Medicare Health Plans >> Comparison of 2011 Medicare Plans

Medicare Health Plans

Comparison of 2011 Medicare Advantage Plans

	WHP Silver (HMO)	WHP Silver Rx (HMO)	WHP Platinum Rx (HMO)	Platinum Select Rx (HMO-POS)
Monthly Premium	$0 In addition to your monthly Medicare Part B premium.	$61 In addition to your monthly Medicare Part B premium.	$99 In addition to your monthly Medicare Part B premium.	$201 In addition to your monthly Medicare Part B premium.
Annual Deductible	$0	$0	$0	$0
PCP Office Visit	$0 to $15	$0 to $15	$0 to $15	$0
Specialist Office Visit	$0 to $35	$0 to $35 copay	$0 to $25	$0 to $10
Inpatient Hospital Care	Days 1-10: $150/day Days 11-90 $0/day $0 copay for additional hospital days	Days 1-10: $150/day Days 11-90 $0/day $0 copay for additional hospital days	Days 1-8: $120/day Days 9-90 $0/day $0 copay for additional hospital days	Days 1-5: $50/day Days 6-90 $0/day $0 copay for additional hospital days
Emergency Room Visit - Not Admitted	$50 Worldwide	$50 Worldwide	$50 Worldwide	$50 Worldwide
Drug Coverage (Generic)	No coverage (you pay 100%)	$8 copay for 30-day supply	$5 copay for 30-day supply	$5 copay for 30-day supply
Drug Coverage (Brand)	No coverage (you pay 100%)	$40 copay for 30-day supply	$30 copay for 30-day supply	$30 copay for 30-day supply
Dental	$0 copay for Preventive Dental
Hearing	Yes
Vision	Yes
Personalized Fitness Program	Yes

A Coordinated Care plan with a Medicare Advantage contract. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Individuals must have both Part A and Part B to enroll. You must continue to pay your Medicare Part B premium even if the plan premium is $0. Members may enroll in the plan only during specific times of the year. Contact Welborn Health Plans for more information. Beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply. HMO members must receive all routine care from plan providers. Plans may be renewed annually. Limitations, copayments, and restrictions may apply. People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to one hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048. Updated 10/2010 H3044_H1558_WEB11_CMS_Approved_10012010