Medicare Advantage Part C Medicare Health Plans in Virginia
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1 Medicare Advantage Part C 2016 Medicare Plans in Virginia Source - U.S. Department of and Human Services Center for Medicare & Medicaid Services CMS Publication No September 2015
2 Ul o\ This chart provides basic information about what your costs will be in each plan. See pages 154 and 155 for information on how to read this chart. Contact the plan for specific details, and ask if it's currently accepting new members. Medicare.gov, or call MEDICARE ( ) to compare plans or look for a plan that isn't listed. TTY users should call See pages for a list of things to consider when choosing a plan or to learn how to get personalized help with your choices. Service Area * Aetna Medicare (113931)/ He lalth Maintenanc e Organizi ation m m Memb( srs' Rating of Plan: 83% 1 Aetna Medicare Connect Plus (HMO) (111) Phone: Richmond, Danville and Tidewater Virginia $188 $4,500 $o $15 $0 $0 Aetna Medicare Innov ration Prime Plan (HMO) (096) Phone: Fairfax County and Surrounding Area $55 $6,700 $10 $40 $0 Aetna Medicare Selec :t Plan (HMO) (098) Phone: Richmond and Surrounding Area $0 Aetna Medicare Select Plan (HMO) (099) Phone: Danville and Surrounding Area ' $150 some $6,300 $5 $40 $0 $0 $28 $6,300 $5 $40 $0 $0 Aetna Medicare Select Plan (HMO) (100) Phone: Newport News and Surrounding Area $0 $6,300 $5 $40 $0 $0 $0 - $47-50% $0 - $6 amedicare.com $4-$45 29% - 50% $4-$47-50% $4 - $47-50% $4 - $47-50% Contact the plan for specific formulary (list of drags) and cost information.
3 IJLllUllilclLlUIl. Service Area * less than the amounts listed in these columns. * If you qualify for Extra Help, your monthly premium and the amount you pay for each prescription may be Contact the plan for specific formulary (list of drugs) and cost information. 0)
4 Service Area * Anthem Blue Cros s and Blue Shield (H4909) / Preferred Provider ( )rganizatio n " _ Membi jrs' Rating of Plan: 86% Anthem MediBlue Access (PPO) (014) Phone: Mathews County $66 $4,500/ $8,500 $10/ $30 $30/ $50 Anthem Ke epers (H34 147) / Mail itenance ( )rganizatin Anthem MediBlue Local (HMO) (001) Phone: f'y 1 "-fy"\fl $120 some $0 - $100 if Membi ers' Rating of Plan: 83% Richmond Metropolitan and South of Richmond Area $0 $3,400 $o $0 - $30 $0 0% - $o Anthem MediBlue Smart Fit (HMO) (005) Phone: $0 - $95 $0-$ Richmond Metropolitan and South of Richmond Area $0 $5,000 $10 $0 - $35 $0 0% - $0. $5 - $95 Erickson Advanta ge (H5652) 1 Mainte nance Org anization lfjjljj B^ IlllllBi Memb ers' Rating of Plan: 86% Erickson Advantage Freedom (HMO-POS) (006) Phone: Erickson Campuses - CO, KS, MA, MD, Ml, NJ, PA, TX, VA $49 $3,400 $20 $50 $0 $0 Erickson Advantage Signature with (HMO-POS) (001) Phone: Erickson Campuses - CO, KS, MA, MD, Ml, NJ, PA, TX, VA $190 $5,000 $0 $35 10% 10% $0 $0 Erickson Advantage Signature without (HMO-POS) (002) Phone: $5 - $85 $5 - $85 Erickson Campuses - CO, KS, MA, MD, Ml, NJ, PA, TX, VA $149 $5,000 $0 $35 10% 10% $0 Contact the plan for specific formulary (list of drugs) and cost information.
5 * Humana PI an. Inc. (HI 2012) / Ma lintenance Organizal inn IOn Membf >rs' Rating of Plan: 83% Humana Gold Plus H (HMO) (008) Phone: Richmond Metro Area $23 $4,900 $10 $45 $0 Humana Gold Plus H (HK 10) (015) Phone: Select VA Counties in the Tri-Cities Area $99 $5,900 $5 $10-$30 $0 Humana Gold Plus H (Hl\ /lo) (016) Phone: Select VA Counties in the Tri-Cities Area $29 $5,900 $5 $10-$35 $0 Humana Gold Plus H (HMO) (029) Phone: Tidewater area $23 $4,900 $10 $45 $0 Humana Gold Plus H (HMO) (055) Phone: Charlottesville Metro Area $34 $6,700 $15 $45 $0 Humana Gold Plus H (HMO) (087) Phone: Northern Virginia area $45 $6,700 $10 $45 $0 Humana Gold Plus H2 > (HI VIO) (101-1) Phone: Roanoke Metro Area $17 $6,700 $15 $45 $0 $200 some $320 some -medicare.com - 58% i-medicare.com $5 - $97 28% $5 - $97. 28%-58% j-medicare.com $6 - $97 $6 - $97-58% a-medicare.com - 58% a-medicare.com - 58% a-medicare.com ' - 58% a-medicare.com - 58% Contact the plan for specific formulary (list of drugs) and cost information. Ui 0\ n
6 1? HumanaHealtnPi IS?. an. Inc. (H * * 2012) / M< nntenance JllitiXsSSSSii, ft Memb ers' Rating of Plan: 83% Humana Gold Plus H (HMO) (101-2) Phone: Roanoke Metro Area $27 $6,700 $15 $45 Humana Gold Choice H (PFFS) (078) Phone: Select Counties in Virginia VUBHW inmua Ml $0 $105 $6,700 $15 $45 $0 HumanaChoice H (PPO) (092) Phone: Select Counties in the Tri-Cities Area of Virginia $57 HumanaChoice H (PPO) (095) Phone: Northeast Virginia area $82 HumanaChoice H (PPO) (096) Phone: Northern Virginia area $68 HumanaChoice H (PPO) l (098) Phone: Richmond Metro Area $55 $15-$35/ $45/ $45/ $45/ %/ n awmpi VBBHHI n S9B8*eeiMMM( - 58% - 58% $5-$97 $5 - $97-58% - 58% - 58% - 58% Contact the plan for specific formulary (list of drugs) and cost information.
7 Contact the plan for specific formulary (list of drugs) and cost information. in o\
8 * Humana Insurant i Comparn f (H8145) / Privat e Fee-for-! Service Pis in lillill Memb ers' Rating of Plan: 84% Humana Gold Choice H PFFS) (091) Phone: Select Counties in Virginia $79 $6,700 Humana Gold Choice H PFFS) (108) Phone: Select Counties in Virginia $0 $6,700 $15-$40/ $15-$40/ $250 some $5-$100 $5-$100 and / or - 58% Humana Insurant! Company / (R5826) / Prefer red Provici ler Organi; ration lillill Iggill; ISlgli Memb ers' Rating of Plan: 84% HumanaChoice R (Regional PPO) (063) Phone: States of North Carolina and Virginia $0 $4,900/ $4,900 $10/ HumanaChoice R (Regional PPO) (079) Phone: States of North Carolina and Virginia $78 $15 - $95 $10-$35/ $15-$45/ $15-$95 $0 $9 - $99 $9- $99-58% Humana WIHealtl i Oroanizfl tinn Insurance C orn IH6622 i\ i Maintenan ra ;fsflll8isff ". V HMI IliiU Memhi ers' Ratinu of- Plan: 85% Organization ilililiu!lg lllt Humana Gold Plus H (HMO) (004) Phone: Richmond Metro Area $0 $4,900 $0 $40 $0 Humana Gold Plus H (HMO) (005) Phone: Tidewater area $0 $4,900 $0 $45 $0 $270 some $270 some $0 - $97 $0 - $97-58% $0 - $97 $0 - $97-58% Contact the plan for specific formulary (list of drugs) and cost information.
9 Kaiser Permanent e (H2150) Medicare Cost I 'Ian Kaiser Permanente Medicare Plus Basic w/d (AB) (Cost) (033) Phone: DC, MD,VA $19 $6,700 $35 $50 $0 - $50 $0 - $50 $0 Kaiser Permanente M edicare Plus Basic w/o D (AB) (Cost) (017) Phone: DC, MD,VA $0 $6,700 $35 $50 $0 - $50 $0 - $50 $0 Kaiser Permanente M edicare Plus High w/o D (AB) (Cost) (021) Phone: DC, MD, VA $85 $3,400 $10 $20 $0 - $47 $0 - $47 $0 Kaiser Permanente M edicare Plus High w/ (AB) (Cost) (002) Phone: * Membi >rs Rating $360 for all drugs DC, MD,VA $129 $3,400 $10 $20 $0 - $47 $0 - $47 $0 $0 Kaiser Permanente M edicare Plus Std w/o D (AB) (Cost) (022) Phone: DC, MD, VA $15 $5,500 $20 $40 $0 - $47 $0 - $47 $0 Kaiser Permanente M edicare Plus Std w/ (AB) (Cost) (009) Phone: DC, MD,VA $25 $5,500 $20 $40 $0 - $47 $0 - $47 $0 $0 Optima Medicare Basic (HMO) (0( )1) Phone: SHI iiiiisa isll HSU SSil Tidewater Virginia $29 $4,700 $0 $40 $0 $0 k p.org/medicare $0 -$100 $0 -$100 kp.org/medicare k p.org/medicare kp.org/medicare $0 - $20 I cp.org/medicare I cp.org/medicare 0% - 58% www,.optimahealt h.com/medicare $0 - $80 Contact the plan for specific formulary (list of drugs) and cost information.
10 * Optima Medicare (»l563fij iealth Maintenai itce Organi zation ' ' ilsis: P Ian too sm all for rating Optima Medicare Enhanced (HMO) (002) Phone: Tidewater Virginia $94 $6,700 $0 $35 $0 $0 $0 - $60 Piedmont Medica re Advant age (H1659) /Pre ferred Pro vider Orga inization Membi sirs' Rating of Plan: 83% Piedmont Select Medicare Option One (PPO) (001) Phone: Cities: LYH, BE Counties: AM, AP, BE, CA, CLT, HA, PE, PI $92 $5,500/ $30/ Piedmont Select Medicare Option Three (PPO) (003) Phone: Cities: LYH, BE Counties: AM, AP, BE, CA, CLT, HA, PE, PI $0 $35/ Piedmont Select Medicare Option Two (PPO) (002) Phone: Cities:LYH, BE Counties:AM, AP, BE, CA, CLT, HA, PE, PI $53 $5,750/ $25/ $50/ $45/ Unitedcare (H5253) / Maintena nee Organ» i IfMliIB SHHI AARP MedicareComplete Plan 1 (HMO) (047) Phone: Select counties in TN/ VA MM $0 $4,500 $0 $35 $0 AARP MedicareComplete Plan 2 (HMO) (048) Phone: Select counties in TN/ VA $o $0 $0 HiWH mmmsl $90 some $55 $3,400 $0 $25 $0 $0 $6 -$80 $10-$100 $8 - $95 wiywpsppi'pwi % Contact the plan for specific formulary (list of drugs) and cost information.
11 PartD PartD * Unitedcare (H5435) / Private Fee-for-S ervice Pla n 1111! Memb ers' Rating of Plan: 81% Unitedcare MedicareDirect Essential (PFFS) (001) Phone: Select counties nationwide $23 $6,700 $25 $50 $0 Unitedcare MedicareDirect Rx (PFFS) (024) Phone: Select counties nationwide $50 $6,700 $25 $50 $0 $270 some $2-$100 Unitedcare (H7187)/ _ Maintena nee Organ ization iiacilji Memb ers' Rating of Plan: 79% AARP MedicareComplete Plan 1 (HMO) (003) Phone: Richmond-Petersburg and Roanoke Metro areas $0 $6,700 $15 $40 $0 $210 some am*? 28% AARP MedicareComplete Plan 1 (HMO) (009) Phone: ' Newport News, Norfolk and Portsmouth counties $0 $6,700 $15 $40 $0 $240 some AARP MedicareComplete Plan 2 (HMO) (010) Phone: , Richmond-Petersburg and Roanoke Metro areas $49 $4,900 $0 $40 $0 AARP MedicareComplete Plan 2 (HMO) (011) Phone: Newport News, Norfolk and Portsmouth counties $49 $4,900 $0 $40 $0 $205 some $235 some 28% Contact the plan for specific formulary (list of drugs) and cost information. Ul
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