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Texas MedicareAdvantage Plans

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Medicare Advantage Plans in Tarrant County, Texas

Below are Medicare Advantage plans available to residents of Tarrant county, Texas. 17 carriers offer 50 plans throughout the county of Tarrant. Residents may choose plans from carriers such as Care Improvement Plus, WellCare and Bravo Health. 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 Tarrant county that is right for you complete the form at the top of the page.

Medicare Advantage Health Plans in the county of Tarrant

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**
          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) (H1264-014) 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 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 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 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
                          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 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
                              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 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.
                                    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 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 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.
                                            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 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.
                                                  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
                                                      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.
                                                          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.
                                                              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.
                                                                      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
                                                                                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
                                                                                          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
                                                                                              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 H8145-084 (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

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