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Make a game plan
What’s the best game plan for your team?
To help you decide the best plan for you, the following charts present several considerations in choosing a new plan.
1. Comparison of network features
Below are the various costs associated with the city medical plans. Be sure to consider your unique needs in determining which plan is best for you and your Medicare-eligible dependent.
Plan feature |
What you pay |
|
Aetna |
TexanPlus |
Texas
HealthSpring |
HMO |
PPO
in-network |
Deductible (Individual/Family) |
N/A |
N/A |
N/A |
N/A |
$200 / $600 |
PCP office visit copayment |
$15 |
$10 |
$10 |
$20 |
$30 |
Specialist office visit copayment |
$15 |
$25 |
$25 |
$45 |
$50 |
Routine physical copayment |
$0 |
$0 |
$0 |
$0 |
$0 |
Well woman/man exam |
$0 |
$0 |
$0 |
$0 |
$0 |
Inpatient copayment/coinsurance |
$0 |
$300 |
$275 |
$500 |
$500 + 20% |
Emergency room |
$50 |
$50 |
$50 |
$150 |
$150 + 20% |
Ambulance |
$15 |
$50 |
$100 |
$100 |
20% |
Outpatient surgery |
$0 |
$125 / $175 |
$200 |
$200 |
20% |
Prescriptions participating pharmacy |
(31-day supply) |
(30-day supply) |
Generic |
$10 |
$10 |
$10 |
$10 |
$10 |
Preferred brand |
$30 |
$30 |
$30 |
$30 |
$30 |
Non-preferred brand |
$45 |
$45 |
N/A |
$45 |
$45 |
Specialty drugs |
$45 |
$45 |
$45** |
$30/$45*** |
$30/$45*** |
Prescriptions (90-day supply) participating pharmacy |
Generic |
$20 |
$20* |
$20 |
$20 |
$20 |
Preferred brand |
$60 |
$60* |
$60 |
$60 |
$60 |
Non-preferred brand |
$90 |
$90* |
N/A |
$90 |
$90 |
Specialty drugs |
$90 |
$90* |
$90** |
$30/$45*** |
$30/$45*** |
Prescriptions special copayments |
Medicare Part B |
$0 |
20% up to $1,500 |
15% up to $1,000 |
Included under “Non-preferred brand” copayments listed above |
*TexanPlus has discontinued the mail order option; however, you can fill a 90-day prescription for a 2-months copayment at your local network pharmacy.
** Prior authorization required
*** Specialty-prescription drugs must be obtained through the Triessent Specialty Drug Program.
2. Comparison of network physicians
In TexanPlus, Texas HealthSpring and HMO Blue Texas, you must select a PCP to coordinate your health care. It is not necessary to select a PCP to direct your care in the Aetna PFFS plan, but it is recommended that you do so. To see if your preferred physicians are in one of these networks, use the contact information on page 1.
Physician Group |
Aetna |
TexanPlus |
Texas
HealthSpring |
HMO Blue Texas |
Brazosport Regional Health System |
Most physicians accepting Medicare and Aetna PFFS terms
of participation. |
|
X |
|
Clear Creek Clinic |
|
X |
|
CyFair IPA |
X |
|
|
Family Practice Associates |
|
X |
|
Heritage |
X |
|
|
North Central LPO (Formerly HispanicCare) |
X |
|
|
Independent Physicians |
|
X |
X |
Integranet |
X |
|
|
Katy IPA |
X |
|
|
Kelsey-Seybold Clinic |
X |
X |
X |
Memorial Clinical Associates |
X |
X |
|
Northwest Diagnostic Clinic |
X |
|
|
Pasadena LPO (Formerly SEMNet) |
X |
|
|
Physicians of East Texas |
|
X |
|
Renaissance |
|
X |
X |
Sr. SelectCare Clinic |
X |
|
|
Sadler Clinic |
|
X |
X |
Southeast Regional LPO |
X |
|
|
Village Family Practice |
X |
X |
|
Total PCPs |
About 96% of all U.S. doctors accept Medicare |
478 |
1,080 |
1,324 |
Total Specialists |
1,668 |
1,476 |
8,412 |
Total Physicians |
2,146 |
2,556 |
9,739 |
Physician count as of 12/31/08.
3. Comparison of network hospitals
Listed below are just some of the hospitals in the TexanPlus, Texas HealthSpring and HMO Blue Texas networks. For a complete list, check the Web sites or call one of the numbers in the contact box on page 1. If a hospital accepts Medicare and Aetna terms and conditions, it will be in the Aetna Private-Fee-for-Service plan.
In an emergency, you may seek treatment at any hospital, under any plan; however, you may be transferred to a network facility as soon as your condition is stabilized.
Hospital |
Aetna* |
TexanPlus |
Texas
HealthSpring |
HMO Blue |
Angleton Danbury Medical Center |
Most hospitals accepting Medicare and Aetna PFFS terms
of participation. |
X |
|
X |
Bayshore Medical Center |
X |
X |
|
Brazosport Regional Health System |
X |
|
|
CHRISTUS St. John |
X |
X |
X |
Clear Lake Regional Medical Center |
X |
X |
X |
East Houston Medical Center |
X |
X |
|
Houston Northwest Medical Center |
X |
X |
X |
Kingwood Medical Center |
X |
X |
X |
Mainland Medical Center |
X |
X |
|
M.D. Anderson Cancer Center |
|
|
X** |
Memorial Hermann Hospital Syst. |
X (8 facilities) |
X |
X |
Methodist Hospital |
X |
X |
X |
Park Plaza |
X |
X |
X |
St. Joseph Medical Center |
X |
X |
X |
St. Luke’s - Woodlands |
X (Kelsey only) |
X (Kelsey only) |
X |
St. Luke’s Episcopal Hospital |
X (Kelsey only) |
X (Kelsey only) |
X |
Spring Branch Medical Center |
X |
X |
X |
West Houston Medical Center |
X |
X |
X |
Women’s Hospital of TX |
X (Kelsey only) |
X |
X |
* Most hospitals accept Medicare. Check the hospital where you live.
** By referral only.
4. Extra services
Listed below are value-added services for MA plans. When making your health-care decision, take into account these unique bonus features.
Extra
Services |
Aetna |
TexanPlus |
Texas HealthSpring |
Free rides to appointments |
N/A |
N/A |
Up to 30 free rides (15 round trips) per year to doctor appointments, hospitals and pharmacies in conjunction with doctor visits. |
Fitness programs for seniors |
Membership discounts through GlobalFit for health clubs. Weight management discount program through Jenny Craig. Call 800-298-7800. |
25-50% membership discounts to participating health clubs through Careington. |
Silver Sneakers - free health club membership and fitness classes. |
Discounted hearing services |
One routine hearing exam free per year. |
30% discount through HearPO on hearing exams. |
N/A |
Hearing aids |
$500 reimbursement on hearing aids every 36 months. Contact Member Services at 866-785-7337 for additional information. |
One-time $500 cash payment per covered member for the purchase of a hearing aid. Up to 62% savings on hearing aids through HearPO at participating providers. Discounts on repairs and batteries. |
Up to a 30% discount for hearing aids from selected providers. |
Discounted dental services |
N/A |
20-50% savings on most dental procedures through Careington. 20% discount on specialty services, cosmetic dentistry and teeth whitening. |
20-50% savings on most dental procedures through Careington. 20% discount on specialty services, cosmetic dentistry and teeth whitening. |
Discounted vision services |
One routine eye exam free per year. Discounts on frames and lenses at participating provider locations. Call 800-793-8616. For discounts on Lasik procedures, call 800-422-6600. |
$25 for an annual eye exam through EyeMed; and discounts on frames and lenses Check provider directory for participating provider locations. |
N/A |
ElderCare services |
N/A |
Services provide wellness assessments, identification of elder-care needs, ongoing support in maintaining an independent quality of life. Discounts on additional care alternatives. |
N/A |
Extra customer service |
N/A |
N/A |
Members are assigned a Personal Assistant Liaison (PAL) to guide them to better understand benefits and help with resolving any issues. Call your PAL at 866-897-0828. |
Newsletters |
Quarterly member newsletter |
Bimonthly member newsletter |
Quarterly member newsletter |
Disease management |
Aetna conducts a health risk assessment for every new member by personalized phone call outreaches. Plan provides care management with dedicated case managers specializing in geriatric case management. |
Each new member receives an initial health risk assessment. The health care program helps manage diabetes, CHF, coronary artery disease and COPD. |
Health-care communications and interventions provided to promote better health, fewer complications and lower health care costs. Examples: diabetes, CHF, asthma, etc. |
Wellness services |
Informed Health Line - provides a 24-hr number, 800-556-1555 to get information on a variety of health topics. IntelliHealth - provides online features to help educate and promote wellness. |
24/7 nurse support line, plus a dedicated team of nurses, a pharmacist and health-care professionals who provide support as you consider lifestyle changes to improve your health. |
Immunizations, well-woman / well man exams, bone mass measurement, colorectal screening and smoking cessation programs. Livingwell health center at St. Joseph’s Hospital. |
Emergency coverage |
Worldwide |
U.S. only |
Worldwide |
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