2018 Medicare Advantage Plans Comparison Chart
[Pages:4]2018 Medicare Advantage Plans Comparison Chart
This comparison chart is a side-by-side representation of services offered through the AvMed, Cigna, UHC, and Humana Medicare Advantage Plans for both in-network and out-of-network providers.
Service
Medical Plan Type Drug Plan Type PCP Required Annual Deductible Annual Maximum Out-of-Pocket (OOP) OOP Exclusions Medical Benefits
AvMed
AvMed
Medicare Choice HMO Medicare Choice HMO
(Broward)
(Miami-Dade)
Broward
Miami-Dade
Retiree Cost HMO
100% Part D Yes $0
Retiree Cost HMO
100% Part D Yes $0
$5,000
$4,500
Dental and Part D Medication
Dental and Part D Medication
$0/Day 1-5
$0/Day 1-5
Inpatient Hospital Care
$40/Day 6-20
$55/Day 6-20
$0/Day 21 and beyond $0/Day 21 and beyond
Inpatient Mental Health Care
$150/Day 1-9
$150/Day 1-9
$0/Day 10-90
$0/Day 10-90
(190 Days lifetime limit) (190 Days lifetime limit)
Skilled Nursing Facility (SNF)
$0/Day 1-20 $135/Day 21-100
$0/Day 1-20 $135/Day 21-100
Home Health Care
Doctor Office Visits Primary Care
Doctor Office Visits Specialist
$0 $0 $10-$40
$0 $0 $0-$40
Emergency Care
$80 copay; waived if admitted within 24
hours
$80 copay; waived if admitted within 24
hours
Urgently Needed Care
$20
$20
Cigna Leon Cares In-Network Retiree Cost HMO 100% Part D Yes $0 $6,700
Part D Medication
$0
$0
$0 for 1-100 days
$0 $0 $0 $50 copay; waived if admitted within 24 hours $0
Humana Comprehensive PPO
In-Network
Out-ofNetwork
Retiree Cost
PPO
100% Part D
No
$0
$2,500
Part D Drugs and the Plan Premium
Humana Zero Premium HMO
(Miami-Dade)
In-Network
Retiree Cost HMO
100% Part D Yes $0
$3,000
Part D Drugs
Humana Zero Premium HMO
(Broward)
Humana Zero Premium HMO
(Palm Beach)
In-Network
In-Network
Retiree Cost HMO
100% Part D Yes $0
Retiree Cost HMO
100% Part D Yes $0
$3,400
$2,500
Part D Drugs
Part D Drugs
UnitedHealthcare Premiere PPO
In-Network
Out-ofNetwork
Retiree Cost
PPO
100% Part D
No
$0
$2,500
Prescription Drugs and the Plan Premium
UnitedHealthcare
Group National PPO
(Miami-Dade Only)
In-Network
Out-ofNetwork
Retiree Cost
PPO
100% Part D
No
$0
$4,500
$10,000
Prescription Drugs and the Plan Premium
$175 copay per Admission
$175 copay per Admission
$0 per Admission
$0 per Admission
$250 per Admission (Days 1-5)
$175 copay per Admission (190 Days lifetime limit)
$175 copay per Admission (190 Days lifetime limit)
$0 per Admission (190 Days lifetime
limit)
$0 per Admission (190 Days lifetime
limit)
$250 per Admission (Days 1-5)
$0 copay $0 copay
days 1-20; days 1-20; $0 copay days 1-20; $0 copay days 1-20; $0 copay days 1-20;
$50 copay $50 copay $50 copayment per $60 copayment per $75 copayment per
days 21-100; days 21-100; day (days 21-100); day (days 21-100); day (days 21-100);
plan pays plan pays
plan pays
plan pays
plan pays
$0 after day $0 after day $0 after day 100
$0 after day 100
$0 after day 100
100
100
$0
$0
$0
$0
$0
$175 copay per admission
$175 copay per admission (190 days
lifetime maximum)
$0/Day for Days 1-20; $50/Day for Days 21-100
$0
$175 copay per admission
$175 copay per admission (190 days
lifetime maximum)
$200/Day for Days 1-8; $0/Day for Days 9 and Beyond
$175/Day for Days 1-8; $0/Day for Days 9 through 190 Days
lifetime limit)
$0/Day for $0/Day for Days 1-20; Days 1-20; $50/Day for $100/ Day for Days 21-100 Days 21-100
$0
$0
40%
40%
$175/Day for Days 1-100
20%
$5
$5
$0
$0
$10
$5
$5
$10
$35
$15
$65 copay; waived if admitted within 24 hours
$15
$15
$65 copay; waived if admitted within 24 hours
$15
$0
$5
$25
$80 copay; waived $100 copay; waived $65 copay; waived
if admitted within 24 if admitted within 24 if admitted within 24
hours
hours
hours
$20
$5
$25
$15
$65 copay (waived if admitted)
$35
$15
$40
$65 copay (waived if admitted)
$80 copay (waived if admitted)
$35
$35
$60
$80 copay (waived if admitted)
$35
Service
AvMed
AvMed
Medicare Choice HMO Medicare Choice HMO
(Broward)
(Miami-Dade)
Cigna Leon Cares
Chiropractic Services
$5
$5
$0
Podiatry Services
$5
$5
$0
Outpatient Mental Health $15/visit Group or
Care
Individual therapy
$15/visit Group or Individual therapy
$0
Outpatient Substance Abuse
$15/visit Group or Individual therapy
$15/visit Group or Individual therapy
Outpatient Surgery Outpatient Hospital Outpatient Surgery Ambulatory Surgical Center Professional Fees for Outpatient Surgeries Outpatient Hospital
Ambulance Services
Outpatient Rehabilitation Durable Medical Equipment Prosthetic Devices Diabetes Monitoring Supplies Diagnostic Outpatient Hospital Diagnostic Freestanding Facility Diagnostic Radiology Services Lab Services Medicare Part B Drugs
$200 $35
$0
$100 $15/visit
20% 0% 20% $225 $75
$0 10-20%
$175 $45
$0
$100 $10/visit
20% 0% 20% $200 $50
$0 10-20%
$0
$0 $0
$0
$0 $0 0% 0% $0 $0 $0
$0 0-20%
Humana Comprehensive PPO
$15 for Medicare Covered Services
$15 for Medicare Covered Services
$15
$15
$40
$40
$40
$40
$50
$50
Humana Zero Premium HMO
(Miami-Dade)
Humana Zero Premium HMO
(Broward)
Humana Zero Premium HMO
(Palm Beach)
$0 for Medicare
$5 for Medicare $20 for Medicare
Covered Services Covered Services Covered Services
UnitedHealthcare Premiere PPO
$15
$15
UnitedHealthcare Group National PPO (Miami-Dade Only)
$10
$15
$0 for Medicare Covered and Routine
Services
$5 for Medicare Covered and Routine
Services
$25 for Medicare Covered and Routine
Services
$15 copay (No visits limit)
$15 copay (No visits limit)
$40
$60
Indiv-$40/
Visit; Indiv-$60/ Visit;
$15
$25
$40
$5
$5
Group-$10/ Group-$35/ Visit; Partial Visit; Partial
Hosp-$55/ Hosp-$55/ Day
Day
Indiv-$40/
Visit; Indiv-$60/ Visit;
$15
$25
$40
$5
$5
Group-$10/ Group-$35/ Visit; Partial Visit; Partial
Hosp-$55/ Hosp-$55/ Day
Day
$25
$100
$200
$15
$15
$200
40%
$15
$15
$0
$50
$150
$15
$15
$200
40%
$0
$50 for Medicare Covered Services
$15 20% 20% $0
$50
$15
$15/$50 $0 20%
$0
$50 for Medicare Covered Services
$15 20% 20% $0
$50
$15
$15/$50 $0 20%
$0
$0
$0
$100 for Medicare- $250 for Medicare- $75 for Medicarecovered services covered services covered services
$15/$20 $0 $0 $0
$5/$25 $0 $0 $0
$25/$40 20% 20% $0
$15
$25
$0
$0
$0
$0
$0/$75
$0/$20 0%
$0/$75
$0/$5/$25 0%
$0/$75
$0 20%
included in $15 copay
$50
$20 20% 20% $0 $20 $20 $20 $0 20%
Included in Included in
$15 copay
$200
$50
$20 20% 20% $0
$20
$20
$20 $0 20%
$150
5% 5% 5% $0
5%
5%
5% 5% 5%
Included in 40%
$150
40% 40% 40% $40 40% 40% 40% 13% 40%
Service
Preventive Services
Wellness Visits Wellness Services Dental Services (Medicare Covered Services) - Exam - Cleaning
- X-Ray
Hearing Services (Hearing Loss Exam)
Vision Services (Medicare Covered Eye Exam) Pharmacy Benefits
Deductible Network Drug Usage Management
AvMed Medicare Choice HMO
(Broward) $0 $0 $0
$0-$25 $0-$45
$0-$35
$5
$5
$0 Major Chains
Yes
AvMed Medicare Choice HMO
(Miami-Dade)
Cigna Leon Cares
$0
$0
$0 $0
$0-$25 $0-$45
$0-$35
$0 $0
$0
Preventive Dental Services: $0 Service Limit:
- up to 1 oral exam, cleaning, 1 fluoride treatment, and 1 dental
x-ray Comphrensive Dental
Services: $0 (Endodontics and Periodontics not
covered) Annual Max: $2,200
$5
$0
$5
$0
$0 Major Chains
Yes
Preferred Pharmacy $0
Leon Medical Center Pharmacies
Yes
Humana Comprehensive PPO
$0
$0
$0
$0
$0
$0
$15
$15
N/A
N/A
N/A
N/A
Humana Zero Premium HMO
(Miami-Dade)
Humana Zero Premium HMO
(Broward)
$0
$0
$0
$0
$0
$0
$0
$5
N/A
N/A
See Humana plan benefit grid for routine
dental coverage.
See Humana plan benefit grid for routine dental
coverage.
$15
$15
$0; see Humana plan benefit grid for routine
hearing coverage.
$5; see Humana plan benefit grid for routine hearing
coverage.
$15
$15
$0; see Humana plan benefit grid for routine
vision coverage.
$5; see Humana plan benefit grid for routine vision
coverage.
Preferred Pharmacy
Non-Preferred Pharmacy
Preferred Pharmacy
N/A
N/A
N/A
Local and
Chain
N/A
Pharmacies
Local and Chain Pharmacies
Preferred Pharmacy
N/A
Local and Chain Pharmacies
Yes
Yes
Yes
Humana Zero Premium HMO
(Palm Beach) $0 $0 $0 $25
N/A
$25
$25
Preferred Pharmacy N/A
Local and Chain Pharmacies Yes
UnitedHealthcare Premiere PPO
$0
$0
$0
$0
$0
$0
$15
$15
N/A
N/A
N/A
N/A
UnitedHealthcare
Group National PPO
(Miami-Dade Only)
40%/
$0
Immunizations $0/Smoking
Cessation $60
$0
40%
$0
40%
$40
$60
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
$15
$15
$40
$60
$15
$15
$15
$15
Preferred Pharmacy
N/A
Non-Preferred Pharmacy
N/A
Preferred Pharmacy
$0
Non-Preferred Pharmacy
N/A
Major Chains
N/A
Major Chains
N/A
Initial Coverage Period
Initial Coverage Limit Tier 1 Tier 2 Tier 3 Tier 4
$3,750 $0 $7 $40 $75
$3,750 $0 $3 $40 $75
$4,000 $0 $0 33% N/A
$3,750
N/A
$5
N/A
$30
N/A
$60
N/A
33%
N/A
$3,750 $0 $10 $55 33%
$3,750 $0 $10 $55 33%
$3,750 $0 $40 $80 33%
$3,750
$5
N/A
$30
N/A
$60
N/A
$80
N/A
$15 $15 $47 $100
$3,750 N/A N/A N/A N/A
Service Tier 5
AvMed Medicare Choice HMO
(Broward)
33%
AvMed Medicare Choice HMO
(Miami-Dade)
33%
Cigna Leon Cares N/A
Humana Comprehensive PPO
N/A
N/A
Gap Tier 1 Tier 2
Tier 3
Tier 4
Tier 5
$0
$0
0%
$5
N/A
$7
$3
35% Covered Brand 44% Generic
35%
N/A
35% Covered Brand 35% Covered Brand 35% Covered Brand
44% Generic
44% Generic
44% Generic
35%
N/A
35% Covered Brand 35% Covered Brand
44% Generic
44% Generic
N/A
35%
N/A
35% Covered Brand 35% Covered Brand
44% Generic
44% Generic
N/A
N/A
N/A
Catastrophic
Catastrophic Coverage Limit
$5,000
$5,000
$5,000
$5,000
Tier 1
Greater of $3.35 or 5% Greater of $3.35 or 5% Greater of 5% or $3.35
Greater of $3.35 or 5%
N/A
Tier 2
Greater of $3.35 or 5% Greater of $3.35 or 5%
Greater of 5% or $8.35
Greater of $ 8.35 or 5%
N/A
Tier 3
Greater of $8.35 or 5% Greater of $8.35 or 5%
N/A
Greater of $8.35 or 5%
N/A
Tier 4
Greater of $8.35 or 5% Greater of $8.35 or 5%
N/A
Greater of $8.35 or 5%
N/A
Tier 5
N/A
Mail Order
(90 Day Supply)
Tier 1 Tier 2 Tier 3
Standard: $0 Preferred MO: $0
Standard: $0 Preferred MO: $0 Prescription drugs may
$0
N/A
Standard: $21
Standard: $9
be obtained at all LMC
Preferred MO: $17.50 Preferred MO: $7.50 Pharmacies or retiree
$60
N/A
Standard: $120
Standard: $120 may ask to have them
Preferred MO: $100 Preferred MO: $100 delivered to their home.
$120
N/A
Tier 4
Standard: $225
Standard: $225
Preferred MO: $187.50 Preferred MO: $187.50
N/A
N/A
Tier 5
Premium
Monthly Premium
$0
$0
$0
$199.44
Humana Zero Premium HMO
(Miami-Dade)
N/A
Humana Zero Premium HMO
(Broward)
N/A
Humana Zero Premium HMO
(Palm Beach)
N/A
0% 35% 35% 35% N/A
0% 35% 35% 35% N/A
0% 35% 35% 35% N/A
UnitedHealthcare Premiere PPO
N/A
N/A
$5
N/A
$30
N/A
$60
N/A
$80
N/A
N/A
N/A
UnitedHealthcare
Group National PPO
(Miami-Dade Only)
$100
N/A
44%
N/A
44%
N/A
35%
N/A
35%
N/A
35%
N/A
$5,000
Greater of $3.35 or 5% Greater of $8.35 or 5% Greater of $8.35 or 5% Greater of $8.35 or 5%
N/A
$5,000
Greater of $3.35 or 5% Greater of $8.35 or 5% Greater of $8.35 or 5% Greater of $8.35 or 5%
N/A
$5,000
Greater of $3.35 or 5% Greater of $8.35 or 5% Greater of $8.35 or 5% Greater of $8.35 or 5%
N/A
$5,000
Greater of $3.35 or 5%
N/A
Greater of $8.35 or 5%
N/A
Greater of $8.35 or 5%
N/A
Greater of $8.35 or 5%
N/A
$5,000
Greater of $3.35 or 5%
N/A
Greater of $3.35 or 5%
N/A
Greater of $8.35 or 5%
N/A
Greater of $8.35 or 5%
N/A
Greater of $8.35 or 5%
$0 $20 $155 N/A
$0
$0 $20 $155 N/A
$0
$0 $80 $200 N/A
$0
$0
N/A
$30
N/A
$60
N/A
$30
N/A
$120
N/A
$94
N/A
$160
N/A
$200
N/A
$200
$407.49
$10
These premiums are for Miami Dade County. Premiums are based upon your county of residence
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