Addendum to "2009 Guide to Health Insurance for People With Medicare"

DEVAL L. PATRICK GOVERNOR TIMOTHY P. MURRAY LIEUTENANT GOVERNOR COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation DIVISION OF INSURANCE One South Station • Boston, MA 02110-2208 (617) 521-7794 • FAX (617) 521-7475 TTY/TDD (617) 521-7490 http://www.mass.gov/doi DANIEL O'CONNELL SECRETARY OF HOUSING AND ECONOMIC DEVELOPMENT DANIEL C. CRANE DIRECTOR NONNIE S. BURNES COMMISSIONER OF INSURANCE # Bulletin 2009-03 TO: Commercial Health Insurers, Blue Cross and Blue Shield of Massachusetts, Inc., and Health Maintenance Organizations FROM: Nonnie S. Burnes, Commissioner of Insurance DATE: January 15, 2009 RE: Addendum to "2009 Guide to Health Insurance for People with Medicare" Attached please find a copy of the "Massachusetts Bulletin for People with Medicare." The Massachusetts Bulletin must be provided along with the "2009 Guide to Health Insurance for People with Medicare" to those people eligible for Medicare pursuant to Massachusetts regulations 211 CMR 42.09(4) and 211 CMR 71.13(2)(d)4. Questions regarding this bulletin may be directed to Nancy Schwartz, Director, Bureau of Managed Care at the Division of Insurance at (617) 521-7347.  # The Commonwealth of Massachusetts # Executive Office of Elder Affairs # One Ashburton Place, Boston, MA 02108 DEVAL L. PATRICK Governor TIMOTHY P. MURRAY Lieutenant Governor MICHAEL E. FESTA, ESQ. Secretary SANDRA K. ALBRIGHT Undersecretary Tel : (617) 727-7750 Fax: (617) 727-9368 TTY/TTD 1-800-872-016 www.ma.gov/elder ## Massachusetts Bulletin for People with Medicare Medicare beneficiaries of all ages have choices for getting health and prescription drug coverage. Major health insurance choices include: - Original Medicare(Parts A and B) - Original Medicare +Medicare Supplement Insurance(Medigap) - Medicare Advantage Plans (Medicare Part C) - Medicare Prescription Drug Coverage (Medicare Part D) - Prescription Advantage (the state prescription drug assistance program) - Employer or Union Health Coverage (including retiree health plans) - MassHealth (Medicaid) ( for people with limited income and resources) - Senior Care Options (SCO) (an option for people with MassHealth) - PACE (Program of All-inclusive Care for the Elderly) - Veterans Health Benefits - Military Benefits(TRICARE) This Bulletin provides basic information about some of the programs listed above and programs that help people with limited income and resources pay for their health care costs. If you have employer, union, retiree or other group health coverage, contact the benefits administrator of your health plan for information about coverage and other questions. If you are a veteran, contact your local veterans agent for information about veterans health care services and TRICARE. SHINE Bulletin January 2009 THE SHINE PROGRAM Serving the Health Information Needs of Elders ELDER EXECUTIVE OFFICE OF AFFAIRS Promoting Your Independence ship state health insurance assistance programs LOCAL HELP FOR PEOPLE WITH MEDICARE 1 ## Medicare Medicare is health insurance that helps pay many health care services and supplies to people: - age 65 or older, - under age 65 with certain disabilities, and - any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) Medicare has four parts: - Medicare Part A (Hospital) helps cover inpatient care in hospitals, skilled nursing facilities, hospice care, home health care and other services. - Medicare Part B (Medical) helps cover out-patient medically-necessary services like doctor's services, outpatient care, some preventive services, x-rays, tests, physical, occupational and speech therapy, ambulance service, medical supplies and equipment. - Medicare Part C (Medicare Advantage Plans) are sold by private insurers. Medicare Advantage Plans cover Part A and Part B and other services. Some plans include Medicare prescription drug coverage (Part D). See details below. - Medicare Part D (Medicare Prescription Drug Coverage) helps pay for outpatient prescription drugs. ## Medicare Options There are two ways to get Medicare health coverage: 1. Original Medicare covers Part A and Part B services. You can go to any doctor, hospital or other provider that accepts Medicare. Original Medicare is managed directly by Medicare. People who choose Original Medicare may purchase Medicare Supplement Insurance (Medigap) to cover out-of-pocket costs (gaps) in Original Medicare. If you want prescription drug coverage, you must choose and join a Medicare Prescription Drug Plan 2. Medicare Advantage Plans (Part C) Medicare Advantage Plans include both Part A and Part B and may cover extra services not covered by Medicare such as vision, hearing, dental, health and wellness programs. You must have Medicare Part A and Part B and pay the Part B premium. In addition, You usually pay the plan monthly premium, copayments, coinsurance and deductibles. Costs, extra benefits and rules vary by plan. SHINE Bulletin January 2009 THE SHINE PROGRAM Serving the Health Information Needs of Elders ELDER EXECUTIVE AFFAIRS OFFICE OF AFFAIRS Promoting Your Independence ship State health insurance assistance programs AFFILIATED LOCAL HELP FOR PEOPLE WITH MEDICARE 2 There are five different types of Medicare Advantage Plans(MAP): - Preferred Provider Organization (PPO) Plan - Medicare Health Maintenance Organization (HMO) Plan - Private Fee-For-Service (PFFS) Plan - Medical Savings Account (MSA) Plan - Special Needs Plan (SNP) Medicare Advantage insurance is not Medicare Supplement Insurance (Medigap). You do not need to buy (or can't buy) a Medigap policy to cover Medicare Advantage Plan out-of-pocket costs. ### Medicare Prescription Drug Coverage (Medicare Part D) Medicare offers prescription drug coverage (Part D) to help pay for prescription drug costs for people with Medicare. Medicare prescription drug plans are sold by private companies approved by Medicare. Most Medicare Advantage Plans offer prescription drug coverage (Part D) usually for an extra cost. People with Medicare who do not join a Medicare prescription drug plan when first eligible, may have to pay a late enrollment penalty (higher premiums). People with limited income and resources, may be eligible for extra help to pay for Medicare drug plan costs. Medicare Advantage Plans (Part C) and prescription drug plans (Part D) benefits, formularies, premiums, copayments, coinsurance and rules etc. vary from company to company and from plan to plan. Medicare enrollees should examine, compare and choose the plan that best works with their health care needs. For detailed information or help choosing a Medicare health plan or prescription drug coverage contact your regional SHINE office at 1-800-AGE-INFO(1-800-243-4636) press 2 (TTY 1-800-872-1066) or call 1-800-Medicare (1-800-633-4227) or visit www.medicare.gov SHINE Bulletin January 2009 THE SHINE PROGRAM Serving the Health Information Needs of Elders ELDER EXECUTIVE OFFICE OF AFFAIRS Promoting Your Independence ship state health insurance assistance programs EST 1978 LOCAL HELP FOR PEOPLE WITH MEDICARE 3 # Medicare Supplement Insurance ("Medigap") A Medigap policy is a health insurance policy sold by private insurance companies to individuals enrolled in the Original Medicare Plan to cover the “gaps” in the Original Medicare Plan. Some Medigap policies also cover benefits that the Original Medicare Plan does not cover. Two standard Medigap policies are offered to Massachusetts residents: - Medicare Supplement Core - Medicare Supplement 1 In compliance with Federal regulations, Medicare Supplement 2 which includes prescription drug coverage cannot be sold after December 31, 2005; however, existing members can remain enrolled in Supplement 2 and continue their prescription coverage. Medicare Supplement Insurance is regulated by federal and state laws - The Medigap policy must clearly define it as “Medicare Supplement Insurance”. Coverage and text is standard for all insurers. - Medigap policies are guaranteed renewable and cannot be cancelled unless the beneficiary stops paying the premium or provides false information on the application. - Medigap insurers cannot refuse to sell a policy, exclude or limit coverage, or require a waiting period before coverage starts due to existing health problems. - Medigap insurers must offer the same premium (a “community rate”) to all policyholders and cannot charge a different premium based on age or health. The Massachusetts Division of Insurance monitors insurance companies authorized to sell insurance in Massachusetts. For information and counseling about Medigap, contact your regional SHINE office at 1-800-AGE-INFO-(1-800-243-4636) (TTY: 1-800-872-0166). For general information visit www.state.ma.us/doi or call the Massachusetts Division of Insurance at 617-521-7794 (Boston), 413-7785-5526 (Springfield) (TTY: 617-521-7490). SHINE Bulletin January 2009 THE SHINE PROGRAM Serving the Health Information Needs of Elders ELDER EXECUTIVE OFFICE OF AFFAIRS Promoting Your Independence ship state health insurance assistance programs LOCAL HELP FOR PEOPLE WITH MEDICARE 4 # Prescription Advantage (State Pharmacy Assistance Program-SPAP) Prescription Advantage is a State Pharmacy Assistance Program for seniors and people with disabilities. Prescription Advantage is administered by the Commonwealth of Massachusetts Executive Office of Elder Affairs. Prescription Advantage is available to Massachusetts residents who are not receiving prescription drug coverage from MassHealth/Medicaid and who are: - Age 65 or older; and enrolled in a Medicare prescription drug plan (Medicare Part D) or other creditable coverage and must not have a gross household income exceeding 500% of the Federal Poverty Level(FPL). - Under age 65, have a qualified disability, work no more than 40 hours per month, and meet Prescription Advantage income requirements. ## Prescription Advantage benefits: ### For people eligible for Medicare... Prescription Advantage provides supplemental coverage to Medicare prescription drug insurance (Part D). Based on household income, Prescription Advantage may help pay for the Medicare Part D monthly premium, deductible, copayments and provide coverage through the gap. Prescription Advantage also provides an out-of-pocket spending limit. ### People not eligible for Medicare... Prescription Advantage may offer you prescription drug coverage. This coverage has no premium. You will pay a co-payment and quarterly deductible for your prescriptions drugs and you will have an out-of pocket spending limit. Medicare beneficiaries of all ages who meet the eligibility requirements for Prescription Advantage may join at any time during the year. For detailed information about Prescription Advantage enrollment and eligibility call Prescription Advantage Customer Service 1-800-AGE-INFO (1-800-243-4636) press 2 (TTY: 1-800-610-0241) or visit ww800ageinfo.com SHINE Bulletin January 2009 THE SHINE PROGRAM Serving the Health Information Needs of Elders ELDER EXECUTIVE OFFICE OF AFFAIRS Promoting Your Independence ship state health insurance assistance programs LOCAL HELP FOR PEOPLE WITH MEDICARE 5 # Help for People with Limited Income and Resources ## MassHealth (Medicaid) MassHealth manages health insurance programs for elders, children, low income parents and adults with disabilities. MassHealth pays for all or part of health care costs for seniors and persons of any age needing long-term-care. Several of the programs are outlined below. MassHealth is a joint Federal and state program and is administered by the Massachusetts Executive Office of Health and Human Services. MassHealth Standard pays for a wide range of health-care benefits and is the only coverage that pays for long-term care services. You may enroll in Standard MassHealth if you are: - single and your income is not greater than 100%* of the Federal Poverty Level (FPL) and your assets do not exceed $2,000 - married and your combined marital income is not greater than 100%* of the FPL and your combined assets do not exceed $3,000. ## MassHealth Standard for people aged 65 or older who need personal care attendant (PCA) services You may enroll into Standard MassHealth if you are 65 or older and need PCA services if you are: - single and your income is not greater than 133%* of the FPL and your assets do not exceed $2,000. - married and your combined marital income is not greater than 133%* of the FPL and your combined assets do not exceed $3,000. ## PACE (Program for All-Inclusive Care for the Elderly) PACE combines medical, social, and long-term care services and prescription drug coverage for frail elderly and disabled people. Services are provided by PACE-authorized health centers. This program allows people who need nursing home-level care to remain in the community. The PACE program health-care program sponsored by the Centers for Medicare and Medicaid Services and the Commonwealth of Massachusetts Division of Medical Assistance. SHINE Bulletin January 2009 THE SHINE PROGRAM Serving the Health Information Needs of Elders ELDER EXECUTIVE OFFICE OF AFFAIRS Promoting Your Independence ship state health insurance assistance programs LOCAL HELP FOR PEOPLE WITH MEDICARE 6 ## Medicaid Waiver Program The Medicaid Waiver Program or Frail Elder Waiver Program is available through the Massachusetts Home Care Program. For more information about eligibility and to find out if you live in a designated service area call the MassHealth Enrollment Center at 800-408-1253 (TTY: 1-800-231-5698) ## SCO (Senior Care Options) MassHealth Senior Care Options (SCO) is a coordinated health plan that combines Medicare and Medicaid health care services with social support services to help elders maintain their health and live in the community as long as possible. SCO is also available to elders residing in long-term care facilities. SCO covers all of the services covered by MassHealth. Medicare services are also covered for people with Medicare. For more information call MassHealth Senior Care Options (SCO) at 1-888-885-0484 (TTY: 1-888-821-5225) or visit www.state.ma.us/masshealth ## "Extra Help" to pay for Prescription Drug Coverage (Part D) "Extra Help"(also called low-income subsidy) is available from Medicare to help pay prescription drug costs if the person's yearly income and resources are below certain limits (adjusted annually) and the person is enrolled in a Medicare prescription drug plan. "Extra Help" includes: - Help paying the Medicare drug plan monthly premium - Help paying the yearly deductible - Help paying coinsurance and copayments for prescription drugs that are on the person's plan formulary - Exclusion from the "no coverage gap" For more information and qualifications for "Extra Help" call Social Security at 1-800-772-1213 or visit www.socialsecurity.gov or contact your regional SHINE office at 1-800-AGE-INFO (1-800-243-4636) press 3 ## MassHealth Buy-In Programs MassHealth Buy-in Programs (also called Medicare Savings Programs) are federal programs that help pay for Medicare premiums, deductibles and copayments for Medicare beneficiaries with limited income and resources. For more information call at MassHealth 1-800-841-2900 SHINE Bulletin January 2009 THE SHINE PROGRAM Serving the Health Information Needs of Elders ELDER EXECUTIVE OFFICE OF AFFAIRS Promoting Your Independence ship state health insurance assistance programs LOCAL HELP FOR PEOPLE WITH MEDICARE 7 # Directory ## Massachusetts Elder Service Connections To directly connect with elder services in your area call 1-800-AGE-INFO(1-800-243-4636) press or say: - to connect to your local elder service agency or caregiver program 1 - to connect to Prescription Advantage-state prescription drug program 2 - to connect to your regional SHINE Program 3 - to report elder abuse, neglect or financial exploitation 4 - for all other matters 5 ## MassHealth Customer Service 1-800-841-2900 www.mass.gov/masshealth TTY: 800-497-4648 MassHealth provides a wide range of health care services that pay for all or part of the health care cost for elders with limited income and resources. Contact MassHealth for information about their health care programs including MassHealth Standard and Medicare Savings Programs. ## MassHealth Senior Care Options (SCO) 1-888-885-0484 www.mass.gov/masshealth. TTY: 1-888-821-5225 A health plan that combines Medicare and Medicaid services with social support services that helps seniors maintain their health and continue to live in their own homes. ## Massachusetts Division of Insurance Boston 617-521-7794 www.state.ma.us/doi Springfield 413-785-5526 TTY: 617-521-7490 DOI regulates insurance companies authorized to sell insurance in Massachusetts, reviews insurance contracts, forms and rates to ensure compliance with Massachusetts regulations, and investigates consumer complaints against insurance companies, brokers, agents and other licensees. ## Protective Services Elder Abuse Hotline 1-800-922-2275 Protective Services provide services to eliminate or alleviate abuse of elders. Community agencies and case workers coordinate and provide a variety of health, mental health, legal and social services. To report elder abuse, call the Elder Abuse Hotline 24-hours a day, 7 days a week. SHINE Bulletin January 2009    LOCAL HELP FOR PEOPLE WITH MEDICARE 8 # Office of the Massachusetts Attorney General Hotline 1-888-830-6277 www.ago.state.ma.us The Attorney General's Hotline staff answers questions and assists with consumer complaints for all types of insurance. The Attorney General's Office mediates problems and provides educational materials. # MassPRO (Heath Quality Improvement Organization) Helpline 1-800-252-5533 www.masspro.org MassPRO contracts with Medicare as a Quality Improvement Organization (QIO) that oversees and improves the care given to Medicare patients. MassPro processes appeals for Medicare patients and reviews Medicare beneficiary medical quality of care complaints. # Massachusetts Medicare Advocacy Project (MAP) 1-800-323-3205 MAP provides Medicare beneficiaries free legal advice and legal representation for appealing medical decisions made by Medicare providers in both fee-for-service Medicare and Medicare HMOs and for other insurance programs. # Medicare Helpline (24 hours a day, 7 days a week) 1-800-MEDICARE www.medicare.gov (1-800-633-4227) For help with questions about Medicare and to order Medicare publications # MassMedLine 1-866-633-1617 www.massmedline.com MassMedLine provides prescription medication information and help to Massachusetts residents applying for prescription drug assistance programs. MassMedLine is staffed by pharmacy professionals. MassMedLine is service of the Massachusetts College of Pharmacy and Sciences and the Massachusetts Executive Office of Elder Affairs. # Social Security Administration 1-800-772-1213 www.social security.gov Contact Social Security to enroll in Social Security, SSI, SSDI and Medicare, or to report a change in address or income, or to replace a lost Medicare card. # SHINE Health Insurance Counseling Program 1-800-AGE -INFO press 3 www.mass.gov (1-800-243-4636) SHINE provides free health insurance information, counseling, and assistance and Massachusetts residents with Medicare and their caregivers. SHINE Bulletin January 2009 THE SHINE PROGRAM Serving the Health Information Needs of Elders ELDER EXECUTIVE OFFICE OF AFFAIRS Promoting Your Independence ship state health insurance assistance programs LOCAL HELP FOR PEOPLE WITH MEDICARE 9 # Standard Medigap Plans Available in Massachusetts in 2009 | Comparison of Plans | Core | Supplement 1 | | --- | --- | --- | | **Basic Benefits Included In All Plans:** | | | | **Hospitalization Part A Co-payments** | | | | Days 61 - 90: $267 per day | X | X | | Days 91-150: $534 per day | X | X | | 365 Additional Lifetime Hospital days - Paid in full | X | X | | **Part B Coinsurance -** | | | | Coverage of coinsurance, in most cases, 20% of approved amount | X | X | | **Parts A and B Blood** First 3 pints | X | X | | Additional Benefits | Core | Supplement 1 | | **Part A Deductible for Hospital Days 1 - 60** | | X | | $1068 per benefit period | | | | **Skilled Nursing Facility Coinsurance** | | X | | Days 21-100 - $133.50 per day | | | | **Part B Annual Deductible - $135** | | X | | **Foreign Travel** - For Medicare-covered services needed while traveling abroad. | | X | | **Inpatient Days in Mental Health Hospitals** In addition to Medicare's coverage of 190 lifetime days and less any days previously covered by plan in same benefit period | 60 days per calendar year | 120 days per benefit period | January 2009 # Medicare Supplement Plans Offered in Massachusetts in 2009 | Medigap Carriers Please note that rates may change in 2009 | Medicare Supplement Core | Medicare Supplement 1 | | --- | --- | --- | | **Bankers Life and Casualty Company** 1-800-231-9150 to find an agent 1-800-621-3724 general information www.bankerslife.com (continuous open enrollment) | $97.47 Effective March 15, 2009 $114.84 | $191.38 Effective March 15, 2009 $207.56 | | **Blue Cross & Blue Shield of MA (Medex™)** 1-800-678-2265 sales/apps 1-800-258-2226 member services 1-800-522-1254 (TDD) www.bluecrossma.com (continuous open enrollment) | $86.30 | $162.97 | | **Humana Insurance Company** 1-800-872-7294 sales/apps 1-800-866-0581 member services 1-800-833-3301 (TDD) www.humana-medicare.com (continuous open enrollment) | $107.00 | $167.00 | | **United HealthCare™ Insurance Company** Only for members of AARP (American Association of Retired Persons) 1-800-523-5800 (continuous open enrollment) | $124.00 | $177.00 | January 2009 # Medicare Advantage Plans Offered in Massachusetts in 2009 | Company | Plan Name | Plan Type | Monthly Premium | Drugs | Doctor Choice | Counties | | --- | --- | --- | --- | --- | --- | --- | | AARP P.O. Box 459008 Sunrise, FL 33345 1-800-547-5514 | Medicare Complete Plus | HMO | $0.00 | Yes | Plan Doctors Only (some exceptions) | Middlesex Suffolk | | | Medicare Complete Choice | PPO | $0.00 | Yes | Any Doctor | Barnstable Berkshire Bristol Dukes Essex Franklin Hampden Hampshire Middlesex Nantucket Norfolk Plymouth Suffolk Worcester | | Advantra Freedom P.O. Box 690 Mahwah, NJ 07430 1-800-711-1607 | Freedom 1 | PFFS | $96.00 | No | Any Willing Doctor | Dukes Franklin Hampshire | | | Freedom 2 | PFFS | $0.00 | No | Any Willing Doctor | Dukes Franklin Hampshire | | | Freedom 2 | PFFS | $35.00 | No | Any Willing Doctor | Worcester | | | Freedom 3 | PFFS | $0.00 | No | Any Willing Doctor | Bristol Essex Hampden Middlesex Norfolk Plymouth Suffolk | | | Freedom 3 | PFFS | $23.00 | No | Any Willing Doctor | Worcester | | | Freedom 5 | PFFS | $34.00 | Yes | Any Willing Doctor | Bristol Essex Hampden Middlesex Norfolk Plymouth Suffolk | January 2009 | | Freedom 5 | PFFS | $0.00 | Yes | Any Willing Doctor | Dukes Franklin Hampshire | | --- | --- | --- | --- | --- | --- | --- | | | Freedom 5 Plus Gap | PFFS | $0.00 | Yes | Any Willing Doctor | Dukes Franklin Hampshire | | | Freedom 5 Plus OTC | PFFS | $27.00 | Yes | Any Willing Doctor | Bristol Essex Hampden Middlesex Norfolk Plymouth Suffolk | | | Advantra Savings Plan 1 or 3 | MSA | $0.00 | No | Any Doctor | Bristol Dukes Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk | | Aetna 151 Farmington Ave Hartford, CT 06156 1-800-455-1560 | Medicare Open Standard Plan | PFFS | $107.00 | No | Any Willing Doctor | Berkshire | | | Medicare Open Standard Plan w/ Rx | PFFS | $139.00 | Yes | Any Willing Doctor | Berkshire | | | Medicare Open Basic Plan | PFFS | $35.00 | No | Any Willing Doctor | Berkshire | | | Medicare Open Basic Plan w/Rx | PFFS | $62.00 | Yes | Any Willing Doctor | Berkshire | | Blue Cross Blue Shield of Massachusetts P. O. Box 9201 North Quincy, MA 02171 1-800-678-2265 | Blue Medicare PFFS PlusRx | PFFS | $40.00 | Yes | Any Willing Doctor | Barnstable Berkshire Bristol Dukes Essex Franklin Hampden Hampshire Middlesex Nantucket Norfolk Plymouth Suffolk Worcester | January 2009 | | Medicare HMO Blue PlusRx | HMO | $119.00 | Yes | Plan Doctors Only | Barnstable Bristol Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester | | --- | --- | --- | --- | --- | --- | --- | | | Medicare HMO Blue PremierRx | HMO | $173.00 | Yes | Plan Doctors Only | Barnstable Bristol Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester | | | Medicare PPO Blue PlusRx | PPO | $126.00 | Yes | Any Doctor | Barnstable Bristol Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester | | | Medicare PPO Blue PremierRx | PPO | $180.00 | Yes | Any Doctor | Barnstable Bristol Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester | January 2009 | CIGNA Medicare Access P.O. Box 696016 San Antonio, TX 78269 1-800-577-9409 | CIGNA Medicare Access Plan One | PFFS | $70.00 | No | Any Willing Doctor | Bristol Dukes Essex Middlesex Norfolk Plymouth Worcester | | --- | --- | --- | --- | --- | --- | --- | | | CIGNA Medicare Access Plan One | PFFS | $0.00 | No | Any Willing Doctor | Franklin Suffolk | | | CIGNA Medicare Access Plan One | PFFS | $40.00 | No | Any Willing Doctor | Hampden | | | CIGNA Medicare Access Plan One | PFFS | $20.00 | No | Any Willing Doctor | Hampshire | | | CIGNA Medicare Access Plus RX Plan Two | PFFS | $95.00 | Yes | Any Willing Doctor | Bristol Dukes Essex Middlesex Norfolk Plymouth Worcester | | | CIGNA Medicare Access Plus RX Plan Two | PFFS | $25.00 | Yes | Any Willing Doctor | Franklin Suffolk | | | CIGNA Medicare Access Plus RX Plan Two | PFFS | $65.00 | Yes | Any Willing Doctor | Hampden | | | CIGNA Medicare Access Plus RX Plan Two | PFFS | $45.00 | Yes | Any Willing Doctor | Hampshire | | | CIGNA Medicare Access Plan Three | PFFS | $125.00 | No | Any Willing Doctor | Bristol Dukes Essex Middlesex Norfolk Plymouth Worcester | | | CIGNA Medicare Access Plan Three | PFFS | $55.00 | No | Any Willing Doctor | Franklin Suffolk | | | CIGNA Medicare Access Plan Three | PFFS | $95.00 | No | Any Willing Doctor | Hampden | | | CIGNA Medicare Access Plan Three | PFFS | $75.00 | No | Any Willing Doctor | Hampshire | | | CIGNA Medicare Access Plus RX Plan Four | PFFS | $100.00 | Yes | Any Willing Doctor | Franklin Suffolk | January 2009 | | CIGNA Medicare Access Plus RX Plan Four | PFFS | $140.00 | Yes | Any Willing Doctor | Hampden | | --- | --- | --- | --- | --- | --- | --- | | | CIGNA Medicare Access Plus RX Plan Four | PFFS | $120.00 | Yes | Any Willing Doctor | Hampshire | | Evercare Health Plan 275 Grove Street Suite 3-120 Auburndale, MA 02466 1-888-834-3721 | Evercare Plan IP (institutional) | SNP | $30.70 | Yes | Any Doctor | Bristol Essex Hampden Middlesex Norfolk Plymouth Suffolk Worcester | | | Evercare Plan MP (chronic or disabling condition) | SNP | $0.00 | Yes | Any Doctor | Bristol Essex Hampden Middlesex Norfolk Plymouth Suffolk Worcester | | Fallon Community Health Plan One Chestnut Place 10 Chestnut Street Worcester, MA 01608 1-888-377-1980 | Fallon Senior Plan Plus | HMO | $132.00 | No | Plan Doctors Only | Franklin Hampden Middlesex Worcester | | | Fallon Senior Plan Plus Basic Rx | HMO | $160.00 | Yes | Plan Doctors Only | Franklin Hampden Middlesex Worcester | | | Fallon Senior Plan Plus Enhanced Rx | HMO | $160.00 | Yes | Plan Doctors Only | Franklin Hampden Middlesex Worcester | | | Fallon Senior Plan Preferred Enhanced Rx | PPO | $120.00 | Yes | Any Doctor | Franklin Middlesex Worcester | | | Fallon Senior Plan Saver | HMO | $0.00 | No | Plan Doctors Only | Franklin Hampden Middlesex Worcester | | | Fallon Senior Plan Saver Basic Rx | HMO | $28.00 | Yes | Plan Doctors Only | Franklin Hampden Middlesex Worcester | January 2009 | | Fallon Senior Plan Saver Enhanced Rx | HMO | $28.00 | Yes | Plan Doctors Only | Franklin Hampden Middlesex Worcester | | --- | --- | --- | --- | --- | --- | --- | | | Fallon Senior Plan Standard | HMO | $72.00 | No | Plan Doctors Only | Franklin Hampden Middlesex Worcester | | | Fallon Senior Plan Standard Basic Rx | HMO | $100.00 | Yes | Plan Doctors Only | Franklin Hampden Middlesex Worcester | | | Fallon Senior Plan Standard Enhanced Rx | HMO | $100.00 | Yes | Plan Doctors Only | Franklin Hampden Middlesex Worcester | | Fresenius Medical Care Health Plan 4888 Loop Central Drive, Suite 300 Houston, TX 77081 1-866-307-3625 | Fresenius Medical Care Health Plan | Demo SNP | $0.00 | No | Any Doctor | Barnstable Bristol Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester | | Harvard Pilgrim Health Care 93 Worcester Street Wellesley, MA 02481 1-800-779-7723 | Freedom - Drug | PFFS | $54.10 | Yes | Any Willing Doctor | Barnstable Dukes Franklin Hampden Hampshire | | | Freedom - Drug | PFFS | $73.40 | Yes | Any Willing Doctor | Bristol Plymouth | | | Freedom - Drug | PFFS | $54.90 | Yes | Any Willing Doctor | Essex Middlesex Norfolk Suffolk | | | Freedom – No Drug | PFFS | $29.20 | No | Any Willing Doctor | Barnstable Dukes Franklin Hampden Hampshire | | | Freedom – No Drug | PFFS | $97.70 | No | Any Willing Doctor | Berkshire Nantucket Worcester | January 2009 | | Freedom – No Drug | PFFS | $42.00 | No | Any Willing Doctor | Bristol Plymouth | | --- | --- | --- | --- | --- | --- | --- | | | Freedom – No Drug | PFFS | $29.70 | No | Any Willing Doctor | Essex Middlesex Norfolk Suffolk | | | Freedom Plus - Drug | PFFS | $104.50 | Yes | Any Willing Doctor | Barnstable Dukes Franklin Hampden Hampshire | | | Freedom Plus - Drug | PFFS | $114.10 | Yes | Any Willing Doctor | Bristol Plymouth | | | Freedom Plus - Drug | PFFS | $121.10 | Yes | Any Willing Doctor | Essex Middlesex Norfolk Suffolk | | Health Net 1230 W. Washington St., Tempe, AZ 85281 1-800-200-0410 | Health Net Pearl CA Option 4 | PFFS | $129.00 | No | Any Willing Doctor | Barnstable Bristol Essex Middlesex | | | Health Net Pearl CA Option 3 | PFFS | $109.00 | No | Any Willing Doctor | Franklin Hampden Hampshire Suffolk | | | Health Net Pearl CA Option 2 | PFFS | $49.00 | No | Any Willing Doctor | Barnstable Bristol Essex Middlesex | | | Health Net Pearl CA Option 1 | PFFS | $29.00 | No | Any Willing Doctor | Franklin Hampden Hampshire Suffolk | | Health New England One Monarch Place Springfield, MA 01144 1-413-787-0010 | HNE Medicare Basic No RX | HMO | $0.00 | No | Plan Doctors Only | Franklin Hampden Hampshire | | | HNE Medicare Basic RX | HMO | $38.00 | Yes | Plan Doctors Only | Franklin Hampden Hampshire | | | HNE Medicare Basic RX Enhanced | HMO | $56.00 | Yes | Plan Doctors Only | Franklin Hampden Hampshire | | | HNE Medicare Plus No RX | HMO | $35.00 | No | Plan Doctors Only | Franklin Hampden Hampshire | January 2009 | | HNE Medicare Plus RX | HMO | $73.00 | Yes | Plan Doctors Only | Franklin Hampden Hampshire | | --- | --- | --- | --- | --- | --- | --- | | | HNE Medicare Plus RX Enhanced | HMO | $91.00 | Yes | Plan Doctors Only | Franklin Hampden Hampshire | | | HNE Medicare Premium No RX | HMO | $66.00 | No | Plan Doctors Only | Franklin Hampden Hampshire | | | HNE Medicare Premium RX | HMO | $103.00 | Yes | Plan Doctors Only | Franklin Hampden Hampshire | | | HNE Medicare Premium RX Enhanced | HMO | $121.00 | Yes | Plan Doctors Only | Franklin Hampden Hampshire | | Humana Insurance Company 500 West Main Street, Louisville, KY 40202 1-800-833-2312 | Humana Gold Choice PFFS H1804-254 | PFFS | $98.00 | Yes | Any Willing Doctor | Berkshire Franklin Hampden Hampshire | | | Humana Gold Choice PFFS H1804-256 | PFFS | $41.00 | Yes | Any Willing Doctor | Berkshire Franklin Hampden Hampshire | | Secure Horizons 13621 NW 12th St Sunrise, FL 33323 1-800-555-5757 | Medicare Direct Plan 5 | PFFS | $0.00 | No | Any Willing Doctor | Dukes Franklin Hampden Hampshire | | | Medicare Direct Plan 56 | PFFS | $0.00 | Yes | Any Willing Doctor | Dukes Franklin Hampden Hampshire | | Universal American P.O. Box 742528 Houston, TX 77274 1-800-996-8867 | Today's Options Premier | PFFS | $99.00 | No | Any Willing Doctor | Barnstable Berkshire Nantucket Worcester | | | Today's Options Premier | PFFS | $84.00 | No | Any Willing Doctor | Bristol Middlesex Norfolk Plymouth | | | Today's Options Premier | PFFS | $29.00 | No | Any Willing Doctor | Dukes Franklin | | | Today's Options Premier | PFFS | $69.00 | No | Any Willing Doctor | Essex Hampden Suffolk | January 2009 | Today's Options Premier | PFFS | $49.00 | No | Any Willing Doctor | Hampshire | | --- | --- | --- | --- | --- | --- | | Today's Options Premier Powered by CCRx | PFFS | $139.10 | Yes | Any Willing Doctor | Barnstable Berkshire Nantucket Worcester | | Today's Options Premier Powered by CCRx | PFFS | $124.10 | Yes | Any Willing Doctor | Bristol Middlesex Norfolk Plymouth | | Today's Options Premier Powered by CCRx | PFFS | $70.10 | Yes | Any Willing Doctor | Dukes Franklin | | Today's Options Premier Powered by CCRx | PFFS | $109.10 | Yes | Any Willing Doctor | Essex Hampden Suffolk | | Today's Options Premier Powered by CCRx | PFFS | $93.10 | Yes | Any Willing Doctor | Hampshire | | Today's Options Value | PFFS | $55.00 | No | Any Willing Doctor | Barnstable Berkshire Nantucket Worcester | | Today's Options Value | PFFS | $40.00 | No | Any Willing Doctor | Bristol Middlesex Norfolk Plymouth | | Today's Options Value | PFFS | $0.00 | No | Any Willing Doctor | Dukes Franklin | | Today's Options Value | PFFS | $25.00 | No | Any Willing Doctor | Essex Hampden Suffolk | | Today's Options Value | PFFS | $10.00 | No | Any Willing Doctor | Hampshire | | Today's Options Value Powered by CCRx | PFFS | $74.90 | Yes | Any Willing Doctor | Barnstable Berkshire Nantucket Worcester | | Today's Options Value Powered by CCRx | PFFS | $59.90 | Yes | Any Willing Doctor | Bristol Middlesex Norfolk Plymouth | | Today's Options Value Powered by CCRx | PFFS | $20.00 | Yes | Any Willing Doctor | Dukes Franklin | January 2009 | | Today's Options Value Powered by CCRx | PFFS | $44.90 | Yes | Any Willing Doctor | Essex Hampden Suffolk | | --- | --- | --- | --- | --- | --- | --- | | | Today's Options Value Powered by CCRx | PFFS | $29.90 | Yes | Any Willing Doctor | Hampshire | | Tufts Health Plan 705 Mt Auburn Street Watertown, MA 02471 1-800-254-2475 | Medicare Preferred HMO Basic | HMO | $0.00 | No | Plan Doctors Only | Barnstable Bristol Essex Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester | | | Medicare Preferred HMO Basic RX | HMO | $21.00 | Yes | Plan Doctors Only | Barnstable Bristol Essex Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester | | | Medicare Preferred HMO Basic Rx Plus | HMO | $37.00 | Yes | Plan Doctors Only | Barnstable Bristol Essex Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester | | | Medicare Preferred HMO Prime | HMO | $72.00 | No | Plan Doctors Only | Barnstable Bristol Hampden Hampshire Middlesex Norfolk Plymouth | | | Medicare Preferred HMO Prime | HMO | $96.00 | No | Plan Doctors Only | Essex Suffolk Worcester | January 2009 | | Medicare Preferred HMO Value Rx Plus | HMO | $95.00 | Yes | Plan Doctors Only | Essex Suffolk Worcester | | --- | --- | --- | --- | --- | --- | --- | | | Medicare Preferred PFFS Basic | PFFS | $45.00 | No | Any Willing Doctor | Barnstable Berkshire Bristol Dukes Essex Franklin Hampden Hampshire Middlesex Nantucket Norfolk Plymouth Suffolk Worcester | | | Medicare Preferred PFFS Basic RX | PFFS | $66.00 | Yes | Any Willing Doctor | Barnstable Berkshire Bristol Dukes Essex Franklin Hampden Hampshire Middlesex Nantucket Norfolk Plymouth Suffolk Worcester | | | Medicare Preferred PFFS Basic RX Plus | PFFS | $82.00 | Yes | Any Willing Doctor | Barnstable Berkshire Bristol Dukes Essex Franklin Hampden Hampshire Middlesex Nantucket Norfolk Plymouth Suffolk Worcester | January 2009 | | Medicare Preferred PFFS Prime | PFFS | $92.00 | No | Any Willing Doctor | Barnstable Berkshire Bristol Dukes Franklin Hampden Hampshire Middlesex Nantucket Norfolk Plymouth | | --- | --- | --- | --- | --- | --- | --- | | | Medicare Preferred PFFS Prime | PFFS | $107.00 | No | Any Willing Doctor | Essex Suffolk Worcester | | | Medicare Preferred PFFS Prime Rx | PFFS | $113.00 | Yes | Any Willing Doctor | Barnstable Berkshire Bristol Dukes Franklin Hampden Hampshire Middlesex Nantucket Norfolk Plymouth | | | Medicare Preferred PFFS Prime Rx | PFFS | $128.00 | Yes | Any Willing Doctor | Essex Suffolk Worcester | | | Medicare Preferred PFFS Prime Rx Plus | PFFS | $129.00 | Yes | Any Willing Doctor | Barnstable Berkshire Bristol Dukes Franklin Hampden Hampshire Middlesex Nantucket Norfolk Plymouth | | | Medicare Preferred PFFS Prime Rx Plus | PFFS | $144.00 | Yes | Any Willing Doctor | Essex Suffolk Worcester | January 2009 | | Medicare Preferred PPO | PPO | $87.00 | No | Any Doctor | Barnstable Bristol Essex Hampden Middlesex Norfolk Plymouth Suffolk Worcester | | --- | --- | --- | --- | --- | --- | --- | | | Medicare Preferred PPO RX | PPO | $108.00 | Yes | Any Doctor | Barnstable Bristol Essex Hampden Middlesex Norfolk Plymouth Suffolk Worcester | | | Medicare Preferred PPO RX Plus | PPO | $124.00 | Yes | Any Doctor | Barnstable Bristol Essex Hampden Middlesex Norfolk Plymouth Suffolk Worcester | | Unicare P.O. Box 9092 Oxnard, CA 93031 1-888-949-5384 | Security Choice Classic | PFFS | $0.00 | No | Any Willing Doctor | Dukes Franklin Hampden Hampshire Suffolk | | | Security Choice Essential | PFFS | $0.00 | No | Any Willing Doctor | Berkshire Bristol Essex Middlesex Norfolk Plymouth Worcester | | | Security Choice Essential Plus | PFFS | $35.00 | Yes | Any Willing Doctor | Berkshire Bristol Essex Middlesex Norfolk Plymouth Worcester | January 2009 | | Security Choice Plus | PFFS | $0.00 | Yes | Any Willing Doctor | Dukes Franklin Hampden Hampshire Suffolk | | --- | --- | --- | --- | --- | --- | --- | **HMO = Health Maintenance Organization** A type of plan in which you can only go to doctors, hospitals and other providers that belong to the plan network, except in an emergency. **MSA = Medical Savings Account** A plan that has two parts. The first part is a high-deductible Medicare Advantage MSA Health Plan. This health plan won't begin to pay covered costs until you have met the annual deductible, which varies by plan. The second part is a Medical Savings Account into which Medicare deposits money that you may use to pay health care costs. **PPO = Preferred Provider Organization** A type of plan in which you pay less if you use doctors, hospitals, and other providers that belong to the plan network. You can use doctors, hospitals, and other providers outside of the network for an additional cost. **PFFS = Private Fee for Service** A type of Medicare Health Plan in which you may go to any Medicare-approved doctor or hospital that accepts the plan's payment. The insurance plan, rather than the Medicare Program, decides how much it will pay and how much you will pay for the services you have. Under this type of plan you may pay more or less for Medicare-covered benefits and you may have extra benefits that Original Medicare Plan doesn't cover. **SCO = Senior Care Option** A voluntary program that combines health care services with social support services to help low-income seniors maintain their health and stay in their own homes. With SCO, a team of medical professionals works together to provide you with care that is individually tailored to meet your needs. You must be 65 years of age or older and eligible for MassHealth (Medicaid) to join; you may also have Medicare. **SNP = Special Needs Plan** A special type of Medicare Advantage Plan that provides all Medicare Part A and Part B health care and services to people who can benefit the most from things like special care for chronic illnesses, care management of multiple diseases, and focused care management. These plans may limit membership to people in certain institutions (like a nursing home), eligible for both Medicare and Medicaid, or with certain chronic or disabling conditions. January 2009 # Medicare Prescription Drug Plans Offered in Massachusetts in 2009 | Company | Prescription Drug Plan | Monthly Premium | Annual Deductible | Customer Service Phone Number | | --- | --- | --- | --- | --- | | Aetna Medicare 980 Jolly Road Blue Bell, PA 19422 | • Aetna Medicare Rx Essentials • Aetna Medicare Rx Plus • Aetna Medicare Rx Premier | $31.80 $65.10 $111.30 | $195 $0 $0 | Phone: 1-800-455-1560 TTY: 1-800-628-3323 | | Blue Cross Blue Shield of Massachusetts P.O. Box 34160 Louisville, KY 40232 | • Blue MedicareRx Value • Blue MedicareRx Value Plus • Blue MedicareRx Premier | $41.70 $43.30 $80.90 | $295 $0 $0 | Phone: 1-866-832-9702 TTY: 1-866-552-6288 | | Bravo Health 3601 O'Donnell Street Baltimore, MD 21224 | • Bravo Rx | $30.20 | $295 | Phone: 1-877-7252 TTY: 1-800-964-2561 | | CIGNA Medicare Rx P.O. Box 269005 Weston, FL 33326 | • CIGNA Medicare RX Plan One • CIGNA Medicare Rx Plan Two • CIGNA Medicare Rx Plan Three | $30.60 $42.80 $79.60 | $295 $0 $0 | Phone: 1-800-735-1459 TTY: 1-800-322-1210 | | Coventry AdvantraRx 2222 Ewing Rd. Moon Township, PA 15108 | • AdvantraRx Value • AdvantraRx Premier • AdvantraRx Premier Plus | $25.30 $43.60 $59.20 | $0 $0 $0 | Phone: 1-800-882-3822 TTY: 1-888-788-4010 | January 2009 | Envision RxPlus 2181 Aurora Road Suite 201 Twinsburg, OH 44087 | • Envision Rx Plus Silver • Envision RX Plus Gold | $31.00 $68.80 | $295 $0 | Phone: 1-866-250-2005 TTY: 1-866-763-9630 | | --- | --- | --- | --- | --- | | First Health Part D 2222 Ewing Road Moon Township, PA 15108 | • First Health Part D Secure • First Health Part D Premier | $19.40 $28.40 | $175 $0 | Phone: 1-800-588-3322 TTY: 1-888-788-4010 | | Health Net 950 N. Finance Center Drive Tucson, AZ 85710 | • Health Net Orange Option 1 • Health Net Orange Option 2 | $31.70 $46.20 | $295 $0 | Phone: 1-800-606-3604 TTY: 1-800-929-9955 | | Health Spring Prescription Drug Plan 601 Mainspring Rd Nashville, TN 37228 | • Health Spring Prescription Drug Plan – Reg 2 | $29.10 | $295 | Phone: 1-800-331-6293 TTY: 1-866-845-7230 | | Humana Insurance Company 500 West Main Street Louisville, KY 40202 | • Humana PDP Standard S5884-061 • Humana PDP Enhanced S5884-002 • Humana PDP Complete S5884-031 | $41.40 $39.30 $96.10 | $295 $0 $0 | Phone: 1-800-706-0872 TTY: 1-877-833-4486 | January 2009 | Medco Medicare Prescription Plan P.O. Box 630246 Irving, TX 75063 | • Medco Value • Medco Choice • Medco Access | $28.20 $46.40 $69.00 | $295 $0 $0 | Phone: 1-800-758-3605 TTY: 1-800-716-3231 | | --- | --- | --- | --- | --- | | Pennsylvania Life Insurance Company P.O. Box 1232 Pensacola, FL 32591 | • PrescribaRx Bronze • PrescribaRx Gold • PrescribaRx Platinum | $30.40 $39.20 $73.30 | $295 $0 $0 | Phone: 1-800-807-9990 TTY: 1-800-777-9083 | | Rx America 221 N. Charles Lindbergh Drive SLC, UT 84116 | • Advantage Star Plan • Advantage Freedom Plan | $30.00 $40.70 | $295 $0 | Phone: 1-800-429-6686 | | SilverScript Insurance Company P.O. Box 52067 Phoenix, AZ 85072 | • SilverScript Value • SilverScript Plus • Silver Script Complete | $28.30 $50.60 $70.10 | $295 $0 $0 | Phone: 1-866-552-6106 TTY: 1-866-552-6288 | | Sterling Life Insurance Company 2219 Rimland Drive P.O. Box 1917 Bellingham, WA 98227 | • Sterling Rx | $37.00 | $295 | Phone: 1-888-909-1713 TTY: 1-888-858-8567 | January 2009 | Unicare P.O. Box 9092 Oxnard, CA 93031 | • Medicare RX Rewards Standard | $30.40 | $295 | Phone: 1-866-892-5334 TTY: 1-800-297-1538 | | --- | --- | --- | --- | --- | | United American Insurance Company 3700 S. Stonebridge Drive McKinney, TX 75070 | • UA Medicare Part D Rx Coverage – Silver Plan • UA Medicare Part D Prescription Drug Coverage | $36.90 $41.00 | $180 $0 | Phone: 1-866-299-3406 (Silver Plan) 1-866-524-4169 (Part D Prescription Drug Coverage) TTY: 1-866-524-4170 | | United HealthCare Insurance Company P.O. Box 29300 Hot Springs, AR 71903 | • AARP Medicare Rx – Saver | $26.30 | $295 | Phone: 1-800-745-0922 TTY: 1-877-730-4192 | | | • AARP Medicare Rx Preferred • AARP Medicare Rx Plan Enhanced | $38.50 $81.90 | $0 $0 | Phone: 1-888-867-5564 TTY: 1-877-730-4192 | | United HealthCare Insurance Company P.O. Box 29350 Hot Springs, AR 71903 | • United Health Rx Basic | $39.90 | $0 | Phone: 1-888-867-5561 TTY: 1-877-730-4203 | | Universal American P.O. Box 5201 Rensselaer, NY 12144 | • Community CCRx Basic | $32.10 | $295 | Phone: 1-866-684-5040 TTY: 1-866-644-5351 | | WellCare 8735 Henderson Blvd Tampa, FL 33634 | • WellCare Classic • WellCare Signature | $31.90 $35.70 | $295 $0 | Phone: 1-888-423-5252 TTY: 1-888-5252 | January 2009