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HMO plans PPO and POS plans Nationwide coverage

HMO plans at a glance HMO service areas What it costs per month Time of service costs HMO networks chart HMO hospitals chart

PPO and POS plans at a glance PPO and POS service areas What it costs per month Time of service costs PPO and POS in-network hospitals

Network-free plans at a glance Medicare supplement Plan F Network-free service area What it costs per month Time of service costs

Prescription highlight reel Prescription copayments Top 10 retiree prescriptions

Want to join the game? Medicare plans rules to know

Comparison of plans

Your playbook

You’ve got options like never before. There are five different kinds of plans — a total of nine plans to choose from. There’s bound to be a plan that fits you. To choose which is best for you, read over the summary of each plan type below. See which one best fits your priorities. Then, follow the directions to choose a specific plan.

We’ve grouped the nine plans into three categories: HMO plans, PPO and similar plans, and network-free plans. Prescription drug coverage is the same under each plan, although the formulary for each plan is different.

Which plan type is best for me?

HMO plans:

Texas HealthSpring
TexanPlus
KelseyCare Advantage HMO
BlueCross BlueShield HMO

Low-cost, great care. These four plans offer you low premiums and copayments – you pay as little as $3.50 a month for coverage, and copayments for most services are between $0 and $20. But you have to stay within a network for services and must select a primary-care physician to coordinate your care.

These are high-quality doctors who will get to know you and your ailments well and who are close by where you live. Service areas vary by plan. Available networks include Kelsey-Seybold, Renaissance, Sadler, Memorial and independent doctors. If you don’t mind having your coverage access limited to a local network of doctors, and you want to save money, compare these different HMO plans.

PPO and POS plans:

Aetna PPO
BlueCross BlueShield PPO
KelseyCare Advantage Plus Choice POS

Room to stretch your wings. These plans give you greater flexibility. You select a network for coverage, but you can go outside that network for a slight increase in cost of services. You select a primary-care physician but have the freedom to see a doctor outside your network. The KelseyCare Point-of-Service plan lets you go out of network for specialists.

These plans may cost a little more – although KelseyCare Advantage Plus Choice POS is just $17.25 a month. Copayments for most services in-network are $15-30. If you want to balance a little more freedom to choose a doctor near your grandkids with paying a little more, compare these plans.

Nationwide coverage:

Aetna Private-Fee-For-Service

Medicare supplement Plan F

Unfettered freedom! But, as freedom fighters everywhere discover, freedom comes with a price. These plans allow you to go to doctors nationwide, but they have a slightly higher monthly contribution. In the Aetna PFFS, there are no deductibles, and copayments for most services are $15 or less — and in the Medicare supplement Plan F, the plan pays most out-of-pocket expenses for most Medicare-approved services not paid by Original Medicare.

Medicare supplement insurance plans, or Medigap plans, are Medicare-based. Medicare supplement plans are sold to individuals by many companies in the U.S. There are 12 different kinds of supplement plans, each with their own features. Medicare supplement insurance companies can only sell you a “standardized” Medicare supplement plan identified by letters A through L. Each standardized Medicare supplement policy must offer the same basic benefits.

Recently, a few companies have offered these plans through employers. That’s why we can offer this new plan to you now. The cost is the same to you. The advantage is that you can have the monthly premiums deducted from your pension check, and the city handles the administration for you.

The more expensive plans move beyond the basic benefits and cover most time-of-service costs. We’re offering Medicare supplement Plan F. For less than $92 a month, you get coverage for nearly everything that Medicare doesn’t cover —leaving you with very little out-of-pocket expenses. The plan costs you less than the BCBS PPO and has better benefits. This plan is especially beneficial to retirees living outside Texas, or for those who travel.

If freedom to choose any doctor who will have you is more important to you than the price tag of the plan, turn to page 19 to compare these plans.

Medicare is eliminating PFFS plans throughout the United States. On Dec. 31, 2010, the Aetna PFFS will no longer be available to city of Houston retirees and you will need to elect another plan for the future.

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