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Missouri MedicareAdvantage Plans

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Medicare Advantage Plans in Saint Charles County, Missouri

Below are Medicare Advantage plans available to residents of Saint Charles county, Missouri. 9 carriers offer 26 plans throughout the county of Saint Charles. Residents may choose plans from carriers such as WellCare, Anthem Blue Cross and Blue Shield and Humana Insurance Company. This data has been made available by the Centers for Medicare & Medicaid Services (CMS) and is for informational purposes only. Some data may be inaccurate or incomplete. Please note that plans can vary by city, county, and state and all plans listed may not be available in all areas. To speak to an advisor and find the Medicare Advantage plan in Saint Charles county that is right for you complete the form at the top of the page.

Medicare Advantage Health Plans in the county of Saint Charles

Carrier Plan Title Plan Type
WellCare WellCare Value (HMO-POS) (H1216-001) HMO with POS Option

    Premium and Other Important Information

    • $3 400 out-of-pocket limit for Medicare-covered services.
    • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
    • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

    Doctor Office Visits

    • $0 copay for each primary care doctor visit for Medicare-covered benefits.
    • $35 copay for each in-area network urgent care Medicare-covered visit
    • $35 copay for each specialist visit for Medicare-covered benefits.
    WellCare WellCare Access (HMO SNP) (H1216-003) HMO

      Premium and Other Important Information

      • * Depending on your level of Medicaid eligibility you may not have any cost-sharing responsibility for original Medicare services
      • $0 annual deductible.*
      • ** Please consult with your plan about cost sharing when receiving services from out-of-network providers.
      • $6 700 out-of-pocket limit for Medicare-covered services. However in this plan you will have no cost sharing responsibility for Medicare-covered services based on your level of Medicaid eligibility.
      • $0 monthly plan premium*

      Doctor Office Visits

      • $0 copay for each primary care doctor visit for Medicare-covered benefits.*
      • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.*
      • $0 copay for each specialist doctor visit for Medicare-covered benefits.*
      Anthem Blue Cross and Blue Shield Anthem Medicare Preferred Core (PPO) (H1517-004) Local Preferred Provider Organization

        Premium and Other Important Information

        • Package: 1 - Preventive Dental Package:
        • Package: 2 - Comprehensive Dental and Vision Package:
        • Package: 3 - Combination Package:
        • $12 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental
        • $31 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental Eye Exams Eye Wear
        • $44 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Chiropractic Services Acupuncture Preventive Dental Compreh
        • $4 500 out-of-pocket limit. All plan services included.
        • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
        • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
        • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

        Doctor Office Visits

        • $0 copay for each primary care doctor visit for Medicare-covered benefits.
        • $45 copay for each in-area network urgent care Medicare-covered visit
        • $45 copay for each specialist visit for Medicare-covered benefits.
        • $25 to $45 copay for each primary care doctor visit
        • $50 copay for each specialist visit
        Humana Insurance Company HumanaChoice H1716-006 (PPO) (H1716-006) Local Preferred Provider Organization

          Premium and Other Important Information

          • Package: 1 - MyOption Vision:
          • Package: 2 - MyOption Enhanced Dental PPO:
          • $15 monthly premium in addition to your $73 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Eye Exams Eye Wear
          • $19 monthly premium in addition to your $73 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
          • $290 plan coverage limit every year for these benefits.
          • $4 000 out-of-pocket limit for Medicare-covered services.
          • $5 100 out-of-pocket limit for Medicare-covered services.
          • $73 monthly plan premium in addition to your monthly Medicare Part B premium.
          • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
          • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

          Doctor Office Visits

          • $10 copay for each primary care doctor visit for Medicare-covered benefits.
          • $35 copay for each in-area network urgent care Medicare-covered visit
          • $35 copay for each specialist visit for Medicare-covered benefits.
          • 30% of the cost for each primary care doctor visit
          • 30% of the cost for each specialist visit
          Humana Insurance Company HumanaChoice H1716-019 (PPO) (H1716-019) Local Preferred Provider Organization

            Premium and Other Important Information

            • Package: 1 - MyOption Dental High PPO:
            • Package: 2 - MyOption Dental Low PPO:
            • Package: 3 - MyOption Vision:
            • Package: 4 - MyOption Plus:
            • $20 monthly premium in addition to your $122 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
            • $13 monthly premium in addition to your $122 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
            • $15 monthly premium in addition to your $122 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Eye Exams Eye Wear
            • $24 monthly premium in addition to your $122 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental Eye Exams Eye Wear
            • $1 500 plan coverage limit every year for these benefits.
            • $1 000 plan coverage limit every year for these benefits.
            • $290 plan coverage limit every year for these benefits.
            • $3 400 out-of-pocket limit for Medicare-covered services.
            • $1 000 annual deductible. Contact the plan for services that apply.
            • $5 100 out-of-pocket limit for Medicare-covered services.
            • $122 monthly plan premium in addition to your monthly Medicare Part B premium.
            • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
            • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

            Doctor Office Visits

            • $0 copay for each primary care doctor visit for Medicare-covered benefits.
            • $0 copay for each in-area network urgent care Medicare-covered visit
            • $0 copay for each specialist visit for Medicare-covered benefits.
            • 30% of the cost for each primary care doctor visit
            • 30% of the cost for each specialist visit
            Humana Insurance Company HumanaChoice H1716-020 (PPO) (H1716-020) Local Preferred Provider Organization

              Premium and Other Important Information

              • Package: 1 - MyOption Dental High PPO:
              • Package: 2 - MyOption Dental Low PPO:
              • Package: 3 - MyOption Vision:
              • Package: 4 - MyOption Plus:
              • $21 monthly premium in addition to your $39 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
              • $14 monthly premium in addition to your $39 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
              • $15 monthly premium in addition to your $39 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Eye Exams Eye Wear
              • $25 monthly premium in addition to your $39 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental Eye Exams Eye Wear
              • $1 500 plan coverage limit every year for these benefits.
              • $1 000 plan coverage limit every year for these benefits.
              • $290 plan coverage limit every year for these benefits.
              • $5 000 out-of-pocket limit for Medicare-covered services.
              • $500 annual deductible. Contact the plan for services that apply.
              • $6 700 out-of-pocket limit for Medicare-covered services.
              • $39 monthly plan premium in addition to your monthly Medicare Part B premium.
              • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
              • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

              Doctor Office Visits

              • $15 copay for each primary care doctor visit for Medicare-covered benefits.
              • $35 copay for each in-area network urgent care Medicare-covered visit
              • $35 copay for each specialist visit for Medicare-covered benefits.
              • 30% of the cost for each primary care doctor visit
              • 30% of the cost for each specialist visit
              Essence Healthcare Essence Advantage (HMO) (H2610-005) HMO

                Premium and Other Important Information

                • $2 250 out-of-pocket limit for Medicare-covered services.
                • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
                • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                Doctor Office Visits

                • $5 copay for each primary care doctor visit for Medicare-covered benefits.
                • $25 copay for each in-area network urgent care Medicare-covered visit
                • $35 copay for each specialist visit for Medicare-covered benefits.
                Essence Healthcare Essence Advantage Plus (HMO) (H2610-006) HMO

                  Premium and Other Important Information

                  • $1 975 out-of-pocket limit for Medicare-covered services.
                  • $46 monthly plan premium in addition to your monthly Medicare Part B premium.
                  • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                  Doctor Office Visits

                  • $5 copay for each primary care doctor visit for Medicare-covered benefits.
                  • $25 copay for each in-area network urgent care Medicare-covered visit
                  • $25 copay for each specialist visit for Medicare-covered benefits.
                  Coventry Health Care Advantra (PPO) (H2611-001) Local Preferred Provider Organization

                    Premium and Other Important Information

                    • $750 annual deductible. Contact the plan for services that apply.
                    • $3 125 out-of-pocket limit. All plan services included.
                    • $1 250 annual deductible. Contact the plan for services that apply.
                    • $5 100 out-of-pocket limit. All plan services included.
                    • $19 monthly plan premium in addition to your monthly Medicare Part B premium.
                    • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                    • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                    Doctor Office Visits

                    • $15 copay for each primary care doctor visit for Medicare-covered benefits.
                    • $40 copay for each in-area network urgent care Medicare-covered visit
                    • $30 copay for each specialist visit for Medicare-covered benefits.
                    • 30% of the cost for each primary care doctor visit
                    • 30% of the cost for each specialist visit
                    Humana Health Plan Inc. Humana Gold Plus H2649-023 (HMO) (H2649-023) HMO

                      Premium and Other Important Information

                      • Package: 1 - MyOption Enhanced Dental HMO:
                      • $22 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                      • $2 500 out-of-pocket limit for Medicare-covered services.
                      • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
                      • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                      Doctor Office Visits

                      • Authorization rules may apply.
                      • $5 copay for each primary care doctor visit for Medicare-covered benefits.
                      • $35 copay for each in-area network urgent care Medicare-covered visit
                      • $35 copay for each specialist visit for Medicare-covered benefits.
                      UnitedHealthcare AARP MedicareComplete (HMO) (H2654-004) HMO

                        Premium and Other Important Information

                        • Package: 1 - Deluxe Rider:
                        • Package: 2 - Fitness Rider:
                        • $39 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental Eye Wear Hearing Aid
                        • $13 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Supplemental Education/Wellness Programs
                        • $4 500 out-of-pocket limit for Medicare-covered services.
                        • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
                        • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                        Doctor Office Visits

                        • $15 copay for each primary care doctor visit for Medicare-covered benefits.
                        • $30 copay for each in-area network urgent care Medicare-covered visit
                        • $35 copay for each specialist visit for Medicare-covered benefits.
                        UnitedHealthcare AARP MedicareComplete Plus Plan 1 (HMO-POS) (H2654-013) HMO with POS Option

                          Premium and Other Important Information

                          • Package: 1 - Deluxe Rider:
                          • Package: 2 - Fitness Rider:
                          • $39 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental Eye Wear Hearing Aid
                          • $13 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Supplemental Education/Wellness Programs
                          • $2 700 out-of-pocket limit for Medicare-covered services.
                          • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
                          • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                          Doctor Office Visits

                          • $10 copay for each primary care doctor visit for Medicare-covered benefits.
                          • $30 copay for each in-area network urgent care Medicare-covered visit
                          • $35 copay for each specialist visit for Medicare-covered benefits.
                          UnitedHealthcare AARP MedicareComplete Essential (HMO) (H2654-020) HMO

                            Premium and Other Important Information

                            • Package: 1 - Deluxe Rider:
                            • Package: 2 - Fitness Rider:
                            • $39 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental Eye Wear Hearing Aid
                            • $13 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Supplemental Education/Wellness Programs
                            • $3 800 out-of-pocket limit for Medicare-covered services.
                            • $0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                            • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i

                            Doctor Office Visits

                            • $15 copay for each primary care doctor visit for Medicare-covered benefits.
                            • $30 copay for each in-area network urgent care Medicare-covered visit
                            • $35 copay for each specialist visit for Medicare-covered benefits.
                            UnitedHealthcare UnitedHealthcare Dual Complete (HMO SNP) (H2654-024) HMO

                              Premium and Other Important Information

                              • * Depending on your level of Medicaid eligibility you may not have any cost-sharing responsibility for original Medicare services
                              • In 2012 the annual Part B deductible amount is $0 or $140 .* Contact the plan for services that apply.
                              • ** Please consult with your plan about cost sharing when receiving services from out-of-network providers.
                              • $6 700 out-of-pocket limit for Medicare-covered services.*
                              • $21.2 monthly plan premium in addition to your monthly Medicare Part B premium.*

                              Doctor Office Visits

                              • 0% or 20% of the cost for each primary care doctor visit for Medicare-covered benefits.*
                              • 0% or 20% of the cost for each in-area network urgent care Medicare-covered visit*
                              • 0% or 20% of the cost for each specialist visit for Medicare-covered benefits.*
                              Group Health Plan Inc. Advantra Option 2 (HMO-POS) (H2663-002) HMO with POS Option

                                Premium and Other Important Information

                                • $2 675 out-of-pocket limit for Medicare-covered services.
                                • $88 monthly plan premium in addition to your monthly Medicare Part B premium.
                                • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                                Doctor Office Visits

                                • Authorization rules may apply.
                                • $10 copay for each primary care doctor visit for Medicare-covered benefits.
                                • $35 copay for each in-area network urgent care Medicare-covered visit
                                • $25 copay for each specialist visit for Medicare-covered benefits.
                                Group Health Plan Inc. Gold Advantage Option 1 (HMO) (H2663-005) HMO

                                  Premium and Other Important Information

                                  • $2 700 out-of-pocket limit for Medicare-covered services.
                                  • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
                                  • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                                  Doctor Office Visits

                                  • Authorization rules may apply.
                                  • $10 copay for each primary care doctor visit for Medicare-covered benefits.
                                  • $35 copay for each in-area network urgent care Medicare-covered visit
                                  • $30 copay for each specialist visit for Medicare-covered benefits.
                                  Group Health Plan Inc. Advantra Option 1 (HMO) (H2663-006) HMO

                                    Premium and Other Important Information

                                    • $3 350 out-of-pocket limit for Medicare-covered services.
                                    • $27 monthly plan premium in addition to your monthly Medicare Part B premium.
                                    • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                                    Doctor Office Visits

                                    • Authorization rules may apply.
                                    • $20 copay for each primary care doctor visit for Medicare-covered benefits.
                                    • $35 copay for each in-area network urgent care Medicare-covered visit
                                    • $45 copay for each specialist visit for Medicare-covered benefits.
                                    Coventry Health Care Gold Advantage Option II (HMO) (H2667-003) HMO

                                      Premium and Other Important Information

                                      • $4 450 out-of-pocket limit. All plan services included.
                                      • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
                                      • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                                      Doctor Office Visits

                                      • $20 copay for each primary care doctor visit for Medicare-covered benefits.
                                      • $35 copay for each in-area network urgent care Medicare-covered visit
                                      • $40 copay for each specialist visit for Medicare-covered benefits.
                                      Coventry Health Care Coventry Total Care (HMO-POS) (H2667-016) HMO with POS Option

                                        Premium and Other Important Information

                                        • $2 660 out-of-pocket limit. All plan services included.
                                        • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
                                        • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co

                                        Doctor Office Visits

                                        • Authorization rules may apply.
                                        • $5 copay for each primary care doctor visit for Medicare-covered benefits.
                                        • $35 copay for each in-area network urgent care Medicare-covered visit
                                        • $30 copay for each specialist visit for Medicare-covered benefits.
                                        UnitedHealthcare AARP MedicareComplete Choice (PPO) (H5507-001) Local Preferred Provider Organization

                                          Premium and Other Important Information

                                          • Package: 1 - Fitness Rider:
                                          • $13 monthly premium in addition to your $42 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Supplemental Education/Wellness Programs
                                          • $4 500 out-of-pocket limit for Medicare-covered services.
                                          • $10 000 out-of-pocket limit for Medicare-covered services.
                                          • $42 monthly plan premium in addition to your monthly Medicare Part B premium.
                                          • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                                          • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                                          Doctor Office Visits

                                          • $20 copay for each primary care doctor visit for Medicare-covered benefits.
                                          • $30 copay for each in-area network urgent care Medicare-covered visit
                                          • $35 copay for each specialist visit for Medicare-covered benefits.
                                          • 30% of the cost for each primary care doctor visit
                                          • 30% of the cost for each specialist visit
                                          Care Improvement Plus Care Improvement Plus Medicare Advantage (PPO) (H6528-005) Local Preferred Provider Organization

                                            Premium and Other Important Information

                                            • $6 700 out-of-pocket limit for Medicare-covered services.
                                            • $38 monthly plan premium in addition to your monthly Medicare Part B premium.
                                            • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                                            • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                                            Doctor Office Visits

                                            • $35 copay for each primary care doctor visit for Medicare-covered benefits.
                                            • $35 copay for each in-area network urgent care Medicare-covered visit
                                            • $50 copay for each specialist visit for Medicare-covered benefits.
                                            • $35 copay for each primary care doctor visit
                                            • $50 copay for each specialist visit
                                            Care Improvement Plus Care Improvement Plus Silver Rx (PPO SNP) (H6528-012) Local Preferred Provider Organization

                                              Premium and Other Important Information

                                              • $6 700 out-of-pocket limit for Medicare-covered services.
                                              • In 2012 the annual Part B deductible amount is $140. Contact the plan for services that apply.
                                              • $32.1 monthly plan premium in addition to your monthly Medicare Part B premium.
                                              • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                                              • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                                              Doctor Office Visits

                                              • 20% of the cost for each primary care doctor visit for Medicare-covered benefits.
                                              • 20% of the cost for each in-area network urgent care Medicare-covered visit
                                              • 20% of the cost for each specialist visit for Medicare-covered benefits.
                                              • 20% of the cost for each primary care doctor visit
                                              • 20% of the cost for each specialist visit
                                              Care Improvement Plus Care Improvement Plus Gold Rx (PPO SNP) (H6528-013) Local Preferred Provider Organization

                                                Premium and Other Important Information

                                                • $6 700 out-of-pocket limit for Medicare-covered services.
                                                • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
                                                • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                                                • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                                                Doctor Office Visits

                                                • $35 copay for each primary care doctor visit for Medicare-covered benefits.
                                                • $35 copay for each in-area network urgent care Medicare-covered visit
                                                • $50 copay for each specialist visit for Medicare-covered benefits.
                                                • $35 copay for each primary care doctor visit
                                                • $50 copay for each specialist visit
                                                Care Improvement Plus Care Improvement Plus Dual Advantage (PPO SNP) (H6528-014) Local Preferred Provider Organization

                                                  Premium and Other Important Information

                                                  • * Depending on your level of Medicaid eligibility you may not have any cost-sharing responsibility for original Medicare services
                                                  • $0 annual deductible.*
                                                  • ** Please consult with your plan about cost sharing when receiving services from out-of-network providers.
                                                  • $6 700 out-of-pocket limit for Medicare-covered services. However in this plan you will have no cost sharing responsibility for Medicare-covered services based on your level of Medicaid eligibility.
                                                  • $0 annual deductible.**
                                                  • $6 700 out-of-pocket limit for Medicare-covered services. However in this plan you will have no cost sharing responsibility for Medicare-covered services based on your level of Medicaid eligibility.**
                                                  • $0 monthly plan premium*
                                                  • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                                                  Doctor Office Visits

                                                  • $0 copay for each primary care doctor visit for Medicare-covered benefits.*
                                                  • $0 copay for the cost of each in-area network urgent care Medicare-covered visit.*
                                                  • $0 copay for each specialist doctor visit for Medicare-covered benefits.*
                                                  • 20% of the cost for each primary care doctor visit**
                                                  • 20% of the cost for each specialist visit**
                                                  Humana Insurance Company Humana Gold Choice H8145-120 (PFFS) (H8145-120) Private Fee for Service

                                                    Premium and Other Important Information

                                                    • Package: 1 - MyOption Fitness Well Being:
                                                    • $30 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Supplemental Education/Wellness Programs
                                                    • $162 annual deductible. Contact the plan for services that apply.
                                                    • $6 700 out-of-pocket limit for Medicare-covered services.
                                                    • $0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
                                                    • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more i
                                                    • This plan does not allow providers to balance bill (charging more than your cost share amount).

                                                    Doctor Office Visits

                                                    • You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
                                                    • 20% of the cost for each primary care doctor visit for Medicare-covered benefits.
                                                    • 20% of the cost for each in-area network urgent care Medicare-covered visit
                                                    • 20% of the cost for each specialist visit for Medicare-covered benefits.
                                                    • 20% of the cost for each primary care doctor visit
                                                    • 20% of the cost for each specialist visit
                                                    Humana Insurance Company Humana Gold Choice H8145-125 (PFFS) (H8145-125) Private Fee for Service

                                                      Premium and Other Important Information

                                                      • Package: 1 - MyOption Dental High PPO:
                                                      • Package: 2 - MyOption Dental Low PPO:
                                                      • Package: 3 - MyOption Vision:
                                                      • Package: 4 - MyOption Plus:
                                                      • $20 monthly premium in addition to your $33 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                                                      • $13 monthly premium in addition to your $33 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                                                      • $15 monthly premium in addition to your $33 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Eye Exams Eye Wear
                                                      • $24 monthly premium in addition to your $33 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental Eye Exams Eye Wear
                                                      • $1 500 plan coverage limit every year for these benefits.
                                                      • $1 000 plan coverage limit every year for these benefits.
                                                      • $290 plan coverage limit every year for these benefits.
                                                      • $5 000 out-of-pocket limit for Medicare-covered services.
                                                      • $33 monthly plan premium in addition to your monthly Medicare Part B premium.
                                                      • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                                                      • This plan does not allow providers to balance bill (charging more than your cost share amount).

                                                      Doctor Office Visits

                                                      • You may go to any doctor specialist or hospital that accepts the plan's terms and conditions of payment.
                                                      • $15 copay for each primary care doctor visit for Medicare-covered benefits.
                                                      • $35 copay for each in-area network urgent care Medicare-covered visit
                                                      • $35 copay for each specialist visit for Medicare-covered benefits.
                                                      • $15 copay for each primary care doctor visit
                                                      • $35 copay for each specialist visit

                                                      Missouri Plan Data by County

                                                      Missouri Plan Data by City

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