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Wisconsin MedicareAdvantage Plans

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Medicare Advantage Plans in Milwaukee County, Wisconsin

Below are Medicare Advantage plans available to residents of Milwaukee county, Wisconsin. 9 carriers offer 24 plans throughout the county of Milwaukee. Residents may choose plans from carriers such as Community Care, iCare and Anthem Blue Cross and Blue Shield. 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 Milwaukee county that is right for you complete the form at the top of the page.

Medicare Advantage Health Plans in the county of Milwaukee

Carrier Plan Title Plan Type
Community Care Community Care's Partnership Program Disabled (HMO SNP) (H2034-002) 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
    • $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.*
    iCare iCare Medicare Plan (HMO SNP) (H2237-001) 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.
      • $6 700 out-of-pocket limit for Medicare-covered services.*
      • $36.7 monthly plan premium in addition to your monthly Medicare Part B premium.*

      Doctor Office Visits

      • 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 in-area network urgent care Medicare-covered visit*
      • 0% or 0% to 20% of the cost for each specialist visit for Medicare-covered benefits.*
      iCare iCare Family Care Partnership (HMO SNP) (H2237-007) 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.*
        Anthem Blue Cross and Blue Shield Anthem Medicare Preferred Select (PPO) (H4036-003) Local Preferred Provider Organization

          Premium and Other Important Information

          • Package: 1 - Preventive Dental Package:
          • Package: 2 - Comprehensive Dental and Vision Package:
          • Package: 3 - Combination Package:
          • $12 monthly premium in addition to your $36 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental
          • $30 monthly premium in addition to your $36 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental Eye Exams Eye Wear
          • $43 monthly premium in addition to your $36 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Chiropractic Services Acupuncture Preventive Dental Compre
          • $3 400 out-of-pocket limit. All plan services included.
          • $36 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.
          • $20 copay for each in-area network urgent care Medicare-covered visit
          • $20 copay for each specialist visit for Medicare-covered benefits.
          • $15 to $20 copay for each primary care doctor visit
          • $30 copay for each specialist visit
          Anthem Blue Cross and Blue Shield Anthem Medicare Preferred Core (PPO) (H4036-004) Local Preferred Provider Organization

            Premium and Other Important Information

            • Package: 1 - Preventive Dental Package:
            • Package: 2 - Comprehensive Dental and Vision Package:
            • Package: 3 - Combination Package:
            • $12 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental
            • $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 Eye Exams Eye Wear
            • $43 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Chiropractic Services Acupuncture Preventive Dental Compreh
            • $4 500 out-of-pocket limit. All plan services included.
            • $0 monthly plan premium in addition to your monthly Medicare Part B premium.
            • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
            • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

            Doctor Office Visits

            • $0 copay for each primary care doctor visit for Medicare-covered benefits.
            • $45 copay for each in-area network urgent care Medicare-covered visit
            • $45 copay for each specialist visit for Medicare-covered benefits.
            • $35 to $45 copay for each primary care doctor visit
            • $50 copay for each specialist visit
            UnitedHealthcare Community Plan UnitedHealthcare Dual Complete (HMO SNP) (H4837-001) 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.
              • $6 700 out-of-pocket limit for Medicare-covered services.*
              • $0 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.*
              Community Care Community Care's Partnership Program (HMO SNP) (H5207-001) 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

                • $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.*
                Community Care Community Care's PACE Program (PACE) (H5212-001) National PACE
                  Community Care Community Care's PACE Program (PACE) (H5212-002) National PACE
                    Humana Insurance Company HumanaChoice H5216-001 (PPO) (H5216-001) Local Preferred Provider Organization

                      Premium and Other Important Information

                      • Package: 1 - MyOption Vision:
                      • Package: 2 - MyOption Enhanced Dental:
                      • $15 monthly premium in addition to your $67 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Eye Exams Eye Wear
                      • $29 monthly premium in addition to your $67 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                      • $290 plan coverage limit every year for these benefits.
                      • $4 500 out-of-pocket limit for Medicare-covered services.
                      • $6 000 out-of-pocket limit for Medicare-covered services.
                      • $67 monthly plan premium in addition to your monthly Medicare Part B premium.
                      • Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married co
                      • Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept

                      Doctor Office Visits

                      • $10 copay for each primary care doctor visit for Medicare-covered benefits.
                      • $35 copay for each in-area network urgent care Medicare-covered visit
                      • $35 copay for each specialist visit for Medicare-covered benefits.
                      • $40 copay for each primary care doctor visit
                      • $40 copay for each specialist visit
                      UnitedHealthcare AARP MedicareComplete Plus (HMO-POS) (H5253-004) HMO with POS Option

                        Premium and Other Important Information

                        • Package: 1 - Deluxe Rider:
                        • $38 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
                        • $4 450 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

                        • $20 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.
                        UnitedHealthcare UnitedHealthcare Nursing Home Plan (HMO-POS SNP) (H5253-007) HMO with POS Option

                          Premium and Other Important Information

                          • $5 000 out-of-pocket limit for Medicare-covered services.
                          • $35.3 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

                          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 AARP MedicareComplete Plus Essential (HMO-POS) (H5253-021) HMO with POS Option

                            Premium and Other Important Information

                            • Package: 1 - Deluxe Rider:
                            • Package: 2 - Fitness Rider:
                            • $38 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
                            • $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
                            • $3 950 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

                            • $20 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.
                            UnitedHealthcare UnitedHealthcare Dual Complete LP (HMO SNP) (H5253-024) HMO

                              Premium and Other Important Information

                              • * Depending on your level of Medicaid eligibility you may not have any cost-sharing responsibility for original Medicare services
                              • In 2012 the annual Part B deductible amount is $0 or $140 .* Contact the plan for services that apply.
                              • ** Please consult with your plan about cost sharing when receiving services from out-of-network providers.
                              • $6 700 out-of-pocket limit for Medicare-covered services.*
                              • $36.7 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.*
                              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 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 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) (H6169-053) 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) (H6169-057) 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
                                          Humana WisconsinHealth Organization Insurance Corp Humana Gold Plus H6622-002 (HMO-POS) (H6622-002) HMO with POS Option

                                            Premium and Other Important Information

                                            • Package: 1 - MyOption Vision:
                                            • Package: 2 - MyOption Enhanced Dental HMO:
                                            • $15 monthly premium in addition to your $19 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Eye Exams Eye Wear
                                            • $35 monthly premium in addition to your $19 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                                            • $290 plan coverage limit every year for these benefits.
                                            • $3 400 out-of-pocket limit for Medicare-covered services.
                                            • $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

                                            Doctor Office Visits

                                            • Authorization rules may apply.
                                            • $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 [or 20% of the cost] for each specialist visit for Medicare-covered benefits.
                                            Humana Insurance Company Humana Gold Choice H8145-110 (PFFS) (H8145-110) 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:
                                              • $31 monthly premium in addition to your $109 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                                              • $19 monthly premium in addition to your $109 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 $109 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Eye Exams Eye Wear
                                              • $30 monthly premium in addition to your $109 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.
                                              • $6 700 out-of-pocket limit for Medicare-covered services.
                                              • $109 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 H8145-121 (PFFS) (H8145-121) Private Fee for Service

                                                Premium and Other Important Information

                                                • Package: 1 - MyOption Dental High PPO:
                                                • Package: 2 - MyOption Dental Low PPO:
                                                • $31 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: Preventive Dental Comprehensive Dental
                                                • $19 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.
                                                • 15% of the cost for each primary care doctor visit for Medicare-covered benefits.
                                                • 15% of the cost for each in-area network urgent care Medicare-covered visit
                                                • 15% 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
                                                Advantage by Managed Health Services Advantage by Managed Health Services (HMO SNP) (H8189-001) 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.*

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