You’ll pay anywhere from $0 for 30-day supplies of preferred tier 1 generics at a preferred retail pharmacy to 33 percent of the cost of specialty drugs on tier 5.

Aetna Medicare Prime (HMO)

If you are 65 to 69 years old and in fair health, which means that you may have one or two chronic conditions or could be facing one major medical treatment, the monthly premium for the Aetna Medicare Prime HMO plan is zero, and you might spend around $1,944 a year on medical costs. As long as you use in-network providers, there’s no deductible for this plan. Plus, there’s an out-of-pocket cap in place of $2,200, which keeps your costs in check throughout the year. Trips to the doctor (primary or specialist) don’t require a copay. Inpatient hospital stays, lab services and diagnostic procedures also have a $0 copay. It’s important to note that care provided outside of the network may not be covered at all by this plan unless outlined by the plan documents.

Alternative therapies, meals, transportation and over-the-counter medications are not covered with this plan, but prescription drugs are included, as are fitness services. Costs for prescription drugs will depend on tier, supply count and where you get them filled. For example, preferred brand name drugs from a mail-order pharmacy require a $136 copay while preferred generics (tier 1, 30-day supply) from a preferred retail pharmacy cost nothing out of pocket.

Aetna Medicare Select Plan (HMO)

Aetna’s Medicare Select Plan has no premium each month. If you’re between 65 and 69 years old and in fair health, you can expect to pay about $1,942 per year for coverage (though estimates are just that, of course). You must use a physician within the network or your costs won’t be covered. There’s a maximum out-of-pocket limit for in-network care of $2,000. And as long as you stay inside the network, you won’t have any out-of-pocket costs (copays) for visits to your primary care doctor, specialists, inpatient hospital stays, lab services or some diagnostic procedures. Costs for other services vary by type.

This plan covers routine vision, dental and hearing services as well as fitness benefits, including membership in a local participating fitness center. What you pay for prescriptions will depend on the pharmacy and type. Generic tier 1 drugs, for example, cost nothing if you fill them at a preferred pharmacy (30-day supply). Nonpreferred drugs at tier 4 might cost $100 at the same pharmacy type.

Aetna/Coventry Medicare Advantage Plans 2019 (Los Angeles, CA)
Medicare Choice PPO Medicare Prime HMO Medicare Select HMO
Monthly cost $73 $0 $0
Deductible $0 $0 $0
Doctor copays $5 primary doctor

$40 specialist

$0 primary doctor

$0 specialist

$0 primary doctor

$0 specialist

Urgent care $5 to $40 copay $0 to $20 copay $0 to $55 copay
Emergency care $90 copay $100 copay $90 copay
Inpatient hospital stays $220 for days 1 to 4, then nothing for days 5 and beyond $0 $0
Rx deductible $0 $0 $0
Rx copays Ranges from $0 copay for preferred tier 1 generics (preferred retail, 30-day supply) to 33% of the cost of tier 5 specialty drugs Ranges from $0 copay for preferred tier 1 generics (preferred retail, 30-day supply) to 33% of the cost of tier 5 specialty drugs Ranges from $0 copay for preferred tier 1 generics (preferred retail, 30-day supply) to 33% of the cost of tier 5 specialty drugs
Medical out-of-pocket cap $6,700 (in-network) $2,200 (in-network) $2,000 (in-network)
Extra benefits Eyewear coverage with optional benefits for routine dental, hearing and vision not covered by Medicare Routine dental, vision and hearing as well as fitness benefits (such as membership to fitness center) Routine dental, vision and hearing as well as fitness benefits (such as membership to fitness center)
Overall rating from the CMS 4 stars 3.5 stars 3.5 stars

Blue Cross Blue Shield – 34230 – Sarasota, Florida

Medicare.net is powered by Health Network Group, LLC, which is related to Health Compare Insurance Services, Inc., who is a licensed, authorized agent of: Anthem Blue Cross of California, Anthem Blue Cross of Colorado, Anthem Blue Cross of Connecticut, Anthem Blue Cross of Georgia, Anthem Blue Cross of Indiana, Anthem Blue Cross of Kentucky, Anthem Blue Cross of Maine, Anthem Blue Cross of Missouri, Anthem Blue Cross of New Hampshire, Anthem Blue Cross of Nevada, Anthem Blue Cross of New York, Anthem Blue Cross of Ohio, Anthem Blue Cross of Texas, Anthem Blue Cross of Virginia, Anthem Blue Cross of Wisconsin, Blue Cross Blue Shield of Illinois, Blue Cross Blue Shield of Montana, Blue Cross Blue Shield of New Mexico, Blue Cross Blue Shield of Oklahoma, Capital Blue Cross of Pennsylvania, Highmark of West Virginia, Premera in Washington, Premera in Alaska, and Vibra in Pennsylvania.

Blue Cross and Blue Shield (BCBS) has been providing health insurance since 1929. Represented through various associated health plans and affiliate companies, the parent company offers policies in all 50 states, Washington D.C. and Puerto Rico, providing subscribers with a personal approach to health insurance based on the communities where they live and work. More than 106 million members subscribe to BCBS plans, and more than 96 percent of hospitals and 95 percent of doctors contract with BCBS, a higher percentage than any other insurance company.

In Sarasota, Florida, BCBS provides Medicare Advantage coverage through Florida Blue, which offers five Medicare Advantage plans.

BlueMedicare Preferred HMO

Under BlueMedicare Preferred HMO, visits to your primary care doctor have no copay while specialists have a $30 copay. Inpatient hospital stays are $130 for days 1 through 5. Urgent care facility visits have no copay as long as you visit a preferred location while non-preferred locations have a $30 copay. Emergency room visits have a $85 copay, but this fee may be waived if you are admitted.

With this plan, if you receive care from an out-of-network provider without proper authorization, the costs will not be covered unless the care was provided in an emergency. The plan does cover routine dental, hearing and vision services as well as fitness programs and routine transportation.

Prescription coverage is also included. Drug costs from out-of-network pharmacies are only covered if you are unable to use an in-network pharmacy. For example, if you’re traveling, need urgent or emergency care, or if you need a drug that an in-network pharmacy does not carry, then your plan will cover out-of-network pharmacies.

BlueMedicare Preferred POS

There is no premium for BlueMedicare Preferred POS. Primary care office visits have a $0 copay while specialists have a $25 copay. Days 1 through 5 of a hospital stay require a copay of $120 per day, and urgent care facilities have a $25 copay. Emergency room services, both in and out-of-network, are $85 but the fee may be waived if you get admitted.

An examination for routine hearing is covered as well as routine vision and fitness programs. If you obtain care from an out-of-network provider without authorization, those costs will not be covered unless it is an emergency.

Prescription drugs are included, but out-of-network pharmacy costs are only covered if you are unable to use an in-network pharmacy. This may be because you are traveling, need emergency or urgent care, or an in-network pharmacy does not carry the drug you need.

BlueMedicare Classic HMO

Blue Medicare Classic HMO has no monthly premium and primary care office visits have a $0 copay. Specialists have a $40 copay while inpatient hospital services are $200 for days 1 through 7. Emergency visits have a $90 copay which may be waived if you are admitted. Urgent care facilities have a $45 copay.

Routine dental, hearing and vision are also covered. Members also receive free membership in the SilverSneakers Fitness Program. Services provided by an out-of-network provider without prior authorization are not covered under this plan unless the service was provided in an emergency.

This plan covers prescription drugs, but out-of-network pharmacy costs are only covered if you can’t use an in-network pharmacy. Travel, needing emergency care or an in-network pharmacy not carrying the medication you need are all valid reasons why you might get non-network coverage under this plan.

BlueMedicare Value PPO

There is no monthly premium for the BlueMedicare Value PPO. Primary care visits have a $10 copay and specialists have a $50 copay. Inpatient hospital services are $350 for days 1 through 5 and urgent care facilities have a $50 copay. Emergency room services, both in- and out-of-network, have a $90 copay, which may be waived if you are admitted.

Routine vision exams, routine hearing and the SilverSneakers Fitness Program are covered under this policy. If you receive care from an out-of-network provider and have not obtained prior authorization, costs will not be covered unless the coverage was due to an emergency.

Prescription drugs have a $250 deductible for Tiers 2, 3, 4 and 5. Out-of-network pharmacy costs are only covered if you are unable to use an in-network pharmacy, such as if you’re traveling, you need emergency or urgent care, or an in-network pharmacy does not carry the drug you need.

BlueMedicare Choice HMO

BlueMedicare Choice HMO has a $42 monthly premium and primary care visits have $10 copay. Specialists have a $45 copay while inpatient hospital facility services are $290 copay per day for days 1 through 5. Urgent care facilities are $50 copay and emergency room visits have a copay of $90, but this may be waived if you are admitted.

Routine vision examinations and hearing services as well as the SilverSneakers Fitness Program are covered. Routine transportation and some over-the-counter items are also covered. If you use an out-of-network provider, your out-of-pocket costs will be higher than if you remain within the network. Emergency care, urgent care and dialysis services are the only exceptions.

Prescriptions are included in this plan as well, but you won’t get coverage for out-of-network pharmacies.

Blue Cross Blue Shield 2019 Medicare Advantage Plans (Sarasota, FL)
BlueMedicare Preferred HMO BlueMedicare Preferred POS BlueMedicare Classic HMO BlueMedicare Value PPO BlueMedicare Choice HMO
Monthly cost $0 $0 $0 $0 $42
Deductible $0 $0 $0 $0 (in-network) $ (in-network)
Doctor copays $0 primary doctor

$30 specialist

$0 primary doctor

$25 specialist

$0 primary doctor

$40 specialist

$10 primary doctor

$50 specialist

$10 primary doctor

$45 specialist

Urgent care $0 copay for preferred centers ($30 for nonpreferred) $25 copay $45 copay $50 copay $50 copay
Emergency care $85 copay $85 copay $90 copay $90 copay $90 copay
Inpatient hospital stays $130 per day for days 1-5; no copay after this $120 per day for days 1-5; no copay after this $200 per day for days 1-7; no copay after this $350 per day for days 1-5; no copay after this $290 per day for days 1-5; no copay after this
Rx deductible $0 $0 $0 $250 $250
Rx copays Ranges from $0 copay for preferred tier 1 generics (preferred retail, 30-day supply) to 33% of the cost of tier 5 specialty drugs Ranges from $0 copay for preferred tier 1 generics (preferred retail, 30-day supply) to 33% of the cost of tier 5 specialty drugs Ranges from $3 copay for preferred tier 1 generics (preferred retail, 31-day supply) to 33% of the cost of tier 5 specialty drugs Ranges from $0 copay for preferred tier 1 generics (preferred retail, 31-day supply) to 28% of the cost of tier 5 specialty drugs Ranges from $0 copay for preferred tier 1 generics (preferred retail, 31-day supply) to 28% of the cost of tier 5 specialty drugs
Medical out-of-pocket cap $3,400 $4,900 $5,500 $6,700 $6,700
Extra benefits Dental, hearing, vision as well as Silver Sneakers fitness program, some transportation and some over-the-counter reimbursement Routine vision, routine hearing exams and a fitness program Routine dental, vision and hearing, as well as Silver Sneakers fitness program Routine vision and hearing services as well as Silver Sneakers fitness program Routine vision and hearing services as well as Silver Sneakers fitness program, some transportation and some over-the-counter reimbursement
Overall rating from the CMS 4 stars 4 stars 5 stars N/A 4 stars

 

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