2014 Medicare Advantage Plans in Orange County California


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2014 Medicare Advantage Plans in Orange County California

There are 30 Medicare Advantage Plans available in Orange County CA from 17 health insurance providers and 21 Special Needs Plans available. 21 Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $2000 and the highest out of pocket is $6700. The highest rated plan available in Orange County received a 5 overall star rating from CMS and the lowest rated plan is 3 stars.

(Click the Plan Name for More Details)

Plan Name Type Premium C+D Part D
Deductible
Gap Max Out of Pocket Overall Rating
Return to Counties In California
AARP MedicareComplete SecureHorizons Essential (HMO)
(H0543-121)
Local HMO * $0 $4,900
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
(H0543-138)
Local HMO $0 $0 Some Generics $3,400
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
(H0543-153)
Local HMO $16.20 $310.00 No Gap Coverage $6,700
AARP MedicareComplete SecureHorizons Premier (HMO)
(H0543-004)
Local HMO $0 $0 No Gap Coverage $4,900
Aetna Medicare Select Plan (HMO)
(H0523-002)
Local HMO $0 $0 Few Generics $6,700
Aetna Medicare Value Plan (HMO)
(H0523-060)
Local HMO $0 $0 Many Generics $2,000
Anthem Medicare Preferred Standard (PPO)
(H8552-002)
Local PPO $100.00 $135.00 No Gap Coverage $4,500
Blue Cross Senior Secure Plan I (HMO)
(H0564-006)
Local HMO $0 $0 No Gap Coverage $5,000
Blue Shield 65 Plus (HMO)
(H0504-015)
Local HMO $0 $0 Many Generics $2,800
Blue Shield 65 Plus Choice Plan (HMO)
(H0504-021)
Local HMO $0 $0 Many Generics $2,000
Brand New Day Enhanced Drug Savings for So Cal (HMO)
(H0838-022)
Local HMO $0 $0 Many Generics $6,700
Brand New Day Extra Care (HMO)
(H0838-023)
Local HMO $28.10 $310.00 No Gap Coverage $6,700
Care1st AdvantageOptimum Plan (HMO)
(H5928-004)
Local HMO $0 $0 Many Generics $3,400
CareMore StartSmart Plus (HMO)
(H0544-007)
Local HMO $0 $0 No Gap Coverage $6,700
CareMore Value Plus (HMO)
(H0544-002)
Local HMO $0 $0 Many Generics, Few Brands $3,400
Central Health Medicare Plan (HMO)
(H5649-001)
Local HMO $0 $0 All Generics $3,400
Central Health Premier Plan (HMO)
(H5649-004)
Local HMO $28.10 $310.00 Many Generics $6,700
Citizens Choice Healthplan (HMO)
(H3815-001)
Local HMO $0 $0 No Gap Coverage $3,400
Coordinated Choice Plan (HMO)
(H5928-037)
Local HMO $26.30 $310.00 Few Generics $3,400
Easy Choice Best Plan (HMO)
(H5087-005)
Local HMO $0 $0 Many Generics $6,700
Easy Choice Plus Plan (HMO)
(H5087-002)
Local HMO $28.10 $310.00 Call plan for details $6,700
Golden State Medicare Health Plan, Golden (HMO)
(H2241-001)
Local HMO $0 $0 Many Generics, Few Brands $3,400 NA
Health Net Gold Select (HMO)
(H0562-101)
Local HMO $0 $0 Many Generics, Few Brands $2,200
Health Net Healthy Heart (HMO)
(H0562-100)
Local HMO $0 $0 Many Generics, Few Brands $3,400
Health Net Seniority Plus Ruby (HMO)
(H0562-099)
Local HMO $0 $0 Many Generics, Few Brands $3,400
Humana Gold Plus H0108-013 (HMO)
(H0108-013)
Local HMO $0 $0 Some Generics, Few Brands $3,400
Inter Valley Health Plan OC Preferred (HMO)
(H0545-013)
Local HMO $0 $0 Some Generics $3,400
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
(H0524-003)
Local HMO $0 $0 All Generics, Few Brands $5,900
SCAN Classic (HMO)
(H5425-007)
Local HMO $0 $0 Many Generics $3,400
SCAN Plus (HMO)
(H5425-037)
Local HMO $24.90 $310.00 No Gap Coverage $6,700

* Plan Type Indicates plan does not offer Part D drug coverage.



Medicare Special Needs Plans in Orange county California

Plan Name Type Consolidated Premium C+D Part D
Deductible
Gap Special Needs Type Overall Rating
Brand New Day Dementia with Enhanced Drug Benefits (HMO SNP)
(H0838- 028)
Local HMO $0 $0 Many Generics Chronic or Disabling Condition
Brand New Day Dementia with Extra Care (HMO SNP)
(H0838- 029)
Local HMO $28.10 $310.00 No Gap Coverage Chronic or Disabling Condition
Brand New Day Diabetes with Enhanced Drug Benefits (HMO SNP)
(H0838- 026)
Local HMO $0 $0 Many Generics Chronic or Disabling Condition
Brand New Day Diabetes with Extra Care (HMO SNP)
(H0838- 027)
Local HMO $28.10 $310.00 No Gap Coverage Chronic or Disabling Condition
Brand New Day Dual Coverage (HMO SNP)
(H0838- 024)
Local HMO $28.10 $310.00 No Gap Coverage Dual-Eligible
Brand New Day for Mental Illness (HMO SNP)
(H0838- 020)
Local HMO $28.10 $310.00 No Gap Coverage Chronic or Disabling Condition
Care1st TotalDual Plan (HMO SNP)
(H5928- 005)
Local HMO $21.90 $310.00 Few Generics Dual-Eligible
CareMore Breathe (HMO SNP)
(H0544- 014)
Local HMO $0 $0 Many Generics, Few Brands Chronic or Disabling Condition
CareMore ESRD (HMO SNP)
(H0544- 015)
Local HMO $0 $0 Many Generics, Few Brands Chronic or Disabling Condition
CareMore Heart (HMO SNP)
(H0544- 013)
Local HMO $0 $0 Many Generics, Few Brands Chronic or Disabling Condition
CareMore Reliance (HMO SNP)
(H0544- 004)
Local HMO $0 $0 Many Generics, Few Brands Chronic or Disabling Condition
CareMore Touch (HMO SNP)
(H0544- 005)
Local HMO $0 $0 Many Generics, Few Brands Institutional
Health Net Jade (HMO SNP)
(H0562- 092)
Local HMO $0 $0 Many Generics, Few Brands Chronic or Disabling Condition
Health Net Seniority Plus Amber I (HMO SNP)
(H0562- 055)
Local HMO $28.10 $310.00 No Gap Coverage Dual-Eligible
Health Net Seniority Plus Amber II (HMO SNP)
(H0562- 070)
Local HMO $28.10 $310.00 No Gap Coverage Dual-Eligible
Heart First (HMO SNP)
(H5425- 028)
Local HMO $0 $0 Many Generics, Few Brands Chronic or Disabling Condition
OneCare (HMO SNP)
(H5433- 001)
Local HMO $26.10 $0 No Gap Coverage Dual-Eligible
SCAN Balance (HMO SNP)
(H5425- 034)
Local HMO $0 $0 Many Generics, Few Brands Chronic or Disabling Condition
SCAN Healthy at Home (HMO SNP)
(H9104- 006)
Local HMO $0 $0 Many Generics Institutional
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
(H0524- 029)
Local HMO $14.40 $0 No Gap Coverage Dual-Eligible
VillageHealth (HMO SNP)
(H5943- 002)
Local HMO $28.10 $310.00 No Gap Coverage Chronic or Disabling ConditionNA


Source: CMS.

Plans as of September 3, 2013.

Plans are subject to change as contracts are finalized.

Includes 2014 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.



Plan Type Is the type of organization offering the Medicare Plans.

  • HMO - Health Maintenance Organization
  • PPO - Preferred Provider Organization
  • PDP - Prescrition Drug Plan
  • SNP - Special Needs Plan
  • POS - Point of Service
  • PFFS - Private Fee For Service

Monthly Consolidated Premium (Includes Part C + D) Your premium may be lower depending on your eligibility for medical assistance. Call your plan for details.

Part D Total Premium: The Part D Total Premium is the sum of the Basic and Supplemental Premiums. Note: the Part D Total Premium is net of any Part A/B rebates applied to "buy down" the drug premium for Medicare Advantage plans; for some plans the total premium may be lower than the sum of the basic and supplemental premiums due to negative basic or supplemental premiums.

Benefit Type

Enhanced Alternative plans may offer additional gap coverage which is calculated as the percentage of “generic” formulary products with coverage above standard "generic" coverage gap cost-sharing benefit and/or the percentage of “brand” formulary products covered in addition to the coverage gap discount for applicable drugs.

GAP

Coverage gap ("donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs. (Unless you get the low-income subsidy) Once you reach the coverage gap in 2014, you will pay 47.5% of the plan's cost for covered brand-name prescription drugs. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail.

Additional gap coverage levels are determined separately for formulary generic and brand products and are described as follows:

  • All: 100% of formulary drugs are covered through the gap
  • Many: 65% to 100% of formulary drugs are covered through the gap
  • Some: 10% to 65 % of formulary drugs are covered through the gap
  • Few: 0% to 10% of formulary drugs are covered through the gap (and must also be >15 "brand" products covered through the gap)
  • No Gap Coverage: 0% of formulary drugs are covered through the gap (or 15 "brand" products covered through the gap)
  • All Formulary Drugs: cover 100% of “generic” and 100% of “brand” products (either by covering all formulary drug products in the gap or by having no initial coverage limit)

Maximum Out-of-Pocket (MOOP) limit on enrollee spending that includes costs for all in-network Part A and Part B Services. NOT Part D - prescription drugs. N/A is defined as Not Applicable