Addendum to “Guide to Health Insurance for People with Medicare”; Issued 2/6/2019

1 CHARLES D. BAKER Governor The Commonwealth of Massachusetts Executive Office of Elder Affairs One Ashburton Place, 5th Floor Boston, Massachusetts 02108 Tel: (617) 727-7750 Fax: (617) 727-9368 www.mass.gov/elders KARYN E. POLITO Lieutenant Governor ROBIN M. LIPSON Acting Secretary Massachusetts Bulletin for People with Medicare  January 2019                                 Health Insurance Options for People with Medicare     Original Medicare (Part A and Part B)   Medicare Supplement Insurance (Medigap)    Medicare Advantage Plans (Medicare Part C)   Medicare Prescription Drug Coverage (Medicare Part D)   Employer, Union, Retiree, other group health insurance coverage   COBRA   Veterans Health Benefits   Military Benefits (TRICARE)   Indian Health Services                                  Programs for People with Limited Income and Resources      Extra Help Paying for Medicare Prescription Drug Coverage (Part D)    Medicare Savings Programs (help with Medicare costs)     Prescription Advantage (prescription drug insurance assistance program  for Massachusetts residents)  2  MassHealth (Medicaid)       This Bulletin provides basic health insurance information for people eligible for Medicare.  Contact your plan benefits administrator for information about employer, union, retiree, or other  group health coverage. Contact your local Veterans Service Officer for Veterans and TRICARE  health insurance information. Contact the Indian Health Services for  health information for  American Indians and Alaska Natives.                                                                                                                                   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                                 Medicare has 4 parts:    Part A (Medicare Hospital Insurance)        Helps pay for inpatient care in hospitals, skilled nursing facilities, hospice,       home health care and other services.     Part B (Medicare Medical Insurance)   Helps pay for outpatient medical services including doctor visits,   medical equipment, home health care, outpatient care, and some   preventive services.                                                                                                                                         Part C (Medicare Advantage Plan)         Medicare Advantage Plans include Medicare Part A (Hospital Insurance)        and Part B (Medical Insurance).        Some Medicare Advantage Plans may offer Medicare Part D, prescription        drug coverage at additional charge and other services not covered by Medicare.           Medicare Advantage Plans (like HMOs, PPOs) are sold by private health           insurance companies approved by Medicare.       Part D (Medicare Prescription Drug Coverage)  Helps pay for outpatient prescription drugs. Medicare prescription drug   plans are sold by private insurance companies approved by Medicare.                       3                                   There are 2 ways to get Medicare coverage:                                                                                (1) Original Medicare is fee‐for‐service coverage administered directly by                   Medicare. Original Medicare covers Medicare Part A (Hospital) and                   Part B (Medical) services.                   Under Original Medicare, you have the choice of doctors, hospitals and                  other providers that accept Medicare.                                                                   You may purchase optional Medicare Supplement (Medigap) insurance                   from a private company or have employer or other health insurance to                   help pay for deductibles and coinsurance in Original Medicare.                                      You may decide to purchase a Medicare Prescription Drug plan (Part D)                  to help pay for outpatient prescription drugs.                (2) Medicare Advantage Plan (like an HMO or PPO)                                   Medicare Advantage Plan/s (MA‐PD) cover Medicare Part A and Part B                    Services. MA‐PDs are sold by private companies approved by Medicare                   and usually charge a monthly premium.                      Some plans offer additional benefits not covered by Medicare.                  Most plans require use of network doctors, hospitals and other providers.                   Most MA‐PDs offer Medicare prescription drug coverage (Part D) at                   additional cost.  Some plans do not offer drug coverage (MA plans)                                You must be enrolled in Medicare A and B, pay plan premiums,                   deductibles, copays and coinsurance.                   (Medicare Supplement Insurance cannot be sold to MA‐PD enrollees)                                                            Medicare Advantage Plans sold in Massachusetts                        Health Maintenance Organizations (HMO)                          Must be a resident of the plan’s service area and use provider network    Preferred Provider Organization (PPO)   Must be a resident of the plan’s service area           May use out‐of‐network Medicare providers at higher premium    Point‐of Service (HMO/POS)   Must be a resident of the plan’s service area.    May use of out‐of‐network Medicare providers at higher premium            Private Fee‐for‐Service (PFFS)    4  May use any Medicare provider that agrees to treat patient.         The Plan determines provider and patient payment for the services.    Special Needs Plan (SNP)   For people with Medicare and Medicaid or special conditions.      Medicare Prescription Drug Coverage (Part D)                          Medicare prescription drug coverage (Part D) helps pay for prescription drugs.                                           Medicare prescription drug plans are sold by private companies approved by                         Medicare. Each plan can vary in cost and specific drugs covered.                                                                     Medicare Prescription Drug Plans (PDPs) are stand‐alone plans for                        for enrollees in Original Medicare.                                                                                                                         Most  Medicare Advantage Plans offer optional Medicare prescription                         drug coverage.                                                                                              Medicare Supplement Insurance (Medigap)                              Medicare Supplement Insurance (also called Medigap Insurance) is sold by           private insurance companies to help pay health care costs that  Original Medicare            does not cover such as deductibles and coinsurance.                                                     Some Medigap insurers may include coverage for services that are not covered                            by Original Medicare.                                                                                           Two standard Medigap policies are offered to Massachusetts residents:                       Medicare Supplement Core & Medicare Supplement 1                           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   5      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  to all  policyholder       and cannot charge a different premium based on age or health.            Medicare Select Plan   Medicare Select Plans are Medicare supplement plans that require the  use of a provider network                                                    The Massachusetts Division of Insurance monitors insurance companies                                authorized to sell insurance in Massachusetts, For information contact:                                                                                              Massachusetts Division of Insurance                                         617‐521‐7794 (Boston)       www.mass.gov/doi                                                                                              Programs for People with Limited Income and Resources                              Extra Help for Medicare Prescription Drug Coverage (Part D)                       also known as the Limited Income Subsidy (LIS) is a federal program                       that helps Medicare beneficiaries with limited income and assets                       pay some of the costs for Medicare prescription drug coverage (Part D).                        For more information or to enroll in Extra Help, contact                       Social Security at 1‐800‐772‐1213 or visit www.socialsecurity.gov                                                  Medicare Savings Program (MassHealth Buy‐In) are federal programs       that help pay Medicare premiums and Part A and Part B deductibles and         coinsurance for Massachusetts residents with limited income and assets       and not receiving other MassHealth benefits.                  For more information about Medicare Savings Programs contact                                   MassHealth Customer Service                                          1‐800‐841‐2900          (TTY: 1‐800‐497‐4648 for people with partial or total hearing loss)                      6                            Prescription Advantage/State Pharmacy Assistance Program (SPAP)                            Is a state program that helps people with limited income and/or medical                             condition and age pay for  prescription drugs.                                                 Prescription Advantage is funded by state legislation and is administered                            by the Massachusetts Executive Office of Elder Affairs.                              For information about eligibility and enrollment contact:    Prescription Advantage Customer Service  1‐800‐AGE‐INFO (1‐800‐243‐4636) press 2  www.prescriptionadvantage.com  (TTY: 1‐800‐610‐0241 for people with partial or total hearing loss)                                                                                                                                                                                                                            MassHealth                              MassHealth provides a wide range of medical services                            and other benefits. These programs are authorized by state and federal                             laws and help pay medical costs for people with limited income and                           resources and meet other eligibility requirements.                            MassHealth Standard provides a full range of health care benefits.      MassHealth CommonHealth for people with disabilities whose income is  too 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)        7                                PACE providers deliver needed medical and support services                                  to people living in the community.      MassHealth Plans for Dual Eligible (MassHealth & Medicare)         Senior Care Options (SCO) is a coordinated health   plan that combines Medicare and Medicaid health care with long term        care supports for consumers 65 and older.      One Care (Integrated Care Organization or ICO) is a coordinated care  demonstration project in Massachusetts that combines Medicare and  MassHealth services with long term care supports for consumers 21‐64  years old with disabilities. Enroll through MassHealth.    MassHealth Long‐Term Care(LTC) covers LTC costs for individuals living  in LTC facilities                                            For information or questions about eligibility, enrollment and to receive a                senior application, contact:                                              MassHealth Customer Service 1‐800‐841‐2900          TTY: 1‐800‐497‐4648 (for people with partial or total hearing loss)                                                 or visit  www.MAhealthconnector.org for information                                                                                                                                                                                                           Helpful Numbers                       Massachusetts Executive Office of Elder Affairs                      To directly connect with elder services in your area call and press or say:                      1‐800‐AGE‐INFO (1‐800‐243‐4636)                                                        to connect to  your local elder service agency or caregiver program: Press 1                  to connect to Prescription Advantage‐state prescription drug program: Press 2               to connect to your regional SHINE Program: Press 3                                                    to report elder abuse, neglect or financial exploitation: Press 4           all other matters: Press 5                                                                       8                                                    MassHealth Senior Care Options (SCO)                                       1‐888‐885‐0484                                                           TTY: 1‐888‐821‐5225    www.mass.gov/masshealth                                                                  A health plan that combines Medicare and Medicaid services with home services.                                    Massachusetts Division of Insurance                                  Boston   617‐521‐7794                    www.mass.gov/doi                                                                                                               Regulates insurance companies authorized to sell insurance in Massachusetts.                                                                                                                                                                        Elder Protective Services Elder Abuse Hotline (24 hour/7 days)                                1‐800‐922‐2275                    A statewide program is administered by the Executive Office of Elder Affairs.                     Protective Service Agencies investigates reports of elder abuse and provide                     protective services to abused elders.                                         Attorney General of Massachusetts                                    Elder Hotline 1‐888‐243‐5337                      www.mass.gov/ago                   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 (MAP)                                    1‐800‐323‐3205                       Provides Medicare beneficiaries free legal advice and legal representation for appealing          medical decisions.                                         MCPHS University Pharmacy Outreach Program              1‐866‐633‐1617                                                                                      www.mcphs.edu/pharmacyoutreach                                                                                                 9                   Provides free prescription drug information and referrals. The Pharmacy Outreach          Program is a public service of the MCPHS and EOEA.                       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.              Massachusetts Health Connector                1‐877‐623‐6765                    www.MAhealthconnector.org        Health insurance, assistance and on‐line application for people without insurance         or small businesses; dental plan list for anyone.                     SHINE (Serving Health Insurance Needs of Everyone)                  1‐800‐243‐4636  Press or say 3                       www.800ageinfo.com                                            SHINE, a State Health Insurance Assistance Program (SHIP), provides                    information, counseling and assistance to Medicare beneficiaries and their families                     regarding Medicare and other health insurance issues.                                           SHINE Health Insurance Counselors are trained and certified by the Massachusetts                                  Executive Office of Elder Affairs (EOEA). SHINE is administered by                      EOEA in partnership with elder service agencies, councils on aging, independent                                        living centers and community based programs.  SHINE is partially funded by the  Administration on Community Living.                                                                                                                                                          Medicare Supplement Plans Offered in Massachusetts 2019 As of December 18, 2018 Comparison of Plans Core Supplement 1 Basic Benefits Included In All Plans: Hospitalization Part A Co-payments Days 61 - 90: $341 per day Days 91-150: $682 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 Part A Deductible for Hospital Days 1 - 60 $1364 per benefit period X Skilled Nursing Facility Coinsurance Days 21-100 - $170.50 per day X Part B Annual Deductible - $185 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 IMPORTANT NOTICE: Medicare Supplement premium rates are required to be in effect for not less than 12 months. Effective dates shown for each Carrier are based on the most recent filing on record with the Division of Insurance. Medicare Supplement Plans Offered in Massachusetts 2019 As of December 18, 2018 Medigap Carriers Please note that rates may change in 2019 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 711 (TDD) www.bluecrossma.com (continuous open enrollment) $98.42 Effective 01/01/2019 $197.74 Effective 01/01/2019 Optional Preventive Care Benefits Rider $ 3.04 Effective 01/01/2019 $ 3.04 Effective 01/01/2019 Fallon Health & Life Assurance Company 1-866-330-6380 sales/apps 1-800-868-5200 member services TRS 711 www.fallonhealth.org/medsupp (continuous open enrollment) $126.00 Effective 01/01/2019 $229.00 Effective 01/01/2019 HNE Insurance Company 1-877-443-3314 711 (TTY) www.healthnewengland.org (continuous open enrollment) $112.00 Effective 01/01/2019 $204.00 Effective 01/01/2019 HPHC Insurance Company, Inc. 1-877-909-4742 sales/apps 1-877-907-4742 member services 711 (TTY) www.hpforlife.org (continuous open enrollment) $125.00 Effective 01/01/2019 $220.00 Effective 01/01/2019 Medicare Supplement Plans Offered in Massachusetts 2019 As of December 18, 2018 Medigap Carriers Please note that rates may change in 2019 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.com (continuous open enrollment) $ 169.91 Effective 10/01/18 $ 270.85 Effective 10/01/18 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.com (continuous open enrollment) $ 183.26 Effective 10/01/18 $ 284.20 Effective 10/01/18 Transamerica Life Insurance Company For eligibility & plan information: 1-800-247-1771 (Group Medicare Supplement Insurance sponsored for members of various participating industry, trade, professional and other special interest associations.) (continuous open enrollment) $116.27 Effective 10/01/2018 $201.12 Effective 10/01/2018 Transamerica Premier Life Insurance Company 1-800-458-5736 (Group Medicare Supplement insurance sponsored exclusively for eligible members of the American Medical Association.) www.amainsure.com (continuous open enrollment) $ 99.41 Effective 10/01/2018 $ 171.95 Effective 10/01/2018 Medicare Supplement Plans Offered in Massachusetts 2019 As of December 18, 2018 Medigap Carriers Please note that rates may change in 2019 Medicare Supplement Core Medicare Supplement 1 Tufts Insurance Company Sales: 1-888-508-1401 Customer Relations: 1-800-701-9000 711 (TTY) www.thpmp.org/medsupp (continuous open enrollment) $114.00 Effective 01/01/2019 $212.00 Effective 01/01/2019 Delta Dental® Option Rider $60.00 Effective 01/01/2019 $60.00 Effective 01/01/2019 UnitedHealthcare Insurance Company Only for members of AARP www.aarpmedicaresupplement.com 1-800-523-5800 (continuous open enrollment) $125.00 Effective 06/01/2018 $224.75 Effective 06/01/2018 Medigap Carriers Please note that rates may change in 2019 Medicare Select** Blue Cross & Blue Shield of Massachusetts HMO Blue, Inc. 1-800-678-2265 sales/apps 1-800-258-2226 member services 711 (TDD) www.bluecrossma.com (continuous open enrollment) $146.23 Effective 01/01/2019 ** Medicare Select Plans are Medicare Supplement Insurance Plans that require the use of a provider network. Medicare Select In-network benefits will be the same as the Medicare Supplement Core benefits or Medicare Supplement 1 benefits, based on the member’s choice of PCP. 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 Effective January 2019 Medicare Prescription Drug Plans Offered in Massachusetts in 2019 Company Prescription Drug Plan Monthly Premium Annual Deductible (See Footnote) Customer Service Phone Number Aetna Medicare  Medicare Rx Saver $33.20 $300.00 Phone: 1-833-856-5680 TTY/TDD: 711  Medicare Rx Select $17.20 $385.00  Medicare Rx Value $58.80 $0.00 Blue Medicare Rx  Blue MedicareRx Value Plus $37.80 $350.00 Phone: 1-877-479-2227 TTY/TDD: 711  Blue MedicareRx Premier $127.90 $0.00 Cigna- HealthSpring Rx  Secure $54.70 $415.00 Phone: 1-800-735-1459 TTY/TDD: 711  Secure Essential $21.80 $415.00  Secure Extra $52.40 $100.00 Envision RxPlus  Envision Rx Plus $14.50 $365.00 Phone: 1-888-377-1439 TTY/TDD: 711 Express Scripts Medicare  Express Scripts Medicare Choice $94.80 $350.00 Phone: 1-866-477-5704 TTY: 1-800-716-3231  Express Scripts Medicare Value $35.20 $415.00  Express Scripts Medicare Saver $24.00 $415.00 Humana Insurance Company  Humana Walmart – RX Plan $30.70 $415.00 Phone: 1-800-706-0872 TTY/TDD: 711  Humana Preferred Rx Plan $34.80 $415.00  Humana Enhanced $73.80 $0.00 Effective January 2019 Medicare Prescription Drug Plans Offered in Massachusetts in 2019 Company Prescription Drug Plan Monthly Premium Annual Deductible (See Footnote) Customer Service Phone Number Mutual of Omaha Rx  Mutual of Omaha Rx Plus  Mutual of Omaha Rx Value $41.20 $26.40 $415.00 $415.00 Phone: 1-800-961-9006 TTY/TDD 1-800-584-6939 SilverScript  Allure $80.00 $0.00 Phone: 1-866-552-6106 TTY/TDD: 711  Choice $34.20 $0.00  Plus $65.50 $0.00 United HealthCare Insurance Company  AARP Medicare Rx Saver Plus $34.90 $415.00 Phone: 1-888-867-5564 TTY/TDD: 711  AARP Medicare Rx Preferred $72.10 $0.00  AARP Medicare Rx Walgreens $28.10 $415.00 WellCare  WellCare Classic $35.10 $415.00 Phone: 1-888-293-5151 TTY: 711  WellCare Extra $68.20 $0.00  WellCare Value Script $14.00 $415.00 NOTE: Annual Deductibles indicated may not apply to all prescription drugs covered under the plan. Contact the Medicare Prescription Drug Plan for more information. Effective January 2019 Medicare Advantage Plans Offered in Massachusetts in 2019 Plan Name Plan Type Monthly Premium Drugs Doctor Choice Counties AARP Medicare Complete Provided by United Healthcare Phone: 1-800-555-5757 TTY/TDD: 711 Medicare Complete Plan 1 HMO $0.00 Yes Plan Doctors for Most Services Bristol Essex Hampden Middlesex Plymouth Suffolk Worcester Medicare Complete Plan 2 HMO $42.00 Yes Plan Doctors for Most Services Bristol Essex Hampden Middlesex Plymouth Suffolk Worcester Medicare Complete Plan 3 HMO $76.00 Yes Plan Doctors for Most Services Bristol Essex Hampden Middlesex Plymouth Suffolk Worcester Medicare Complete Choice PPO $47.00 Yes Any Doctor Barnstable Berkshire Bristol Dukes Essex Franklin Hampden Hampshire Middlesex Nantucket Norfolk Plymouth Suffolk Worcester Aetna Medicare 1-855-275-6627 TTY/TDD: 711 Medicare Value HMO $0.00 Yes Plan Doctors for Most Services Bristol Essex Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester Medicare Freedom PPO $0.00 Yes Any Doctor Bristol Essex Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester Effective January 2019 Medicare Advantage Plans Offered in Massachusetts in 2019 Plan Name Plan Type Monthly Premium Drugs Doctor Choice Counties Aetna Medicare (Continued) 1-855-275-6627 TTY/TDD: 711 Medicare Freedom Complete PPO $57.00 Yes Any Doctor Bristol Essex Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester Blue Cross Blue Shield of Massachusetts Phone: 1-800-678-2265 TTY/TDD: 711 Medicare HMO Blue PlusRx HMO $292.00 Yes Plan Doctors for Most Services Barnstable Bristol Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester Medicare HMO Blue Saver Rx HMO $0.00 Yes Plan Doctors for Most Services Barnstable Bristol Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester Medicare HMO Blue Value Rx HMO $36.00 Yes Plan Doctors for Most Services Barnstable Bristol Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Medicare HMO Blue Value Rx HMO $56.00 Yes Plan Doctors for Most Services Worcester Medicare HMO Blue FlexRx HMO- POS $96.00 Yes Plan Doctors for Most Services Barnstable Bristol Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Effective January 2019 Medicare Advantage Plans Offered in Massachusetts in 2019 Plan Name Plan Type Monthly Premium Drugs Doctor Choice Counties Blue Cross Blue Shield of Massachusetts (continued) Phone: 1-800-678-2265 TTY/TDD: 711 Medicare HMO Blue FlexRx HMO- POS $106.00 Yes Plan Doctors for Most Services Worcester Medicare PPO Blue PlusRx PPO $262.00 Yes Any Doctor Barnstable Bristol Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester Medicare PPO Blue ValueRx PPO $76.00 Yes Any Doctor Barnstable Bristol Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Medicare PPO Blue ValueRx PPO $86.00 Yes Any Doctor Worcester Medicare PPO Blue SaverRx PPO $0.00 Yes Any Doctor Barnstable Bristol Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester Effective January 2019 Medicare Advantage Plans Offered in Massachusetts in 2019 Plan Name Plan Type Monthly Premium Drugs Doctor Choice Counties Erickson Advantage Phone: 1-866-774-9671 TTY/TDD: 711 Erickson Advantage Signature with Drugs HMO- POS $195.00 Yes Plan Doctors Only Essex Plymouth Erickson Advantage Signature without Drugs HMO- POS $160.00 No Plan Doctors Only Essex Plymouth Erickson Advantage Freedom HMO- POS $48.00 Yes Plan Doctors Only Essex Plymouth Fallon Health Phone: 1-888-377-1980 TTY/TDD: 711 Fallon Senior Plan Plus Enhanced Rx HMO $173.00 Yes Plan Doctors Only Bristol Middlesex Norfolk Plymouth Fallon Senior Plan Plus Enhanced Rx HMO $206.00 Yes Plan Doctors Only Berkshire Fallon Senior Plan Plus Enhanced Rx HMO- POS $126.00 Yes Plan Doctors Only Hampden Hampshire Fallon Senior Plan Plus Enhanced Rx HMO $275.00 Yes Plan Doctors Only Franklin Worcester Fallon Senior Plan Plus Enhanced Rx HMO $173.00 Yes Plan Doctors Only Essex Suffolk Fallon Senior Plan Plus Enhanced Rx HMO $227.00 Yes Plan Doctors Only Barnstable Fallon Senior Plan Flex Enhanced Rx HMO $0.00 Yes Plan Doctors Only Bristol Essex Franklin Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester Effective January 2019 Medicare Advantage Plans Offered in Massachusetts in 2019 Plan Name Plan Type Monthly Premium Drugs Doctor Choice Counties Fallon Health (Continued) Phone: 1-888-377-1980 TTY/TDD: 711 Fallon Senior Plan Saver HMO $59.00 No Plan Doctors Only Berkshire Fallon Senior Plan Saver HMO $44.00 No Plan Doctors Only Bristol Essex Middlesex Norfolk Plymouth Suffolk Fallon Senior Plan Saver HMO $93.00 No Plan Doctors Only Franklin Worcester Fallon Senior Plan Saver HMO $8.00 No Plan Doctors Only Hampden Hampshire Fallon Senior Plan Saver HMO $91.00 No Plan Doctors Only Barnstable Fallon Senior Plan Saver Enhanced Rx HMO $93.00 Yes Plan Doctors Only Berkshire Fallon Senior Plan Saver Enhanced Rx HMO $72.00 Yes Plan Doctors Only Bristol Middlesex Norfolk Plymouth Fallon Senior Plan Saver Enhanced Rx HMO $50.00 Yes Plan Doctors Only Hampden Hampshire Fallon Senior Plan Saver Enhanced Rx HMO $103.00 Yes Plan Doctors Only Franklin Worcester Fallon Senior Plan Saver Enhanced Rx HMO $112.00 Yes Plan Doctors Only Barnstable Fallon Senior Plan Saver Enhanced Rx HMO $72.00 Yes Plan Doctors Only Essex Suffolk Fallon Senior Plan Standard Enhanced Rx HMO $218.00 Yes Plan Doctors Only Franklin Worcester Fallon Senior Plan Super Saver Rx HMO $28.00 Yes Plan Doctors Only Barnstable Fallon Senior Plan Super Saver Rx HMO $22.00 Yes Plan Doctors Only Berkshire Bristol Essex Franklin Middlesex Norfolk Plymouth Suffolk Worcester Fallon Senior Plan Super Saver Rx HMO $16.00 Yes Plan Doctors Only Hampden Hampshire Effective January 2019 Medicare Advantage Plans Offered in Massachusetts in 2019 Plan Name Plan Type Monthly Premium Drugs Doctor Choice Counties Harvard Pilgrim Health Care Phone: 1-877-431-4742 TTY/TDD: 711 Stride Basic Rx HMO $0.00 Yes Plan Doctors Only Barnstable Bristol Plymouth Suffolk Worcester Stride Value Rx Plus HMO $163.00 Yes Plan Doctors Only Barnstable Bristol Essex Middlesex Norfolk Plymouth Suffolk Stride Value Rx Plus HMO $190.00 Yes Plan Doctors Only Worcester Stride Value Rx HMO $67.00 Yes Plan Doctors Only Barnstable Bristol Essex Middlesex Norfolk Plymouth Suffolk Stride Value Rx HMO $79.00 Yes Plan Doctors Only Worcester Health New England Phone: 1-877-433-3314 TTY/TDD: 711 HNE Medicare Basic No Rx HMO $0.00 No Plan Doctors Only Berkshire Franklin Hampden Hampshire HNE Medicare Plus Rx HMO $109.00 Yes Plan Doctors Only Berkshire Franklin Hampden Hampshire HNE Medicare Premium No Rx HMO $79.00 No Plan Doctors Only Berkshire Franklin Hampden Hampshire HNE Medicare Premium Rx HMO $166.00 Yes Plan Doctors Only Berkshire Franklin Hampden Hampshire HNE Medicare Value HMO $25.00 Yes Plan Doctors Only Berkshire Franklin Hampden Hampshire HNE Medicare Select HMO- POS $90.00 Yes Plan Doctors for Most Services Berkshire Franklin Hampden Hampshire Effective January 2019 Medicare Advantage Plans Offered in Massachusetts in 2019 Plan Name Plan Type Monthly Premium Drugs Doctor Choice Counties Tufts Health Plan Phone: 1-877-218-4835 TTY/TDD: 711 Medicare Preferred HMO Basic HMO $20.00 No Plan Doctors Only Worcester Medicare Preferred HMO Basic No Rx HMO $28.00 No Plan Doctors Only Essex Suffolk Medicare Preferred HMO Basic Rx HMO $23.00 Yes Plan Doctors Only Hampden Hampshire Medicare Preferred HMO Basic Rx HMO $40.00 Yes Plan Doctors Only Barnstable Bristol Middlesex Norfolk Plymouth Medicare Preferred HMO Basic Rx HMO $66.00 Yes Plan Doctors Only Essex Suffolk Medicare Preferred HMO Basic Rx HMO $42.00 Yes Plan Doctors Only Worcester Medicare Preferred HMO Prime No Rx HMO $133.00 No Plan Doctors Only Barnstable Bristol Middlesex Norfolk Plymouth Medicare Preferred HMO Prime No Rx HMO $67.00 No Plan Doctors Only Hampden Hampshire Medicare Preferred HMO Prime No Rx HMO $156.00 No Plan Doctors Only Essex Suffolk Medicare Preferred HMO Prime No Rx HMO $152.00 No Plan Doctors Only Worcester Medicare Preferred HMO Prime Rx HMO $165.00 Yes Plan Doctors Only Barnstable Bristol Middlesex Norfolk Plymouth Medicare Preferred HMO Prime Rx HMO $79.00 Yes Plan Doctors Only Hampden Hampshire Medicare Preferred HMO Prime Rx HMO $188.00 Yes Plan Doctors Only Essex Suffolk Medicare Preferred HMO Prime Rx HMO $185.00 Yes Plan Doctors Only Worcester Medicare Preferred HMO Prime Rx Plus HMO $99.00 Yes Plan Doctors Only Hampden Hampshire Medicare Preferred HMO Prime Rx Plus HMO $199.00 Yes Plan Doctors Only Barnstable Bristol Middlesex Norfolk Plymouth Medicare Preferred HMO Prime Rx Plus HMO $220.00 Yes Plan Doctors Only Essex Suffolk Medicare Preferred HMO Value No Rx HMO $41.00 No Plan Doctors Only Hampden Hampshire Medicare Preferred HMO Value No Rx HMO $103.00 No Plan Doctors Only Barnstable Bristol Middlesex Norfolk Plymouth Effective January 2019 Medicare Advantage Plans Offered in Massachusetts in 2019 Plan Name Plan Type Monthly Premium Drugs Doctor Choice Counties Tufts Health Plan (Continued) Phone: 1-877-218-4835 TTY/TDD: 711 Medicare Preferred HMO Value No Rx HMO $123.00 No Plan Doctors Only Essex Suffolk Medicare Preferred HMO Value No Rx HMO $112.00 No Plan Doctors Only Worcester Medicare Preferred HMO Value Rx HMO $131.00 Yes Plan Doctors Only Barnstable Bristol Middlesex Norfolk Plymouth Medicare Preferred HMO Value Rx HMO $54.00 Yes Plan Doctors Only Hampden Hampshire Medicare Preferred HMO Value Rx HMO $151.00 Yes Plan Doctors Only Essex Suffolk Medicare Preferred HMO Value Rx HMO $146.00 Yes Plan Doctors Only Worcester Medicare Preferred HMO Saver Rx HMO $0.00 Yes Plan Doctors Only Barnstable Bristol Essex Hampden Hampshire Middlesex Norfolk Plymouth Suffolk Worcester Effective January 2019 Types of Plan and Program Offerings 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 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 may also 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 receive. 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 lowincome seniors maintain their health and stay in their own homes. With SCO, a team of medical professionals work 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 which may include services 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.