MA Bulletin 2012-09
Addendum to “2013 Guide to Health Insurance for People with Medicare”; Issued 12/20/12
COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
DIVISION OF INSURANCE
1000 Washington Street, Suite 810 • Boston, MA 02118-6200
(617) 521-7794 • http://www.mass.gov/doi
DEVAL L. PATRICK
GOVERNOR
TIMOTHY P. MURRAY
LIEUTENANT GOVERNOR
GREGORY BIALECKI
SECRETARY OF HOUSING AND
ECONOMIC DEVELOPMENT
BARBARA ANTHONY
UNDERSECRETARY OF CONSUMER AFFAIRS
AND BUSINESS REGULATION
JOSEPH G. MURPHY
COMMISSIONER OF INSURANCE
BULLETIN 2012-09
TO:
Commercial Health Insurers, Blue Cross and Blue Shield of Massachusetts, Inc.,
and Health Maintenance Organizations
FROM: Joseph G. Murphy, Commissioner of Insurance
DATE:
December 20, 2012
RE:
Addendum to “2013 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 “2013 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.
January 2013
This Bulletin provides basic information for people eligible for Medicare. Contact your plan Benefits Administrator for
information about employer, union, retiree or other coverage. Contact your local Veteran’s agent for veteran’s and
TRICARE information and Indian Health Services for American Indian and Alaska Natives.
1
DEVAL L. PATRICK Tel: (617) 727-7750
Governor Fax: (617) 727-9368
TIMOTHY P. MURRAY TTY/TTD 1-800-872-0166
Lieutenant Governor www.ma.gov/elder
ANN HARTSTEIN
Secretary
SANDRA K. ALBRIGHT
Undersecretary
Massachusetts Bulletin for People with Medicare
Health Insurance Choices for People with Medicare
• Original Medicare (Part A and/or Part B)
• Medicare Supplement Insurance (Medigap)
• Medicare Advantage Plans (Medicare Part C)
• Prescription Drug Coverage (Medicare Part D)
• Employer, Union, Retiree, other group health insurance coverage
• COBRA (employer or union that may allow temporary
health coverage after employment ends)
• Veterans Benefits-Health coverage for veterans and people
who have served in the U.S. military
• Military Benefits(TRICARE) Health plan for active-duty
service members, retirees and their families
• Indian Health Services for American Indians and Alaska Natives
Programs for people with limited income and resources that
may help pay for some health care expenses.
• Extra Help pays for some Medicare prescription drug costs
• Medicare Savings Programs help pay Medicare premiums
• Prescription Advantage, a State Pharmacy Assistance Program, helps
pay for prescription drugs
• MassHealth (Medicaid)
January 2013
This Bulletin provides basic information for people eligible for Medicare. Contact your plan Benefits Administrator for
information about employer, union, retiree or other coverage. Contact your local Veteran’s agent for veteran’s and
TRICARE information and Indian Health Services for American Indian and Alaska Natives.
2
Medicare
Medicare is a Federal Government health insurance program administered by the
Centers for Medicare and Medicaid Services (CMS) for people:
• age 65 or older
• under age 65 with certain disabilities
• People of any age with End-Stage Renal Disease(ESDR) requiring dialysis or
kidney transplant
Medicare has five parts:
• Medicare Part A (Hospital Insurance)
Helps cover inpatient care in hospitals, skilled nursing facility, hospice,
home health care and other services.
• Medicare Part B (Medical Insurance)
Helps cover outpatient medical services including doctors’ and other health care
provider services, durable medical equipment, home health care, outpatient care,
some preventive and other medical services.
• Medicare Part C (Medicare Advantage Plans)
Medicare Advantage Plans (like an HMO or PPO) are health plans run by
Medicare approved private insurance companies include Medicare Part A
and Part B services and may include optional prescription drug coverage (Part D).
• Medicare Part D (Medicare Prescription Drug Coverage)
Helps cover the cost of outpatient prescription drugs. Medicare Prescription Drug
Plans are sold by private insurance companies approved by Medicare.
• Medicare Preventive Services
Medicare helps pay for many services to keep people healthy. Preventive services
include exams, lab tests, shots, screenings, monitoring and information to help
people take care of their health.
January 2013
This Bulletin provides basic information for people eligible for Medicare. Contact your plan Benefits Administrator for
information about employer, union, retiree or other coverage. Contact your local Veteran’s agent for veteran’s and
TRICARE information and Indian Health Services for American Indian and Alaska Natives.
3
There are (2) ways to get Medicare health insurance coverage:
(1) Original Medicare is fee-for-service coverage managed by Medicare.
Original Medicare covers Part A and Part B services and is the prime payer
for Medicare covered services.
Beneficiaries may go to any Medicare participating doctor, hospital or other
Medicare provider accepting Medicare patients.
People with Original Medicare may purchase optional Medicare Supplement
(Medigap) insurance as secondary payer for to cover payment gaps in Original
Medicare coverage.
Effective January 1, 2006, Medicare Supplement Insurance
Insurers cannot offer prescription drug coverage to new enrollees.
People with Original Medicare may purchase a Medicare prescription drug plan
(Medicare Part D) sometimes called “PDP” or stand-alone plan from a Medicare
approved private insurance company.
(2) Medicare Advantage Plans are health plans (like HMO, PPOs, PFFS)
sold by private insurance companies that contract with Medicare to provide
Medicare Part A and Part B services. Some plans include Medicare Part D
(Medicare prescription drug coverage).
Some plans offer additional benefits not covered by Medicare.
There is no need to purchase Medicare Supplement Insurance if a person is
enrolled in a Medicare Advantage Plan. To join a Medicare Advantage Plan,
the person must be enrolled in Medicare A and B, live in the plan’s service area
and pay plan premiums, copays and deductibles. .
Types of Medicare Advantage Plans sold in Massachusetts
• Health Maintenance Organizations (HMO)
The person must be a resident of the plan’s service area, and
must use Medicare providers in the plan’s network.
• Preferred Provider Organization (HMO/PPO)
The person must be a resident of the plan’s service area, and
may use out-of-network Medicare providers for covered services at higher cost
January 2013
This Bulletin provides basic information for people eligible for Medicare. Contact your plan Benefits Administrator for
information about employer, union, retiree or other coverage. Contact your local Veteran’s agent for veteran’s and
TRICARE information and Indian Health Services for American Indian and Alaska Natives.
4
• Point-of Service (HMO/POS)
The person must be a resident of the plan’s service area, and
may use of out-of-network Medicare providers for covered services at higher cost.
• Private Fee-for-Service (PFFS)
The person can go to any Medicare provider that agrees to treat patient.
The Plan determines provider and patient payment for the services.
• Special Needs Plans (SNP)
Provide coordinated Medicare health services for people in institutions or at home.
Medicare Prescription Drug Coverage (Part D)
Medicare prescription drug coverage (Part D) helps pay for outpatient
prescription drugs. Each plan can vary in cost and specific drugs covered.
Medicare prescription drug plans are sold by private companies approved by
Medicare.
There are (2) ways to get Medicare Prescription Drug Coverage (Part D):
(1) Medicare Prescription Drug Plans (PDPs) are offered to individuals who get
health coverage from Original Medicare or other Medicare cost plan.
(2) Medicare Advantage Plans may offer optional Medicare prescription drug
coverage to their Medicare health plans
January 2013
This Bulletin provides basic information for people eligible for Medicare. Contact your plan Benefits Administrator for
information about employer, union, retiree or other coverage. Contact your local Veteran’s agent for veteran’s and
TRICARE information and Indian Health Services for American Indian and Alaska Natives.
5
Medicare Supplement Insurance (Medigap)
Medicare Supplement Insurance (also called Medigap Insurance) is sold by
private insurance companies to fill the “gaps” in Original Medicare coverage.
Some Medigap insurers may include coverage for services that are not covered
by Original Medicare. For example, medical care when traveling outside the U.S.
Two standard Medigap policies are offered to Massachusetts residents:
Medicare Supplement Core and Medicare Supplement 1
Note: In compliance with Medicare regulations, Medicare Supplement 2,
including prescription drug coverage, cannot be sold after December 31, 2005.
Existing members may remain enrolled.
Medicare Supplement Insurance (Medigap) for Massachusetts residents is
regulated by federal and state laws including the following:
Medigap policies must be clearly identified as “Medicare Supplement
Insurance”
Policies and text are standard for all insurers, Basic benefits are the same,
some may offer additional benefits
Medigap insurance is 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 contact,
Massachusetts Division of Insurance
1-877-563-4467/617-521-7794 (Boston)
www.state.ma.us/doi
January 2013
This Bulletin provides basic information for people eligible for Medicare. Contact your plan Benefits Administrator for
information about employer, union, retiree or other coverage. Contact your local Veteran’s agent for veteran’s and
TRICARE information and Indian Health Services for American Indian and Alaska Natives.
6
Programs for People with Limited Income and Resources
Extra Help is a Medicare program to help people with limited income and resources
pay Medicare prescription drug costs.
For more information or to enroll in Extra Help contact
Social Security 1-800-772-1213 or visit www.socialsecurity.gov
Medicare Savings Programs (MassHealth Buy-In) is a federal/state program for people
with limited income and resources get help to pay Medicare costs.
There are 4 Medicare Savings Programs:
1. Qualified Medicare Beneficiary(QMB) Program
Helps pay Part A and/or Part B premiums, deductible, coinsurance, copayments
2. Specified Low-Income Beneficiary(SLMB)
Helps pay Part B premiums
3. Qualified Individual Program(QI)
Helps pay Part B premiums
4. Qualified Disabled and Working Individuals Program(QDWI)
Helps pay Part A premiums
For more information about Medicare Savings Programs contact
MassHealth Customer Service
1-800-841-2900 (TTY: 1-800-497-4648)
Prescription Advantage/State Pharmacy Assistance Program (SPAP)
A state prescription drug assistance program to help people with limited income pay
for prescription drugs. For information contact:
Prescription Advantage Customer Service
1-800-243-4636 press 2 (TTY: 1-800-610-0241)
January 2013
This Bulletin provides basic information for people eligible for Medicare. Contact your plan Benefits Administrator for
information about employer, union, retiree or other coverage. Contact your local Veteran’s agent for veteran’s and
TRICARE information and Indian Health Services for American Indian and Alaska Natives.
7
MassHealth
MassHealth and Commonwealth Care provide a wide range of medical
and other benefits. These programs are authorized by state and federal
law and help pay medical costs for people with limited income and
resources and meet other eligibility requirements.
Several MassHealth programs, for Massachusetts residents are
briefly described below:
• MassHealth Standard provides a full range of health care benefits
• MassHealth CommonHealth for adults and children with disabilities
whose income is to high to be eligible for MassHealth Standard
• MassHealth Frail Elder Waiver Program provides coordinated
community based services to frail elders living in the community.
• MassHealth Personal Care Attendant Services(PCA) helps people with
long-term disabilities live independently at home
• Program for All-inclusive Care for the Elderly (PACE)
PACE providers deliver needed medical and support services to people
living in the community.
• MassHealth SCO (Senior Care Options) is a coordinated health plan
that combines Medicare and Medicaid health care services with social
support services.
• MassHealth Long-Term Care(LTC) covers LTC costs for individuals
living in LTC facilities
For information or questions about eligibility contact
MassHealth Customer Service 1-800-841-2900 (TTY: 1-800-497-4648)
or visit www.mass.gov/masshealth
January 2013
This Bulletin provides basic information for people eligible for Medicare. Contact your plan Benefits Administrator for
information about employer, union, retiree or other coverage. Contact your local Veteran’s agent for veteran’s and
TRICARE information and Indian Health Services for American Indian and Alaska Natives.
8
Helpful Numbers
Massachusetts Executive Office of Elder Affairs
To directly connect with elder services in your area call press or say:
1-800-AGE-INFO (1-800-243-4636)
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
all other matters 5
MassHealth 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 people with limited income and resources.
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 home
support services
MA Division of Insurance Boston 617-521-7794
www.state.ma.us/doi 1-877-563-4467
DOI regulates insurance companies authorized to sell insurance in Massachusetts
Protective Services Elder Abuse Hotline 1-800-922-2275
Protective Services provide services to alleviate abuse of elders.
Elder Abuse Hotline , 24-hours a day, 7 days a week.
January 2013
This Bulletin provides basic information for people eligible for Medicare. Contact your plan Benefits Administrator for
information about employer, union, retiree or other coverage. Contact your local Veteran’s agent for veteran’s and
TRICARE information and Indian Health Services for American Indian and Alaska Natives.
9
Attorney General of Massachusetts Elder Hotline 1-888-243-5337
www.ago.state.ma.us
The Attorney General of Massachusetts is the state’s chief law enforcement officer
The Hotline provides information about elder-related issues and programs.
Massachusetts Medicare Advocacy Project 1-800-323-3205
MAP provides Medicare beneficiaries free legal advice and legal representation
for appealing medical decisions
Medicare 1-800-MEDICARE
www.medicare.gov (1-800-633-4227)
MCPHS Pharmacy Outreach Program 1-866-633-1617
www.massmedline.com
MassMedLine provides free prescription drug information and referrals.
MassMedline is a public service of the Massachusetts College of Pharmacy and Health
Sciences and the Massachusetts Executive Office of Elder Affairs.
Social Security Administration 1-800-772-1213
www.ssa.gov
Contact SSA to enroll in Medicare and for information and issues about
Social Security and other related programs
SHINE (Serving Health Information Needs of Elders) 1-800-243-4636
www.800ageinfo.com
SHINE provides information, counseling and assistance to Medicare beneficiaries
and their families on Medicare and other health insurance issues.
SHINE counselors are trained and certified by the Massachusetts Executive Office of
Elder Affairs.
The SHINE Program is administered by the Massachusetts Executive Office of Elder
Affairs in partnership with elder service agencies, councils on aging and other
community based organizations. SHINE is partially funded by the Centers for
Medicare & Medicaid Services (CMS) and the Administration on Aging (AoA).
Standard Medigap Plans
Available in Massachusetts
in 2013
Comparison of Plans
Core
Supplement 1
Basic Benefits Included In All Plans:
Hospitalization Part A Co-payments
Days 61 - 90: $296 per day
Days 91-150: $592 per day
365 Additional Lifetime Hospital days - Paid in full
Part B Coinsurance -
Coverage of coinsurance, in most cases, 20% of
approved amount
Parts A and B Blood First 3 pints
X
X
X
X
X
X
X
X
X
X
Additional Benefits
Core
Supplement 1
Part A Deductible for Hospital Days 1 - 60
$1184 per benefit period
X
Skilled Nursing Facility Coinsurance
Days 21-100 - $148 per day
X
Part B Annual Deductible - $147
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
Medicare Supplement Plans
Offered in Massachusetts
in 2013
Medigap Carriers
Please note that rates may change
in 2013
Medicare
Supplement Core
Medicare
Supplement 1
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)
$96.38
$183.73
Optional Preventive Care Benefits
Rider 1
$7.67
$7.67
Fallon Health & Life Assurance
Company
1-866-330-6380 sales/apps
1-800-868-5200 member services
1-877-608-7677 (TDD)
www.fchp.org/medicare-choices
(continuous open enrollment)
$100.25
$182.00
HNE Insurance Company
1-877-443-3314
1-800-439-2370 (TDD/TTY)
www.hne.com
(continuous open enrollment)
$97.00
$189.00
HPHC Insurance Company, Inc.
1-800-782-0334 sales/apps
1-877-907-4742 member services
1-888-259-8276 (TDD)
www.harvardpilgrim.org
(continuous open enrollment)
$100.50
$189.50
1 Effective January 1, 2013, an optional innovative hearing and vision coverage benefit rider will be available with Blue Cross
and Blue Shield of Massachusetts, Inc.’s Supplement Core and Supplement 1policies.
Medicare Supplement Plans
Offered in Massachusetts
in 2013
Medigap Carriers
Please note that rates may change
in 2013
Medicare
Supplement Core
Medicare
Supplement 1
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)
$137.18
$214.41
Humana Insurance Company
HEALTHY LIVING (including dental
and vision benefits)
1-800-872-7294 sales/applications
1-800-866-0581 member services
1-800-833-3301 (TDD)
www.humana-medicare.com
(continuous open enrollment)
$149.28
$226.51
Tufts Insurance Company
1-800-714-3000 sales/apps
1-800-701-9000 member services
TDD
1-800-208-9562 (member services)
1-888-899-8977 (sales/apps)
www.tuftsmedicarepreferred.org
(continuous open enrollment)
$102.71
$199.70
United HealthCare Insurance
Company
Only for members of AARP
(American Association of Retired
Persons)
1-800-523-5800
(continuous open enrollment)
$122.75
$211.50
In addition to the above-noted Medicare Supplemental plans, Massachusetts residents may enroll
in Medicare Advantage Plans as well as Part D Prescription Drug Plans with the Centers for
Medicare and Medicaid Services ("CMS"). For further information regarding these plans please
visit the following website:
https://www.medicare.gov/find-a-plan/questions/home.aspx
January 2013
Medicare Advantage Plans
Offered in Massachusetts
in 2013
Plan Name
Plan
Type
Monthly
Premium
Drugs
Doctor
Choice
Counties
AARP Medicare
Complete Provided
by Secure Horizons
Medicare Complete
HMO
$0.00 Yes
Plan
Doctors
Only (some
exceptions)
Middlesex
Suffolk
Phone:
1-800-547-5514
Medicare Complete
Choice
PPO
$20.00 Yes
Any Doctor
Barnstable
Berkshire
Bristol
Dukes
Essex
Franklin
Hampden
Hampshire
Middlesex
Nantucket
Norfolk
Plymouth
Suffolk
Worcester
Blue Cross
Blue Shield of
Massachusetts
Phone:
1-800-678-2265
TTY:
1-800-522-1254
Medicare HMO Blue
PlusRx
HMO
$183.00
Yes
Plan
Doctors
Only
Barnstable
Bristol
Essex
Franklin
Hampden
Hampshire
Middlesex
Norfolk
Plymouth
Suffolk
Worcester
Medicare HMO Blue
Value Rx
HMO
$28.00 Yes
Plan
Doctors
Only
Barnstable
Bristol
Essex
Franklin
Hampden
Hampshire
Middlesex
Norfolk
Plymouth
Suffolk
Worcester
January 2013
Plan Name
Plan
Type
Monthly
Premium
Drugs
Doctor
Choice
Counties
Medicare PPO Blue
PlusRx
PPO
$136.10 Yes
Any Doctor
Barnstable
Bristol
Essex
Franklin
Hampden
Hampshire
Middlesex
Norfolk
Plymouth
Suffolk
Worcester
Medicare PPO Blue
ValueRx
PPO
$66.10 Yes
Any Doctor
Barnstable
Bristol
Essex
Franklin
Hampden
Hampshire
Middlesex
Norfolk
Plymouth
Suffolk
Worcester
Erickson Advantage
Erickson Advantage
Signature with Drugs
HMO
POS
$176.00 Yes
Plan Doctors
Only
Essex
Plymouth
Phone:
1-800-989-1389
Erickson Advantage
Signature without
Drugs
HMO
-POS
$136.00
No
Plan Doctors
Only
Essex
Plymouth
Erickson Advantage
Freedom
HMO
-POS
$48.00 Yes
Plan Doctors
Only
Essex
Plymouth
Fallon Community
Health Plan
Fallon Senior Plan
Plus Enhanced Rx
HMO
$129.00 Yes
Plan Doctors
Only
Bristol
Middlesex
Norfolk
Plymouth
Phone:
1-888-377-1980
Fallon Senior Plan
Plus Enhanced Rx
HMO
$76.00 Yes
Plan Doctors
Only
Hampden
Hampshire
Fallon Senior Plan
Plus Enhanced Rx
HMO
$202.00 Yes
Plan Doctors
Only
Franklin
Worcester
Fallon Senior Plan
Plus Enhanced Rx
HMO
$153.00 Yes
Plan Doctors
Only
Suffolk
Essex
Fallon Senior Plan
Plus Enhanced Rx
HMO
$178.00 Yes
Plan Doctors
Only
Barnstable
January 2013
Plan Name
Plan
Type
Monthly
Premium
Drugs
Doctor
Choice
Counties
Fallon Senior Plan
Saver
HMO
$0.00 No
Plan Doctors
Only
Bristol
Hampden
Hampshire
Middlesex
Norfolk
Plymouth
Fallon Senior Plan
Saver
HMO
$28.00 No
Plan Doctors
Only
Franklin
Worcester
Fallon Senior Plan
Saver
HMO
$0.00 No
Plan Doctors
Only
Suffolk
Essex
Fallon Senior Plan
Saver
HMO
$38.00 No
Plan Doctors
Only
Barnstable
Fallon Senior Plan
Saver Rx
HMO
$58.00 Yes
Plan Doctors
Only
Franklin
Worcester
Fallon Senior Plan
Saver Enhanced Rx
HMO
$32.00 Yes
Plan Doctors
Only
Bristol
Middlesex
Norfolk
Plymouth
Fallon Senior Plan
Saver Enhanced Rx
HMO
$11.00 Yes
Plan Doctors
Only
Hampden
Hampshire
Fallon Senior Plan
Saver Enhanced RX
HMO
$69.00 Yes
Plan Doctors
Only
Franklin
Worcester
Fallon Senior Plan
Saver Enhanced Rx
HMO
$72.00 Yes
Plan Doctors
Only
Barnstable
Fallon Senior Plan
Saver Enhanced Rx
HMO
$52.00 Yes
Plan Doctors
Only
Suffolk
Essex
Fallon Senior Plan
Super Saver Rx
HMO
$0.00 Yes
Plan Doctors
Only
Bristol
Essex
Franklin
Hampden
Hampshire
Middlesex
Norfolk
Plymouth
Suffolk
Worcester
Fallon Senior Plan
Super Saver Rx
HMO
$30.00 Yes
Plan Doctors
Only
Barnstable
Fallon Senior Plan
Standard
HMO
$96.00 No
Plan Doctors
Only
Franklin
Worcester
Fallon Senior Plan
Standard Enhanced Rx
HMO
$142.10 Yes
Plan Doctors
Only
Franklin
Worcester
January 2013
Plan Name
Plan
Type
Monthly
Premium
Drugs
Doctor
Choice
Counties
Health New
England
HNE Medicare Basic
No RX
HMO
$4.00 No
Plan Doctors
Only
Berkshire
Franklin
Hampden
Hampshire
Phone:
1-877-443-3314
HNE Medicare Basic
RX
HMO
$58.00 Yes
Plan Doctors
Only
Berkshire
Franklin
Hampden
Hampshire
TTY:
1-800-439-2370
HNE Medicare Plus
RX
HMO
$92.00 Yes
Plan Doctors
Only
Berkshire
Franklin
Hampden
Hampshire
HNE Medicare
Premium No RX
HMO
$74.00 No
Plan Doctors
Only
Berkshire
Franklin
Hampden
Hampshire
HNE Medicare
Premium RX
HMO
$143.00 Yes
Plan Doctors
Only
Berkshire
Franklin
Hampden
Hampshire
HNE Medicare
Freedom
(HMO-POS)
HMO
$166.00 Yes
Plan Doctors
Only
Berkshire
Franklin
Hampden
Hampshire
Tufts Health Plan
Medicare Preferred
HMO Basic
HMO
$20.00 No
Plan Doctors
Only
Essex
Suffolk
Worcester
Phone:
1-877-218-4835
Medicare Preferred
HMO Basic Rx
HMO
$0.00 Yes
Plan Doctors
Only
Hampden
Hampshire
TTY:
1-888-899-8977
Medicare Preferred
HMO Basic Rx
HMO
$24.80 Yes
Plan Doctors
Only
Barnstable
Bristol
Middlesex
Norfolk
Plymouth
Medicare Preferred
HMO Basic Rx
HMO
$44.80 Yes
Plan Doctors
Only
Essex
Suffolk
Medicare Preferred
HMO Basic Rx
HMO
$66.10 Yes
Plan Doctors
Only
Worcester
Medicare Preferred
HMO Prime
HMO
$112.00 No
Plan Doctors
Only
Barnstable
Bristol
Middlesex
Norfolk
Plymouth
January 2013
Plan Name
Plan
Type
Monthly
Premium
Drugs
Doctor
Choice
Counties
Medicare Preferred
HMO Prime
HMO
$49.00 No
Plan Doctors
Only
Hampden
Hampshire
Medicare Preferred
HMO Prime
HMO
$136.00 No
Plan Doctors
Only
Essex
Suffolk
Medicare Preferred
HMO Prime
HMO
$126.00 No
Plan Doctors
Only
Worcester
Medicare Preferred
HMO Prime Rx
HMO
$140.10 Yes
Plan Doctors
Only
Barnstable
Bristol
Middlesex
Norfolk
Plymouth
Medicare Preferred
HMO Prime Rx
HMO
$77.10 Yes
Plan Doctors
Only
Hampden
Hampshire
Medicare Preferred
HMO Prime Rx
HMO
$164.10 Yes
Plan Doctors
Only
Essex
Suffolk
Medicare Preferred
HMO Prime Rx
HMO
$172.10 Yes
Plan Doctors
Only
Worcester
Medicare Preferred
HMO Prime Rx Plus
HMO
$172.90 Yes
Plan Doctors
Only
Barnstable
Bristol
Middlesex
Norfolk
Plymouth
Medicare Preferred
HMO Prime Rx Plus
HMO
$109.90 Yes
Plan Doctors
Only
Hampden
Hampshire
Medicare Preferred
HMO Prime Rx Plus
HMO
$196.90 Yes
Plan
Doctors
Only
Essex
Suffolk
Medicare Preferred
HMO Value
HMO
$82.00 No
Plan
Doctors
Only
Barnstable
Bristol
Middlesex
Norfolk
Plymouth
Medicare Preferred
HMO Value
HMO
$19.00 No
Plan
Doctors
Only
Hampden
Hampshire
Medicare Preferred
HMO Value
HMO
$103.00 No
Plan
Doctors
Only
Essex
Suffolk
Medicare Preferred
HMO Value
HMO
$93.00 No
Plan
Doctors
Only
Worcester
January 2013
Plan Name
Plan
Type
Monthly
Premium
Drugs
Doctor
Choice
Counties
Medicare Preferred
HMO Value Rx
HMO
$110.10 Yes
Plan
Doctors
Only
Barnstable
Bristol
Middlesex
Norfolk
Plymouth
Medicare Preferred
HMO Value Rx
HMO
$47.10 Yes
Plan
Doctors
Only
Hampden
Hampshire
Medicare Preferred
HMO Value Rx
HMO
$131.10 Yes
Plan
Doctors
Only
Essex
Suffolk
Medicare Preferred
HMO Value Rx
HMO
$139.10 Yes
Plan
Doctors
Only
Worcester
Medicare Preferred
HMO Saver Rx
HMO
$0.00 Yes
Plan
Doctors
Only
Barnstable
Bristol
Essex
Middlesex
Norfolk
Plymouth
Suffolk
Worcester
Universal American
Phone:
1-800-996-8867
Today's Options
Premier 300
PFFS
$105.00 No
Any Willing
Doctor
Berkshire
Nantucket
Today's Options
Premier 600
PFFS
$14.00 No
Any Willing
Doctor
Dukes
Today's Options
Premier Plus 350A
PFFS
$183.00 Yes
Any Willing
Doctor
Berkshire
Nantucket
Today's Options
Premier Plus 350A
PFFS
$105.00 Yes
Any Willing
Doctor
Dukes
Today's Options
Premier 600
PFFS
$58.00 No
Any Willing
Doctor
Berkshire
Nantucket
Today's Options
Premier 300
PFFS
$35.00 No
Any Willing
Doctor
Dukes
Today's Options
Premier Plus 650G
PFFS
$99.00 Yes
Any Willing
Doctor
Berkshire
Nantucket
Today's Options
Premier Plus 650B
PFFS
$48.00 Yes
Any Willing
Doctor
Dukes
January 2013
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 Medicareapproved 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 condition.
January 2013
Medicare Prescription Drug Plans
Offered in Massachusetts in 2013
Company
Prescription
Drug Plan
Monthly
Premium
Annual Deductible
Customer Service
Phone Number
Aetna
• CVS/pharmacy
Prescription Drug
Plan
• Medicare Rx Premier
$31.60
$109.60
$325
$0
Phone:
1-800-832-2640
Blue Cross
Blue Shield of
Massachusetts
• Blue MedicareRx
Value Plus
• Blue MedicareRx
Premier
$39.20
$100.70
$250
$0
Phone:
1-877-479-2227
TTY:
1-866-236-1069
CIGNA Medicare Rx
• CIGNA Medicare RX
Plan One
• CIGNA Medicare Rx
Plan Two
$34.00
$76.50
$325
$0
Phone:
1-800-735-1459
TTY:
1-800-322-1451
Envision RxPlus
• Envision Rx Plus
Silver
• Envision Rx Plus
Gold
$33.20
$54.00
$325
$150
Phone:
1-866-250-2005
Express Scripts
Medicare
• Express Scripts
Medicare Value
$47.80
$325
Phone:
1-866-477-5704
TTY:
1-800-716-3231
January 2013
Company
Prescription
Drug Plan
Monthly
Premium
Annual Deductible Customer Service
Phone Number
First Health Part D
• First Health
Part D Premier
• First Health Part D
Premier Plus
• First Health Part D
Value Plus
$34.90
$92.40
$31.00
$325
$0
$0
Phone:
1-877-815-8163
HealthMarkets
Medicare
• Reader’s Digest
Value Rx
$33.60
$325
Phone:
1-888-625-5531
Health Spring
Prescription Drug Plan
• Health Spring
Prescription Drug
Plan – Reg 2
$37.70
$325
Phone:
1-877-357-1685
Humana Insurance
Company
• Humana Walmart –
Preferred RX Plan
• Humana Enhanced
• Humana Complete
$18.50
$43.10
$114.00
$325
$0
$0
Phone:
1-800-706-0872
SilverScript Insurance
Company
• SilverScript Choice
• SilverScript Basic
• SilverScript Plus
$29.20
$30.50
$102.90
$0
$325
$0
Phone:
1-866-552-6106
TTY:
1-866-552-6288
January 2013
Company
Prescription
Drug Plan
Monthly
Premium
Annual Deductible
Customer Service
Phone Number
SmartD Rx
• SmartD Rx Saver
• SmartD Rx Plus
$32.40
$69.00
$325
$0
1-855-976-2781
TTY:
1-888-328-0419
Unicare
• Medicare RX
Rewards Standard
$52.50
$325
Phone:
1-877-541-7382
United American
Insurance Company
• Enhanced
• Select
$51.20
$33.70
$140
$325
Phone:
1-866-524-4169
TTY:
1-866-524-4170
United HealthCare
Insurance Company
• AARP Medicare Rx
Saver Plus
• AARP Medicare Rx
Preferred
• AARP Medicare Rx
Enhanced
$15.00
$37.70
$90.00
$325
$0
$0
Phone:
1-866-679-3282
WellCare
• WellCare Classic
• WellCare Extra
$30.80
$39.00
$0
$0
Phone:
1-888-293-5151
TTY:
1-888-816-5252