Texas MedicareAdvantage Plans

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Medicare Advantage Plans in Mcallen, Texas

Below are Medicare Advantage plans available to residents of Mcallen, Texas. 33 carriers offer 214 plans throughout the city of Mcallen. Residents may chose plans from carriers such as Care Improvement Plus, KelseyCare Advantage and WellCare. 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 Mcallen that is right for you complete the form at the top of the page.

Medicare Advantage Health Plans in the city of Mcallen

Carrier	Plan Title	Plan Type
Care Improvement Plus	Care Improvement Plus Medicare Advantage (PPO) (H0084-001)	Local Preferred Provider Organization
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $15 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) (H0084-003)	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. $30 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) (H0084-004)	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 $25 copay for each primary care doctor visit for Medicare-covered benefits. $25 copay for each in-area network urgent care Medicare-covered visit $50 copay for each specialist visit for Medicare-covered benefits. $25 copay for each primary care doctor visit $50 copay for each specialist visit
Care Improvement Plus	Care Improvement Plus Dual Advantage (PPO SNP) (H0084-005)	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
Care Improvement Plus	Care Improvement Plus Silver Rx (PPO SNP) (H0084-018)	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. $21.3 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) (H0084-019)	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 $25 copay for each primary care doctor visit for Medicare-covered benefits. $25 copay for each in-area network urgent care Medicare-covered visit $50 copay for each specialist visit for Medicare-covered benefits. $25 copay for each primary care doctor visit $50 copay for each specialist visit
Care Improvement Plus	Care Improvement Plus Medicare Advantage (PPO) (H0084-021)	Local Preferred Provider Organization
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $53 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
KelseyCare Advantage	KelseyCare Advantage Essential (HMO) (H0332-001)	HMO
Premium and Other Important Information KelseyCare Advantage will reduce your monthly Medicare Part B premium by up to $ 30.00. $3 400 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 Authorization rules may apply. $10 copay for each primary care doctor visit for Medicare-covered benefits. $20 copay for each specialist visit for Medicare-covered benefits.
KelseyCare Advantage	KelseyCare Advantage Rx (HMO) (H0332-002)	HMO
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 Authorization rules may apply. $10 copay for each primary care doctor visit for Medicare-covered benefits. $35 copay for each specialist visit for Medicare-covered benefits.
KelseyCare Advantage	KelseyCare Advantage Essential + Choice (HMO-POS) (H0332-003)	HMO with POS Option
Premium and Other Important Information $3 400 out-of-pocket limit for Medicare-covered services. $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 Doctor Office Visits Authorization rules may apply. $10 copay for each primary care doctor visit for Medicare-covered benefits. $20 copay for each specialist visit for Medicare-covered benefits.
KelseyCare Advantage	KelseyCare Advantage Rx + Choice (HMO-POS) (H0332-004)	HMO with POS Option
Premium and Other Important Information $3 400 out-of-pocket limit for Medicare-covered services. $6 700 out-of-pocket limit for Medicare-covered services. $57 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 specialist visit for Medicare-covered benefits.
WellCare	WellCare Value (HMO-POS) (H1264-004)	HMO with POS Option
Premium and Other Important Information $5 500 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 $0 copay for each primary care doctor visit for Medicare-covered benefits. $40 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) (H1264-007)	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.*
WellCare	WellCare Dividend (HMO) (H1264-008)	HMO
Premium and Other Important Information WellCare will reduce your monthly Medicare Part B premium by up to $ 52.50. $5 500 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. $40 copay for each in-area network urgent care Medicare-covered visit $35 copay for each specialist visit for Medicare-covered benefits.
WellCare	WellCare Dividend (HMO) (H1264-014)	HMO
Premium and Other Important Information WellCare will reduce your monthly Medicare Part B premium by up to $ 52.40. $5 500 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. $40 copay for each in-area network urgent care Medicare-covered visit $35 copay for each specialist visit for Medicare-covered benefits.
Bravo Health	Bravo Freedom (PPO) (H1355-001)	Local Preferred Provider Organization
Premium and Other Important Information $3 400 out-of-pocket limit for Medicare-covered services. $5 100 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 $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. 20% of the cost for each primary care doctor visit 20% of the cost for each specialist visit
Bravo Health	Bravo Traditions (PPO SNP) (H1355-002)	Local Preferred Provider Organization
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $10 000 out-of-pocket limit for Medicare-covered services. $30 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 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 H2944-024 (PFFS) (H2944-024)	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: $22 monthly premium in addition to your $119 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 $119 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 $119 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 $119 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. Unless otherwise noted out-of-network services not covered. $5 000 out-of-pocket limit for Medicare-covered services. $119 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 specialist visit for Medicare-covered benefits.
Humana Insurance Company	Humana Gold Choice H2944-201 (PFFS) (H2944-201)	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: $22 monthly premium in addition to your $79 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 $79 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 $79 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 $79 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. Unless otherwise noted out-of-network services not covered. $5 000 out-of-pocket limit for Medicare-covered services. $79.00 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. $15 copay for each primary care doctor visit for Medicare-covered benefits. $35 copay for each specialist visit for Medicare-covered benefits.
Presbyterian MediCare PPO	Presbyterian MediCare PPO Plan 2 with Rx (PPO) (H3206-001)	Local Preferred Provider Organization
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $7 500 out-of-pocket limit. All plan services included. $86 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. $10 copay for each in-area network urgent care Medicare-covered visit $40 copay for each specialist visit for Medicare-covered benefits. $35 copay for each primary care doctor visit $55 copay for each specialist visit
Presbyterian MediCare PPO	Presbyterian MediCare PPO Plan 3 with Rx (PPO) (H3206-002)	Local Preferred Provider Organization
Premium and Other Important Information $3 000 out-of-pocket limit. All plan services included. $7 500 out-of-pocket limit. All plan services included. $107 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. $10 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits. $35 copay for each primary care doctor visit $55 copay for each specialist visit
Presbyterian MediCare PPO	Presbyterian MediCare PPO Plan 1 (PPO) (H3206-003)	Local Preferred Provider Organization
Premium and Other Important Information $3 000 out-of-pocket limit. All plan services included. $7 500 out-of-pocket limit. All plan services included. $49.00 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 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. $10 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits. $35 copay for each primary care doctor visit $55 copay for each specialist visit
WindsorSterling	WindsorSterling Silver Connect Plan (PFFS) (H3410-002)	Private Fee for Service
Premium and Other Important Information $4 000 out-of-pocket limit. All plan services included. $30.00 monthly plan premium in addition to your monthly Medicare Part B premium. $25.00 monthly plan premium in addition to your monthly Medicare Part B premium. $49.00 monthly plan premium in addition to your monthly Medicare Part B premium. $35.00 monthly plan premium in addition to your monthly Medicare Part B premium. $29.00 monthly plan premium in addition to your monthly Medicare Part B premium. $40.00 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. $10 copay for each primary care doctor visit for Medicare-covered benefits. $10 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits. $25 copay for each primary care doctor visit $40 copay for each specialist visit
WindsorSterling	WindsorSterling Gold Connect Plan (PFFS) (H3410-003)	Private Fee for Service
Premium and Other Important Information $4 000 out-of-pocket limit. All plan services included. $59 monthly plan premium in addition to your monthly Medicare Part B premium. $55 monthly plan premium in addition to your monthly Medicare Part B premium. $79 monthly plan premium in addition to your monthly Medicare Part B premium. $60 monthly plan premium in addition to your monthly Medicare Part B premium. $65 monthly plan premium in addition to your monthly Medicare Part B premium. $70 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. $10 copay for each primary care doctor visit for Medicare-covered benefits. $10 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits. $25 copay for each primary care doctor visit $40 copay for each specialist visit
WindsorSterling	WindsorSterling Emerald Connect Plan (PFFS) (H3410-004)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit. All plan services included. $28.5 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. $20 copay for each primary care doctor visit for Medicare-covered benefits. $20 copay for each in-area network urgent care Medicare-covered visit $35 copay 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
Universal American Corp.	TexanPlus Classic (HMO) (H4506-003)	HMO
Premium and Other Important Information $3 000 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. $25 copay for each in-area network urgent care Medicare-covered visit $20 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	TexanPlus Value (HMO) (H4506-010)	HMO
Premium and Other Important Information Universal American Corp. will reduce your monthly Medicare Part B premium by up to $ 53.40. $3 000 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 Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $25 copay for each in-area network urgent care Medicare-covered visit $20 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	TexanPlus Select (HMO) (H4506-027)	HMO
Premium and Other Important Information Universal American Corp. will reduce your monthly Medicare Part B premium by up to $ 35.90. $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 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.
HUMANA HEALTH PLAN OF TEXAS INC.	Humana Gold Plus H4510-012 (HMO) (H4510-012)	HMO
Premium and Other Important Information Package: 1 - MyOption Dental High PPO: Package: 2 - MyOption Dental Low PPO: $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 $14 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 $1 500 plan coverage limit every year for these benefits. $1 000 plan coverage limit every year for these benefits. $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 Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $10 copay for each in-area network urgent care Medicare-covered visit $20 copay for each specialist visit for Medicare-covered benefits.
HUMANA HEALTH PLAN OF TEXAS INC.	Humana Gold Plus H4510-015 (HMO) (H4510-015)	HMO
Premium and Other Important Information Package: 1 - MyOption Dental High PPO: Package: 2 - MyOption Dental Low PPO: $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 $14 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 $1 500 plan coverage limit every year for these benefits. $1 000 plan coverage limit every year for these benefits. $4 000 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. $20 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits.
HUMANA HEALTH PLAN OF TEXAS INC.	Humana Reader's Digest Healthy Living Plan (HMO) (H4510-018)	HMO
Premium and Other Important Information Package: 1 - MyOption Dental High PPO: Package: 2 - MyOption Dental Low PPO: Package: 4 - MyOption Vision: Package: 5 - MyOption Plus: $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 $14 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 $15 monthly premium in addition to your $0 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 $0 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. $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. $20 copay for each in-area network urgent care Medicare-covered visit $20 copay for each specialist visit for Medicare-covered benefits.
HUMANA HEALTH PLAN OF TEXAS INC.	Humana Reader's Digest Healthy Living Plan (HMO) (H4510-020)	HMO
Premium and Other Important Information $3 400 out-of-pocket limit for Medicare-covered services. $112 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. $30 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits.
HUMANA HEALTH PLAN OF TEXAS INC.	Humana Gold Plus SNP-DE H4510-021 (HMO SNP) (H4510-021)	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. $3 400 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 Authorization rules may apply. $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.*
HUMANA HEALTH PLAN OF TEXAS INC.	Humana Gold Plus H4510-022 (HMO) (H4510-022)	HMO
Premium and Other Important Information Package: 1 - MyOption Dental High PPO: Package: 2 - MyOption Dental Low PPO: $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 $14 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 $1 500 plan coverage limit every year for these benefits. $1 000 plan coverage limit every year for these benefits. $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 Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits.
HUMANA HEALTH PLAN OF TEXAS INC.	Humana Gold Plus SNP-DE H4510-023 (HMO SNP) (H4510-023)	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. $3 400 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 Authorization rules may apply. $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.*
HUMANA HEALTH PLAN OF TEXAS INC.	Humana Gold Plus SNP-DE H4510-024 (HMO SNP) (H4510-024)	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 $0 annual deductible.* ** Please consult with your plan about cost sharing when receiving services from out-of-network providers. $3 400 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 Authorization rules may apply. $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.*
HUMANA HEALTH PLAN OF TEXAS INC.	Humana Gold Plus H4510-027 (HMO) (H4510-027)	HMO
Premium and Other Important Information $4 000 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits.
HealthSpring	HealthyAdvantage Preferred (HMO) (H4513-001)	HMO
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 Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $25 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits.
HealthSpring	HealthyAdvantage (HMO) (H4513-009)	HMO
Premium and Other Important Information HealthSpring will reduce your monthly Medicare Part B premium by up to $ 65.00. $3 400 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 Authorization rules may apply. $15 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.
HealthSpring	TotalCare (HMO SNP) (H4513-010)	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 ** Please consult with your plan about cost sharing when receiving services from out-of-network providers. In this plan you will have no cost sharing responsibility for Medicare-covered services. $29.9 monthly plan premium in addition to your monthly Medicare Part B premium.* Doctor Office Visits Authorization rules may apply. $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.*
UnitedHealthcare	UnitedHealthcare Dual Complete (HMO SNP) (H4514-001)	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 ** Please consult with your plan about cost sharing when receiving services from out-of-network providers. $2 500 out-of-pocket limit for Medicare-covered services.* $24.9 monthly plan premium in addition to your monthly Medicare Part B premium.* 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.*
UnitedHealthcare	AARP MedicareComplete Plus (HMO-POS) (H4514-007)	HMO with POS Option
Premium and Other Important Information Package: 1 - Fitness Rider: $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 $3 400 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 $5 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits.
Amarillo Multisvc Ctr For The Aging Inc	DUAL ELIGIBLE (PACE) (H4517-001)	National PACE

Amarillo Multisvc Ctr For The Aging Inc	MEDICARE ONLY (PACE) (H4517-002)	National PACE

Bienvivir Senior Health Services	BSHS Part D Dual Eligibles (PACE) (H4518-001)	National PACE

Bienvivir Senior Health Services	BSHS Part D Medicare Only (PACE) (H4518-002)	National PACE

Humana Insurance Company	HumanaChoice H4520-006 (PPO) (H4520-006)	Local Preferred Provider Organization
Premium and Other Important Information Package: 1 - MyOption Dental High PPO: Package: 2 - MyOption Dental Low PPO: Package: 4 - MyOption Vision: Package: 5 - MyOption Plus: $22 monthly premium in addition to your $49 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 $49 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 $49 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 $49 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. $500 annual deductible. Contact the plan for services that apply. $5 000 out-of-pocket limit for Medicare-covered services. $49 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 $40 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
UnitedHealthcare	AARP MedicareComplete Choice (PPO) (H4522-001)	Local Preferred Provider Organization
Premium and Other Important Information Package: 1 - Dental Platinum Rider: $33 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 $4 200 out-of-pocket limit for Medicare-covered services. $6 200 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 $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. $25 copay for each primary care doctor visit $45 copay for each specialist visit
UnitedHealthcare	UnitedHealthcare Dual Complete (PPO SNP) (H4522-007)	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 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.* In 2012 the annual Part B deductible amount is $0 or $140 .** Contact the plan for services that apply. $10 000 out-of-pocket limit for Medicare-covered services.* $19.4 monthly plan premium in addition to your monthly Medicare Part B 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% 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.* 30% of the cost for each primary care doctor visit 30% of the cost for each specialist visit
UnitedHealthcare	UnitedHealthcare Dual Complete (PPO SNP) (H4522-010)	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 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.* In 2012 the annual Part B deductible amount is $0 or $140 .** Contact the plan for services that apply. $10 000 out-of-pocket limit for Medicare-covered services.* $19.4 monthly plan premium in addition to your monthly Medicare Part B 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% 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.* 30% of the cost for each primary care doctor visit 30% of the cost for each specialist visit
Aetna Medicare	Aetna Medicare Premier Plan (HMO) (H4523-001)	HMO
Premium and Other Important Information Package: 1 - Preventive Dental: Package: 2 - Advantage Dental: $7 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental $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 Comprehensive Dental $3 400 out-of-pocket limit for Medicare-covered services and select Non-Medicare Supplemental Services. Contact plan for details regarding Non-Medicare Supplemental Services covered under this limit. $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. $25 copay for each in-area network urgent care Medicare-covered visit $20 copay for each specialist visit for Medicare-covered benefits.
Aetna Medicare	Aetna Medicare Premier Plan (HMO) (H4523-005)	HMO
Premium and Other Important Information Package: 1 - Preventive Dental: Package: 2 - Advantage Dental: $7 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental $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 Comprehensive Dental $3 400 out-of-pocket limit for Medicare-covered services and select Non-Medicare Supplemental Services. Contact plan for details regarding Non-Medicare Supplemental Services covered under this limit. $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. $25 copay for each in-area network urgent care Medicare-covered visit $20 copay for each specialist visit for Medicare-covered benefits.
Aetna Medicare	Aetna Medicare Premier Plan (HMO) (H4523-015)	HMO
Premium and Other Important Information Package: 1 - Preventive Dental: Package: 2 - Advantage Dental: $7 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental $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 Comprehensive Dental $3 400 out-of-pocket limit for Medicare-covered services and select Non-Medicare Supplemental Services. Contact plan for details regarding Non-Medicare Supplemental Services covered under this limit. $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 $25 copay for each specialist visit for Medicare-covered benefits.
Aetna Medicare	Aetna Medicare Value Plan (PPO) (H4524-001)	Local Preferred Provider Organization
Premium and Other Important Information $5 000 out-of-pocket limit for Medicare-covered services and select Non-Medicare Supplemental Services. Contact plan for details regarding Non-Medicare Supplemental Services covered under this limit. $500 annual deductible. Contact the plan for services that apply. $7 500 out-of-pocket limit for Medicare-covered services and select Non-Medicare Supplemental Services. Contact plan for details regarding Non-Medicare Supplemental Services covered under this limit. $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. $35 copay for each in-area network urgent care Medicare-covered visit $40 copay for each specialist visit for Medicare-covered benefits. 25% of the cost for each primary care doctor visit 25% of the cost for each specialist visit
Aetna Medicare	Aetna Medicare Value Plan (PPO) (H4524-007)	Local Preferred Provider Organization
Premium and Other Important Information $5 000 out-of-pocket limit for Medicare-covered services and select Non-Medicare Supplemental Services. Contact plan for details regarding Non-Medicare Supplemental Services covered under this limit. $500 annual deductible. Contact the plan for services that apply. $7 500 out-of-pocket limit for Medicare-covered services and select Non-Medicare Supplemental Services. Contact plan for details regarding Non-Medicare Supplemental Services covered under this limit. $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 $40 copay for each specialist visit for Medicare-covered benefits. 25% of the cost for each primary care doctor visit 25% of the cost for each specialist visit
Aetna Medicare	Aetna Medicare Value Plan (PPO) (H4524-013)	Local Preferred Provider Organization
Premium and Other Important Information $3 400 out-of-pocket limit for Medicare-covered services and select Non-Medicare Supplemental Services. Contact plan for details regarding Non-Medicare Supplemental Services covered under this limit. $500 annual deductible. Contact the plan for services that apply. $5 000 out-of-pocket limit for Medicare-covered services and select Non-Medicare Supplemental Services. Contact plan for details regarding Non-Medicare Supplemental Services covered under this limit. $49 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 $40 copay for each specialist visit for Medicare-covered benefits. 25% of the cost for each primary care doctor visit 25% of the cost for each specialist visit
FirstCare Advantage	FirstCare Advantage Gold (HMO) (H4525-001)	HMO
Premium and Other Important Information $3 400 out-of-pocket limit for Medicare-covered services. $31 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. $25 copay for each in-area network urgent care Medicare-covered visit $35 copay for each specialist visit for Medicare-covered benefits.
FirstCare Advantage	FirstCare Advantage Gold (HMO) (H4525-002)	HMO
Premium and Other Important Information $3 400 out-of-pocket limit for Medicare-covered services. $31 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. $25 copay for each in-area network urgent care Medicare-covered visit $35 copay for each specialist visit for Medicare-covered benefits.
FirstCare Advantage	FirstCare Advantage Select (HMO SNP) (H4525-003)	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 ** Please consult with your plan about cost sharing when receiving services from out-of-network providers. In this plan you will have no cost sharing responsibility for Medicare-covered services. $29.9 monthly plan premium in addition to your monthly Medicare Part B 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.*
FirstCare Advantage	FirstCare Advantage Silver (HMO) (H4525-004)	HMO
Premium and Other Important Information $3 400 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 $10 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.
FirstCare Advantage	FirstCare Advantage Silver (HMO) (H4525-005)	HMO
Premium and Other Important Information $3 400 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 $10 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.
FirstCare Advantage	FirstCare Advantage Elite (HMO) (H4525-008)	HMO
Premium and Other Important Information $3 400 out-of-pocket limit for Medicare-covered services. $101 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. $25 copay for each in-area network urgent care Medicare-covered visit $0 copay for each specialist doctor visit for Medicare-covered benefits.
FirstCare Advantage	FirstCare Advantage Elite (HMO) (H4525-009)	HMO
Premium and Other Important Information $3 400 out-of-pocket limit for Medicare-covered services. $101 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. $25 copay for each in-area network urgent care Medicare-covered visit $0 copay for each specialist doctor visit for Medicare-covered benefits.
PHYSICIANS HEALTH CHOICE	Physicians Health Choice Total (HMO) (H4527-001)	HMO
Premium and Other Important Information $3 600 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. $10 copay for each in-area network urgent care Medicare-covered visit $10 copay for each specialist visit for Medicare-covered benefits.
PHYSICIANS HEALTH CHOICE	Physicians Health Choice Total (HMO) (H4527-002)	HMO
Premium and Other Important Information $4 200 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. $30 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits.
PHYSICIANS HEALTH CHOICE	Physicians Health Choice Select (HMO SNP) (H4527-003)	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. $3 350 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.*
PHYSICIANS HEALTH CHOICE	Physicians Health Choice Select (HMO SNP) (H4527-004)	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. $3 350 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.*
PHYSICIANS HEALTH CHOICE	Physicians Health Choice Total (HMO) (H4527-005)	HMO
Premium and Other Important Information $3 600 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. $25 copay for each in-area network urgent care Medicare-covered visit $25 copay for each specialist visit for Medicare-covered benefits.
PHYSICIANS HEALTH CHOICE	Physicians Health Choice Select (HMO SNP) (H4527-006)	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. $3 350 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.*
PHYSICIANS HEALTH CHOICE	Physicians Health Choice Total (HMO) (H4527-013)	HMO
Premium and Other Important Information $3 600 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. $20 copay for each in-area network urgent care Medicare-covered visit $20 copay for each specialist visit for Medicare-covered benefits.
PHYSICIANS HEALTH CHOICE	Physicians Health Choice Select (HMO SNP) (H4527-015)	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. $3 350 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.*
PHYSICIANS HEALTH CHOICE	Physicians Health Choice Basic (HMO) (H4527-024)	HMO
Premium and Other Important Information $3 350 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 $0 copay for each primary care doctor visit for Medicare-covered benefits. $10 copay for each in-area network urgent care Medicare-covered visit $10 copay for each specialist visit for Medicare-covered benefits.
Bravo Health	Bravo Classic Plus (HMO-POS) (H4528-001)	HMO with POS Option
Premium and Other Important Information Package: 1 - Enhanced Hearing and Dental: $34.30 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Comprehensive Dental Hearing Exams Hearing Aids $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.
Bravo Health	Bravo Select (HMO SNP) (H4528-002)	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 ** 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.* $30 monthly plan premium in addition to your monthly Medicare Part B 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.*
Bravo Health	Bravo Traditions (HMO SNP) (H4528-013)	HMO
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $30 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. $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.
Bravo Health	Bravo Achieve (HMO SNP) (H4528-014)	HMO
Premium and Other Important Information Package: 1 - Enhanced Hearing and Dental: $38.30 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 Hearing Exams Hea $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 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.
Texas Community Care	Texas Community Care- Plus Point (HMO-POS) (H4529-002)	HMO with POS Option
Premium and Other Important Information $3 200 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. $15 copay for each specialist visit for Medicare-covered benefits.
Texas Community Care	Texas Community Care- Plus (HMO) (H4529-004)	HMO
Premium and Other Important Information $4 950 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. $7 copay for each primary care doctor visit for Medicare-covered benefits. $35 copay for each specialist visit for Medicare-covered benefits.
Texas Community Care	Texas Community Care - Dual Plus (HMO SNP) (H4529-007)	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. $3 400 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 Authorization rules may apply. $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.*
Texas Community Care	Texas Community Care - Plus (HMO) (H4529-014)	HMO
Premium and Other Important Information $4 950 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. $15 copay for each specialist visit for Medicare-covered benefits.
Texas Community Care	Texas Community Care - Plus (HMO) (H4529-027)	HMO
Premium and Other Important Information $4 900 out-of-pocket limit for Medicare-covered services. $20 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. $20 copay for each specialist visit for Medicare-covered benefits.
Texas Community Care	Texas Community Care - Plus (HMO) (H4529-028)	HMO
Premium and Other Important Information $4 400 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 Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $25 copay for each specialist visit for Medicare-covered benefits.
Texas Community Care	Texas Community Care - Plus (HMO) (H4529-030)	HMO
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 Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $15 copay for each specialist visit for Medicare-covered benefits.
Texas Community Care	Texas Community Care - Dual Plus (HMO SNP) (H4529-031)	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. $3 400 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 Authorization rules may apply. $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.*
Scott and White Health Plan SeniorCare	SeniorCare Sr Premium - Basic Rx (Cost) (H4564-001)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $204 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $0 copay for each specialist doctor visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr Preferred - Basic Rx (Cost) (H4564-002)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $124 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. $15 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $15 copay for each specialist visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr Select - Basic Rx (Cost) (H4564-003)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $77 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. $30 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.
Scott and White Health Plan SeniorCare	SeniorCare Sr Premium - Enhanced Rx (Cost) (H4564-004)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $260.1 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 Doctor Office Visits Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $0 copay for each specialist doctor visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr Preferred - Enhanced Rx (Cost) (H4564-005)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $180.1 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 Doctor Office Visits Authorization rules may apply. $15 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $15 copay for each specialist visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr Select - Enhanced Rx (Cost) (H4564-006)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $133.1 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 Doctor Office Visits Authorization rules may apply. $30 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.
Scott and White Health Plan SeniorCare	SeniorCare Sr Premium-Medical Only (Cost) (H4564-010)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $167.00 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 Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $0 copay for each specialist doctor visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr Preferred-Medical Only (Cost) (H4564-011)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $87.00 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 Authorization rules may apply. $15 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $15 copay for each specialist visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr Select-Medical Only (Cost) (H4564-012)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $40.00 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 Authorization rules may apply. $30 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.
Scott and White Health Plan SeniorCare	SeniorCare Sr Premium - Value Rx (Cost) (H4564-013)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $197.6 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $0 copay for each specialist doctor visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr Preferred - Value Rx (Cost) (H4564-014)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $117.6 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. $15 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $15 copay for each specialist visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr Select - Value Rx (Cost) (H4564-015)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $70.6 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. $30 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.
Scott and White Health Plan SeniorCare	SeniorCare Sr VIP - Medical Only (Cost) (H4564-016)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $125.00 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 Authorization rules may apply. $5 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $5 copay for each specialist visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr VIP - Basic Rx (Cost) (H4564-017)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $162 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. $40 copay for each in-area network urgent care Medicare-covered visit $5 copay for each specialist visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr VIP - Enhanced Rx (Cost) (H4564-018)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $218.1 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 Doctor Office Visits Authorization rules may apply. $5 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $5 copay for each specialist visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr VIP - Value Rx (Cost) (H4564-019)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $155.6 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. $40 copay for each in-area network urgent care Medicare-covered visit $5 copay for each specialist visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr MedOption - Medical Only (Cost) (H4564-020)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $148.00 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 Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $0 copay for each specialist doctor visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr MedOption - Basic Rx (Cost) (H4564-021)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $185 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $0 copay for each specialist doctor visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr MedOption - Enhanced Rx (Cost) (H4564-022)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $241.1 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 Doctor Office Visits Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $0 copay for each specialist doctor visit for Medicare-covered benefits.
Scott and White Health Plan SeniorCare	SeniorCare Sr MedOption - Value Rx (Cost) (H4564-023)	Cost Plan
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $178.6 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $0 copay for each specialist doctor visit for Medicare-covered benefits.
UnitedHealthcare	AARP MedicareComplete SecureHorizons (HMO) (H4590-010)	HMO
Premium and Other Important Information Package: 1 - Dental 467 Rider: $15 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental $3 900 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. $30 copay for each in-area network urgent care Medicare-covered visit $32 copay for each specialist visit for Medicare-covered benefits.
UnitedHealthcare	AARP MedicareComplete SecureHorizons (HMO) (H4590-012)	HMO
Premium and Other Important Information Package: 1 - Deluxe Rider: Package: 2 - Dental 467 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 Exams Eye Wear $15 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental $4 900 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. $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) (H4590-020)	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.* $22.1 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.*
UnitedHealthcare	UnitedHealthcare Dual Complete (HMO SNP) (H4590-022)	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 ** 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.* $10.4 monthly plan premium in addition to your monthly Medicare Part B premium.* Doctor Office Visits $0 copay for each primary care doctor visit for Medicare-covered benefits.* $0 or $50 copay for each in-area network urgent care Medicare-covered visit* $0 copay for each specialist visit for Medicare-covered benefits.*
UnitedHealthcare	AARP MedicareComplete SecureHorizons (HMO) (H4590-025)	HMO
Premium and Other Important Information Package: 1 - Dental 467 Rider: Package: 2 - Fitness Rider: $15 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental $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 $4 900 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. $20 copay for each in-area network urgent care Medicare-covered visit $20 copay for each specialist visit for Medicare-covered benefits.
UnitedHealthcare	AARP MedicareComplete SecureHorizons Essential (HMO) (H4590-027)	HMO
Premium and Other Important Information Package: 1 - Deluxe Rider: Package: 2 - Dental 467 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 Exams Eye Wear $15 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental $4 500 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 $5 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 SecureHorizons Essential (HMO) (H4590-029)	HMO
Premium and Other Important Information Package: 1 - Dental 467 Rider: $15 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental $3 900 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 $0 copay for each primary care doctor visit for Medicare-covered benefits. $20 copay for each in-area network urgent care Medicare-covered visit $0 copay for each specialist visit for Medicare-covered benefits.
UnitedHealthcare	UnitedHealthcare Dual Complete (HMO SNP) (H4590-033)	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.* $20.2 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.*
UnitedHealthcare	UnitedHealthcare Chronic Complete (HMO SNP) (H4590-037)	HMO
Premium and Other Important Information Package: 1 - Dental 467 Rider: $15 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental $3 900 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. $30 copay for each in-area network urgent care Medicare-covered visit $32 copay for each specialist visit for Medicare-covered benefits.
UnitedHealthcare	UnitedHealthcare Nursing Home Plan (HMO SNP) (H4590-038)	HMO
Premium and Other Important Information $5 000 out-of-pocket limit for Medicare-covered services. $28.5 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. 20% of the cost for each in-area network urgent care Medicare-covered visit 0% to 20% of the cost for each specialist visit for Medicare-covered benefits.
UnitedHealthcare	UnitedHealthcare Nursing Home Plan (HMO SNP) (H4590-039)	HMO
Premium and Other Important Information $5 000 out-of-pocket limit for Medicare-covered services. $28.5 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. 20% of the cost for each in-area network urgent care Medicare-covered visit 0% to 20% of the cost for each specialist visit for Medicare-covered benefits.
WindsorSterling	WindsorSterling Gold Access Plan (PFFS) (H5006-017)	Private Fee for Service
Premium and Other Important Information $4 000 out-of-pocket limit. All plan services included. $60 monthly plan premium in addition to your monthly Medicare Part B premium. $75 monthly plan premium in addition to your monthly Medicare Part B premium. $70 monthly plan premium in addition to your monthly Medicare Part B premium. $55 monthly plan premium in addition to your monthly Medicare Part B premium. $59 monthly plan premium in addition to your monthly Medicare Part B premium. $80 monthly plan premium in addition to your monthly Medicare Part B premium. $62 monthly plan premium in addition to your monthly Medicare Part B premium. $85 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. $10 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
WindsorSterling	WindsorSterling Silver Access Plan (PFFS) (H5006-018)	Private Fee for Service
Premium and Other Important Information $4 000 out-of-pocket limit. All plan services included. $30.00 monthly plan premium in addition to your monthly Medicare Part B premium. $45.00 monthly plan premium in addition to your monthly Medicare Part B premium. $40.00 monthly plan premium in addition to your monthly Medicare Part B premium. $25.00 monthly plan premium in addition to your monthly Medicare Part B premium. $50.00 monthly plan premium in addition to your monthly Medicare Part B premium. $49.00 monthly plan premium in addition to your monthly Medicare Part B premium. $32.00 monthly plan premium in addition to your monthly Medicare Part B premium. $29.00 monthly plan premium in addition to your monthly Medicare Part B premium. $55.00 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. $10 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal Health Care Insurance Company Inc.	Universal Hassle-Free (PPO) (H5096-001)	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 $15 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each specialist visit for Medicare-covered benefits. $15 copay for each primary care doctor visit $40 copay for each specialist visit
Universal Health Care Insurance Company Inc.	Universal Hassle-Free MA Only (PPO) (H5096-002)	Local Preferred Provider Organization
Premium and Other Important Information Universal Health Care Insurance Company Inc. will reduce your monthly Medicare Part B premium by up to $ 10.00. $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 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 specialist visit for Medicare-covered benefits. $15 copay for each primary care doctor visit $40 copay for each specialist visit
WindsorSterling	WindsorSterling Gold Plus Plan (PPO) (H5162-017)	Local Preferred Provider Organization
Premium and Other Important Information $4 000 out-of-pocket limit. All plan services included. $50 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. $30 copay for each specialist visit for Medicare-covered benefits. $25 copay for each primary care doctor visit $40 copay for each specialist visit
WindsorSterling	Fresenius Health Partners (PPO SNP) (H5162-019)	Local Preferred Provider Organization
Premium and Other Important Information $6 700 out-of-pocket limit. All plan services included. In 2012 the annual Part B deductible amount is $140. Contact the plan for services that apply. $600 plan coverage limit every year for Non-Medicare Supplemental benefits. Contact the plan for services that apply. $30 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% of the cost for each primary care doctor visit for Medicare-covered benefits. 20% of the cost for each specialist visit for Medicare-covered benefits.
Advantage by Superior HealthPlan	Advantage by Superior HealthPlan (HMO SNP) (H5294-001)	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. $3 400 out-of-pocket limit. All plan services included.* $0 monthly plan premium in addition to your monthly Medicare Part B premium.* Doctor Office Visits Authorization rules may apply. 0% or 0% to 20% of the cost for each primary care doctor visit for Medicare-covered benefits.* 0% or 0% to 20% of the cost for each specialist visit for Medicare-covered benefits.*
Universal American Corp.	Today's Options Advantage Plus 250A (PPO) (H5378-010)	Local Preferred Provider Organization
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $132 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 $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. $10 copay for each primary care doctor visit $40 copay for each specialist visit
Universal American Corp.	Today's Options Advantage Plus 450H (PPO) (H5378-016)	Local Preferred Provider Organization
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $62 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 $25 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. $30 copay for each primary care doctor visit $60 copay for each specialist visit
Universal American Corp.	Today's Options Advantage Plus 250A (PPO) (H5378-182)	Local Preferred Provider Organization
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $62 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 $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. $10 copay for each primary care doctor visit $40 copay for each specialist visit
Universal American Corp.	Today's Options Advantage Plus 450F (PPO) (H5378-184)	Local Preferred Provider Organization
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $51 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 $25 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. $30 copay for each primary care doctor visit $60 copay for each specialist visit
Universal American Corp.	Today's Options Advantage Plus 250A (PPO) (H5378-188)	Local Preferred Provider Organization
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $127 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 $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. $10 copay for each primary care doctor visit $40 copay for each specialist visit
Universal American Corp.	Today's Options Advantage Plus 650B (PPO) (H5378-190)	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 $25 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. $30 copay for each primary care doctor visit $60 copay for each specialist visit
Universal American Corp.	Today's Options Advantage Plus 450F (PPO) (H5378-194)	Local Preferred Provider Organization
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $82 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 $25 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. $30 copay for each primary care doctor visit $60 copay for each specialist visit
Universal American Corp.	Today's Options Advantage Plus 250A (PPO) (H5378-200)	Local Preferred Provider Organization
Premium and Other Important Information $3 250 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 $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. $10 copay for each primary care doctor visit $40 copay for each specialist visit
Universal American Corp.	Today's Options Premier 400 (PFFS) (H5421-046)	Private Fee for Service
Premium and Other Important Information $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. $25 copay for each primary care doctor visit for Medicare-covered benefits. $50 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier 400 (PFFS) (H5421-047)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $25.00 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. $25 copay for each primary care doctor visit for Medicare-covered benefits. $50 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier 400 (PFFS) (H5421-048)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $35.00 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. $25 copay for each primary care doctor visit for Medicare-covered benefits. $50 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier 400 (PFFS) (H5421-049)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $60.00 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. $25 copay for each primary care doctor visit for Medicare-covered benefits. $50 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier 400 (PFFS) (H5421-056)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $75.00 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. $25 copay for each primary care doctor visit for Medicare-covered benefits. $50 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier 400 (PFFS) (H5421-057)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $90.00 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. $25 copay for each primary care doctor visit for Medicare-covered benefits. $50 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier Plus 450B (PFFS) (H5421-065)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $60 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. $25 copay for each primary care doctor visit for Medicare-covered benefits. $50 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier Plus 250A (PFFS) (H5421-067)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $139 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. $5 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier Plus 250A (PFFS) (H5421-068)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $165 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. $5 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier Plus 450B (PFFS) (H5421-070)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $41 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. $25 copay for each primary care doctor visit for Medicare-covered benefits. $50 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier Plus 450C (PFFS) (H5421-072)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $56 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. $25 copay for each primary care doctor visit for Medicare-covered benefits. $50 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier Plus 450D (PFFS) (H5421-073)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $82 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. $25 copay for each primary care doctor visit for Medicare-covered benefits. $50 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier Plus 450E (PFFS) (H5421-074)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $108 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. $25 copay for each primary care doctor visit for Medicare-covered benefits. $50 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier Plus 450C (PFFS) (H5421-075)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $102 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. $25 copay for each primary care doctor visit for Medicare-covered benefits. $50 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier 200 (PFFS) (H5421-206)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $35.00 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. $5 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier 200 (PFFS) (H5421-207)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $60.00 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. $5 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier 200 (PFFS) (H5421-208)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $70.00 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. $5 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier 200 (PFFS) (H5421-209)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $95.00 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. $5 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier 200 (PFFS) (H5421-210)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $110.00 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. $5 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier 200 (PFFS) (H5421-211)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $125.00 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. $5 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier Plus 250A (PFFS) (H5421-212)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $98 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. $5 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier Plus 250A (PFFS) (H5421-213)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $119 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. $5 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier Plus 250A (PFFS) (H5421-214)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $114 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. $5 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier Plus 250A (PFFS) (H5421-215)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $159 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. $5 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
UnitedHealthcare	UnitedHealthcare MedicareDirect Essential (PFFS) (H5435-001)	Private Fee for Service
Premium and Other Important Information $6 200 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 copay for each primary care doctor visit for Medicare-covered benefits. $45 copay for each specialist visit for Medicare-covered benefits.
UnitedHealthcare	UnitedHealthcare MedicareDirect Rx (PFFS) (H5435-014)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $28 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. $20 copay for each primary care doctor visit for Medicare-covered benefits. $45 copay for each specialist visit for Medicare-covered benefits.
Erickson Advantage	Erickson Advantage Signature with Drugs (HMO-POS) (H5652-001)	HMO with POS Option
Premium and Other Important Information $5 000 out-of-pocket limit for Medicare-covered services. $175 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. $30 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits.
Erickson Advantage	Erickson Advantage Signature without Drugs (HMO-POS) (H5652-002)	HMO with POS Option
Premium and Other Important Information $5 000 out-of-pocket limit for Medicare-covered services. $136.00 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 $0 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits.
Erickson Advantage	Erickson Advantage Champion (HMO-POS SNP) (H5652-004)	HMO with POS Option
Premium and Other Important Information $5 000 out-of-pocket limit for Medicare-covered services. $175 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. $30 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits.
TexasFirst Health Plans	TexanPlus Classic (HMO) (H5656-001)	HMO
Premium and Other Important Information $3 000 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. $25 copay for each in-area network urgent care Medicare-covered visit $20 copay for each specialist visit for Medicare-covered benefits.
TexasFirst Health Plans	TexanPlus Value (HMO) (H5656-003)	HMO
Premium and Other Important Information Universal American Corp. will reduce your monthly Medicare Part B premium by up to $ 32.90. $3 000 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 Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $25 copay for each in-area network urgent care Medicare-covered visit $20 copay for each specialist visit for Medicare-covered benefits.
Texarkana Community Care	Texarkana Community Care - Plus (HMO) (H5700-020)	HMO
Premium and Other Important Information $4 400 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 Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $25 copay for each specialist visit for Medicare-covered benefits.
Texarkana Community Care	Arkansas Community Care - Dual Plus (HMO SNP) (H5700-028)	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. $3 400 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 Authorization rules may apply. $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.*
Amerigroup Community Care	Amerivantage Specialty + Rx (HMO SNP) (H5817-009)	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 Amerigroup Community Care will reduce your monthly Medicare Part B premium by up to $ 47.20. $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.*
Amerigroup Community Care	Amerivantage Classic Choice + Rx (HMO-POS) (H5817-010)	HMO with POS Option
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 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 $15 copay for each specialist visit for Medicare-covered benefits.
UNIVERSAL HEALTH CARE INSURANCE COMPANY INC.	Any Any Any Gold (PFFS) (H5820-002)	Private Fee for Service
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 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. $40 copay for each specialist visit for Medicare-covered benefits.
UNIVERSAL HEALTH CARE INSURANCE COMPANY INC.	Any Any Any Gold MA Only (PFFS) (H5820-026)	Private Fee for Service
Premium and Other Important Information UNIVERSAL HEALTH CARE INSURANCE COMPANY INC. will reduce your monthly Medicare Part B premium by up to $ 10.00. $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. $15 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each specialist visit for Medicare-covered benefits.
Fidelis SecureCare of Texas Inc.	Fidelis Secure Comfort (HMO SNP) (H5980-005)	HMO
Premium and Other Important Information In 2012 the annual Part B deductible amount is $140. Contact the plan for services that apply. $6 700 out-of-pocket limit for Medicare-covered services. $625 plan coverage limit every year for Non-Medicare Supplemental benefits. Contact the plan for services that apply. $29.9 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. 20% of the cost for each specialist visit for Medicare-covered benefits.
Fidelis SecureCare of Texas Inc.	Fidelis Secure Comfort Plus (HMO SNP) (H5980-006)	HMO
Premium and Other Important Information $750 out-of-pocket limit for Medicare-covered services. $625 plan coverage limit every year for Non-Medicare Supplemental benefits. Contact the plan for services that apply. $98 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. $0 copay for each specialist doctor visit for Medicare-covered benefits.
Fidelis SecureCare of Texas Inc.	Fidelis Secure Independence (HMO SNP) (H5980-007)	HMO
Premium and Other Important Information $500 out-of-pocket limit for Medicare-covered services. $159 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. $0 copay for each specialist doctor visit for Medicare-covered benefits.
Fidelis SecureCare of Texas Inc.	Fidelis Secure Freedom (HMO SNP) (H5980-011)	HMO
Premium and Other Important Information In 2012 the annual Part B deductible amount is $140. Contact the plan for services that apply. $6 700 out-of-pocket limit for Medicare-covered services. $375 plan coverage limit every year for Non-Medicare Supplemental benefits. Contact the plan for services that apply. $29.9 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. $0 copay for each primary care doctor visit for Medicare-covered benefits. 20% of the cost for each specialist visit for Medicare-covered benefits.
Universal American Corp.	Today's Options Premier 200 (PFFS) (H6169-001)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $20.00 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. $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. $10 copay for each primary care doctor visit $40 copay for each specialist visit
Universal American Corp.	Today's Options Premier 400 (PFFS) (H6169-011)	Private Fee for Service
Premium and Other Important Information $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. $25 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. $30 copay for each primary care doctor visit $60 copay for each specialist visit
Universal American Corp.	Today's Options Premier 400 (PFFS) (H6169-013)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $50.00 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. $25 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. $30 copay for each primary care doctor visit $60 copay for each specialist visit
Universal American Corp.	Today's Options Premier 400 (PFFS) (H6169-015)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $84.00 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. $25 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. $30 copay for each primary care doctor visit $60 copay for each specialist visit
Universal American Corp.	Today's Options Premier 400 (PFFS) (H6169-016)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $40.00 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. $25 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. $30 copay for each primary care doctor visit $60 copay for each specialist visit
Universal American Corp.	Today's Options Premier Plus 250A (PFFS) (H6169-021)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $72 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. $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. $10 copay for each primary care doctor visit $40 copay for each specialist visit
Universal American Corp.	Today's Options Premier Plus 250A (PFFS) (H6169-024)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $147 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. $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. $10 copay for each primary care doctor visit $40 copay for each specialist visit
Universal American Corp.	Today's Options Premier Plus 450B (PFFS) (H6169-031)	Private Fee for Service
Premium and Other Important Information $6 700 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 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. $25 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. $30 copay for each primary care doctor visit $60 copay for each specialist visit
Universal American Corp.	Today's Options Premier Plus 450C (PFFS) (H6169-033)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $87 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. $25 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. $30 copay for each primary care doctor visit $60 copay for each specialist visit
Universal American Corp.	Today's Options Premier Plus 450C (PFFS) (H6169-035)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $121 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. $25 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. $30 copay for each primary care doctor visit $60 copay for each specialist visit
Universal American Corp.	Today's Options Premier Plus 450D (PFFS) (H6169-036)	Private Fee for Service
Premium and Other Important Information $6 700 out-of-pocket limit for Medicare-covered services. $101 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. $25 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. $30 copay for each primary care doctor visit $60 copay for each specialist visit
Universal American Corp.	Today's Options Premier 200 (PFFS) (H6169-051)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $80.00 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. $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. $10 copay for each primary care doctor visit $40 copay for each specialist visit
Universal American Corp.	Today's Options Premier 200 (PFFS) (H6169-052)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $120.00 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. $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. $10 copay for each primary care doctor visit $40 copay for each specialist visit
Universal American Corp.	Today's Options Premier 200 (PFFS) (H6169-053)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $85.00 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. $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. $10 copay for each primary care doctor visit $40 copay for each specialist visit
Universal American Corp.	Today's Options Premier Plus 250A (PFFS) (H6169-056)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $187 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. $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. $10 copay for each primary care doctor visit $40 copay for each specialist visit
Universal American Corp.	Today's Options Premier Plus 250A (PFFS) (H6169-057)	Private Fee for Service
Premium and Other Important Information $3 250 out-of-pocket limit for Medicare-covered services. $157 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. $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. $10 copay for each primary care doctor visit $40 copay for each specialist visit
Care N' Care Health Plan	Care N' Care Health Plan I (PPO) (H6328-001)	Local Preferred Provider Organization
Premium and Other Important Information Package: 1 - Dental Rider: $20 monthly premium in addition to your $75 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 and select Non-Medicare Supplemental Services. Contact plan for details regarding Non-Medicare Supplemental Services covered under this limit. $5 100 out-of-pocket limit for Medicare-covered services and select Non-Medicare Supplemental Services. Contact plan for details regarding Non-Medicare Supplemental Services covered under this limit. $75 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 $5 copay for each primary care doctor visit for Medicare-covered benefits. $5 to $30 copay for each in-area network urgent care Medicare-covered visit $15 copay for each specialist visit for Medicare-covered benefits. $20 copay for each primary care doctor visit $30 copay for each specialist visit
Care N' Care Health Plan	Care N' Care Health Plan II (PPO) (H6328-002)	Local Preferred Provider Organization
Premium and Other Important Information Package: 1 - Dental Rider: $20 monthly premium in addition to your $29 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental $3 100 out-of-pocket limit. All plan services included. $5 100 out-of-pocket limit. All plan services included. $29 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. $10 to $30 copay for each in-area network urgent care Medicare-covered visit $25 copay for each specialist visit for Medicare-covered benefits. $25 copay for each primary care doctor visit $35 copay for each specialist visit
Care N' Care Health Plan	Care N' Care Health Plan III (PPO) (H6328-003)	Local Preferred Provider Organization
Premium and Other Important Information Package: 1 - Dental Rider: $20 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 $3 400 out-of-pocket limit. All plan services included. $5 100 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 $15 copay for each primary care doctor visit for Medicare-covered benefits. $15 to $35 copay for each in-area network urgent care Medicare-covered visit $35 copay for each specialist visit for Medicare-covered benefits. $35 copay for each primary care doctor visit $45 copay for each specialist visit
Care N' Care Health Plan	Care N' Care Health Plan I MA-Only (PPO) (H6328-005)	Local Preferred Provider Organization
Premium and Other Important Information Package: 1 - Dental Rider: $20 monthly premium in addition to your $30 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental $3 000 out-of-pocket limit for Medicare-covered services and select Non-Medicare Supplemental Services. Contact plan for details regarding Non-Medicare Supplemental Services covered under this limit. $5 100 out-of-pocket limit for Medicare-covered services and select Non-Medicare Supplemental Services. Contact plan for details regarding Non-Medicare Supplemental Services covered under this limit. $30.00 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 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 $5 copay for each primary care doctor visit for Medicare-covered benefits. $5 to $30 copay for each in-area network urgent care Medicare-covered visit $15 copay for each specialist visit for Medicare-covered benefits. $20 copay for each primary care doctor visit $30 copay for each specialist visit
Care N' Care Health Plan	Care N' Care Health Plan II MA-Only (PPO) (H6328-006)	Local Preferred Provider Organization
Premium and Other Important Information Package: 1 - Dental Rider: $20 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 $3 400 out-of-pocket limit. All plan services included. $5 100 out-of-pocket limit. All plan services included. $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 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. $10 to $30 copay for each in-area network urgent care Medicare-covered visit $25 copay for each specialist visit for Medicare-covered benefits. $25 copay for each primary care doctor visit $35 copay for each specialist visit
Humana Insurance Company	HumanaChoice H6411-002 (PPO) (H6411-002)	Local Preferred Provider Organization
Premium and Other Important Information Package: 1 - MyOption Dental High PPO: Package: 2 - MyOption Dental Low PPO: $22 monthly premium in addition to your $21 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 $21 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental $1 500 plan coverage limit every year for these benefits. $1 000 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. $7 500 out-of-pocket limit for Medicare-covered services. $21 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. $30 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 Insurance Company	HumanaChoice H6411-008 (PPO) (H6411-008)	Local Preferred Provider Organization
Premium and Other Important Information Package: 1 - MyOption Enhanced Dental: $21 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 $3 400 out-of-pocket limit for Medicare-covered services. $500 annual deductible. Contact the plan for services that apply. $5 000 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 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. $30 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
Universal HMO of Texas Inc.	Texas Hassle-Free (HMO-POS) (H6642-001)	HMO with POS Option
Premium and Other Important Information Universal HMO of Texas Inc. will reduce your monthly Medicare Part B premium by up to $ 30.00. $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 Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal HMO of Texas Inc.	Texas Hassle-Free MA Only (HMO-POS) (H6642-004)	HMO with POS Option
Premium and Other Important Information Universal HMO of Texas Inc. will reduce your monthly Medicare Part B premium by up to $ 40.00. $3 400 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 Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal HMO of Texas Inc.	Texas Hassle-Free C-SNP (HMO-POS SNP) (H6642-007)	HMO with POS Option
Premium and Other Important Information Universal HMO of Texas Inc. will reduce your monthly Medicare Part B premium by up to $ 50.00. $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 Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each specialist visit for Medicare-covered benefits.
Universal HMO of Texas Inc.	Texas Hassle-Free D-SNP (HMO-POS SNP) (H6642-008)	HMO with POS Option
Premium and Other Important Information * Depending on your level of Medicaid eligibility you may not have any cost-sharing responsibility for original Medicare services ** Please consult with your plan about cost sharing when receiving services from out-of-network providers. $3 400 out-of-pocket limit for Medicare-covered services.* $29.9 monthly plan premium in addition to your monthly Medicare Part B premium.* Doctor Office Visits Authorization rules may apply. $0 copay for each primary care doctor visit for Medicare-covered benefits.* $0 copay for each specialist doctor visit for Medicare-covered benefits.*
Coventry Health Care	Advantra (PPO) (H7306-001)	Local Preferred Provider Organization
Premium and Other Important Information $3 400 out-of-pocket limit. All plan services included. $10 000 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 $10 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each in-area network urgent care Medicare-covered visit $40 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
Coventry Health Care	Advantra Total Care (PPO) (H7306-003)	Local Preferred Provider Organization
Premium and Other Important Information $3 200 out-of-pocket limit. All plan services included. $10 000 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 $5 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each in-area network urgent care Medicare-covered visit $40 copay for each specialist visit for Medicare-covered benefits. 25% of the cost for each primary care doctor visit 25% of the cost for each specialist visit
Molina Healthcare of Texas Inc.	Molina Medicare Options Plus (HMO SNP) (H7678-001)	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 Authorization rules may apply. $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.*
Molina Healthcare of Texas Inc.	Molina Medicare Options (HMO) (H7678-002)	HMO
Premium and Other Important Information $3 200 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. $25 copay for each in-area network urgent care Medicare-covered visit $20 copay for each specialist visit for Medicare-covered benefits.
HealthSpring Medicare Advantage PPO	HealthyAdvantage Preferred DFW (PPO) (H7787-001)	Local Preferred Provider Organization
Premium and Other Important Information $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. $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 Authorization rules may apply. $5 copay for each primary care doctor visit for Medicare-covered benefits. $25 copay for each in-area network urgent care Medicare-covered visit $30 copay for each specialist visit for Medicare-covered benefits. $40 copay for each primary care doctor visit $60 copay for each specialist visit
HealthSpring Medicare Advantage PPO	HealthyAdvantage (PPO) (H7787-002)	Local Preferred Provider Organization
Premium and Other Important Information HealthSpring Medicare Advantage PPO will reduce your monthly Medicare Part B premium by up to $ 75.00. $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. $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 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 Authorization rules may apply. $10 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. $40 copay for each primary care doctor visit $60 copay for each specialist visit
HealthSpring Medicare Advantage PPO	HealthyAdvantage Preferred (PPO) (H7787-004)	Local Preferred Provider Organization
Premium and Other Important Information $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. $35 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 Authorization rules may apply. $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. $40 copay for each primary care doctor visit $60 copay for each specialist visit
Universal Health Care Insurance Company Inc.	Any Any Any Gold (PFFS) (H8098-001)	Private Fee for Service
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 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. $40 copay for each specialist visit for Medicare-covered benefits. $15 copay for each primary care doctor visit $40 copay for each specialist visit
Universal Health Care Insurance Company Inc.	Any Any Any Gold MA Only (PFFS) (H8098-003)	Private Fee for Service
Premium and Other Important Information Universal Health Care Insurance Company Inc. will reduce your monthly Medicare Part B premium by up to $ 15.00. $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. $15 copay for each primary care doctor visit for Medicare-covered benefits. $40 copay for each specialist visit for Medicare-covered benefits. $15 copay for each primary care doctor visit $40 copay for each specialist visit
Humana Insurance Company	Humana Gold Choice H8145-078 (PFFS) (H8145-078)	Private Fee for Service
Premium and Other Important Information $5 000 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 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
Humana Insurance Company	Humana Gold Choice H8145-084 (PFFS) (H8145-084)	Private Fee for Service
Premium and Other Important Information Package: 1 - MyOption Dental High PPO: Package: 2 - MyOption Dental Low PPO: $22 monthly premium in addition to your $79 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 $79 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental $1 500 plan coverage limit every year for these benefits. $1 000 plan coverage limit every year for these benefits. $5 000 out-of-pocket limit for Medicare-covered services. $79 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. $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. $10 copay for each primary care doctor visit $35 copay for each specialist visit
Humana Insurance Company	Humana Gold Choice H8145-126 (PFFS) (H8145-126)	Private Fee for Service
Premium and Other Important Information Package: 1 - MyOption Dental High PPO: Package: 2 - MyOption Dental Low PPO: $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 $14 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 $1 500 plan coverage limit every year for these benefits. $1 000 plan coverage limit every year for these benefits. $5 000 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. $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. $10 copay for each primary care doctor visit $35 copay for each specialist visit
Humana Insurance Company	Humana Gold Choice H8145-131 (PFFS) (H8145-131)	Private Fee for Service
Premium and Other Important Information $5 000 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. $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
Molina Healthcare of New Mexico Inc.	Molina Medicare Options (HMO) (H9082-002)	HMO
Premium and Other Important Information $2 800 out-of-pocket limit for Medicare-covered services. $16 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 $20 copay for each specialist visit for Medicare-covered benefits.
La Paloma	La Paloma - Dual (PACE) (H9998-001)	National PACE

La Paloma	La Paloma - Medicare only (PACE) (H9998-002)	National PACE

Medicare Advantage Plans in Mcallen, Texas

Medicare Advantage Health Plans in the city of Mcallen

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