最高支付 家庭医生 专科医生 住院 门诊手术 药费首付 首选常药 常药 首选新药 新药 特种药
AetnaMedicare Freedom Plan PPO H2293-016 5900 0 30 300/day 250 150 0 0 47 100 30%
Aetna Medicare Value Plan PPO H3288-047 7550 0 40 350/day 250 300 0 5 47 100 28%
Aetna Medicare Premier Plan HMO H4523-015 6350 0 35 300/day 250 150 0 0 47 100 30%
Aetna Medicare Prime Plan HMO H4523-024 3850 0 25 200/day 200 0 0 0 47 100 33%
Aetna Medicare select Plan HMO H8332-003 3850 0 20 195/day 175 150 0 0 47 100 30%
Aetna Medicare Choice Plan * PPO H3288-006 5900 0 30 300/day 325 250 0 10 0 50% 29%
Amerivantage select plus （WellPoint） HMO H8849-009 3400 0 25 120/day 50 0 3 10 42 95 33%
Blue Cross Medicare advantage Basic HMO H8133-001 3850 0 20 310/day 275 0 0 8 47 100 33%
Blue Cross Medicare advantageValue HMO H9706-005 3850 0 19 310/day 175 0 0 8 47 100 33%
Blue Cross Medicare advantage Dental value HMO H9706-007 3850 0 30 370/day 275 545 0 8 47 100 25%
Blue Cross Medicare advantagesAVER HMO H9706-008 6900 0 30 370/day 350 0 0 8 47 100 33%
Blue Cross Medicare advantage classic PPO H4801-002 5900 0 30 300/day
200 0 8 47 100 30%
Blue Cross Medicare advantage Complete PPO H4801-011 5900 0 19 300/day
0 0 8 47 100 33%
Blue Cross Medicare advantage health Choice PPO H4801-018 6900 0 45 370/day 375 545 0 8 47 100 25%
Blue Cross Medicare advantage Choice Plus PPO H1666-006 7950 9 45 375/day 350 545 0 8 47 100 25%
Cigna Aliance Medicare HMO H4513-064 2900 0 10 215/stay 125 0 0 4 45 95 33%
Cigna Preferred Medicare HMO H4513-061 3400 0 20 300/stay 150 0 0 4 45 95 33%
Cigna True Choice Medicare PPO H7849-038 6100 0 30 325/day 275 0 0 4 45 95 33%
Cigna Preferred Savings Medicare HMO H4513-083 6900 0 45 320/day 350 0 0 4 45 95 33%
Devoted Health great Houston HMO H7993-001 3400 0 20 225/stay 150 0 0 0 40 80 33%
Devoted GiveBack great Houston HMO H7993-006 6900 0 45 325/day 325 395 0 7 47 100 27%
Humana Gold Plus  HMO H0028-042 3450 0 20 350/stay 100 0 0 0 47 100 33%
Humana Choice  PPO H5216-043 6700 0 35 320/day 300 0 0 5 45 99 33%
Humana Choice  PPO H5216-358 7500 0 45 320 300 395 0 5 47 100 27%
KelseyCare Advantage Rx HMO H0332-002 3450 0 20 375/stay 300 100 0 5 45 90 31%
KelseyCare Advantage Gold Freedom HMO-POS H0332-004 3450 0 20 325/stay 300 100 0 5 45 90 31%
KelseyCare Advantage Platinum HMO H0332-009 4000 0 20 300/stay 300 0 0 5 45 90 33%
Memorial Hermann Advantage HMO HMO H7115-001 2950 0 15 350/stay 300 0 0 0 47 100 33%
Molina Medicare Choic Care HMO H7678-004 8300 0 25 325/day 500 125 3 12 47 100 31%
Molina Medicare Choic Care select HMO H7678-005 8300 0 50 450/day 500 200 15 20 47 100 29%
SCAN Classic HMO H8902-005 2900 0 15 200/day 150 0 0 0 35 90 33%
SCAN Venture HMO H8902-008 5000 0 40 275/day 275 0 0 0 35 90 33%
AARP Medicare Advantagefrom UHC TX-0006 PPO H1278-014 6700 0 40 375/day 375 245 0 10 47 100 33%
AARP Medicare Advantagefrom UHC TX-001P HMO-POS H4514-014 3700 0 20 295/day 200 0 0 0 47 100 33%
AARP Medicare Advantagefrom UHC TX-0015 HMO-POS H4527-037 3800 0 25 350/day 250 0 0 12 47 100 33%
AARP Medicare Advantagefrom UHC TX-0031 PPO H1278-021 7900 0 50 390/day 340 350 0 14 47 100 27
Wellcare No Premium HMO H0174-010 3700 0 25 250/day 250 275 0 5 42 49% 29%
Wellcare TexasPlus Class no Premium HMO H4506-003 3400 0 20 325/day 325 0 0 0 42 49% 33%
Wellcare GiveBack HMO H0174-019 8850 0 50 395/day 395 545 0 5 42 47 25%
Wellcare TexasPlus no Premium HMO-POS H4506-029 3400 0 40 325/day 240 250 0 0 42 50% 29%
Wellcare No Premium Open PPO H7323-003 6700 0 35 300/day 300 200 0 5 42 50% 30%































急诊 救护车 健身房 接送 助听器 眼镜/年 牙齿 OTC 每月退款

AetnaMedicare Freedom Plan PPO H2293-016 120 260 y No 1000 $275 2500 55


Aetna Medicare Value Plan PPO H3288-047 100 260 y No 500 $200 2500 50


Aetna Medicare Premier Plan HMO H4523-015 120 290 y No 500 $250 2500 30


Aetna Medicare Prime Plan HMO H4523-024 135 270 y No 1250 $225 3500 40


Aetna Medicare select Plan HMO H8332-003 135 255 y y 500 325 3500 55


Aetna Medicare Choice Plan* PPO H3288-006 100 300 y No 500 325 3500 55


Amerivantage select plus （WellPoint） HMO H8849-009 120 210 y y 3000 200 2500 66.67


Blue Cross Medicare advantage Basic HMO H8133-001 135 295 y y 699 150 1000 33.33


Blue Cross Medicare advantageValue HMO H9706-005 135 295 y y 699 150 1000 33.33


Blue Cross Medicare advantage Dental value HMO H9706-007 135 275 y No 699 100 5000 16.66


Blue Cross Medicare advantagesAVER HMO H9706-008 100 275 y No 699 100 1000 No


Blue Cross Medicare advantage classic PPO H4801-002

y No 699 125 2000 16.66


Blue Cross Medicare advantage Complete PPO H4801-011

y No 699 100 2000 25


Blue Cross Medicare advantage health Choice PPO H4801-018 100 275 y NO 699 100 1000 16.66


Blue Cross Medicare advantage Choice Plus PPO H1666-006 100 275 y No 699 100 1000 no


Cigna Aliance Medicare HMO H4513-064 135 250 Y Y 399 350 2500 56.66


Cigna Preferred Medicare HMO H4513-061 135 250 y y 399 250 2000 30


Cigna True Choice Medicare PPO H7849-038 120 260 y No 399 300 2100 30


Cigna Preferred Savings Medicare HMO H4513-083 100 250 Y No 399 200 2000 20 125

Devoted Health great Houston HMO H7993-001 135 250 y No 399 300 4000 31.66


Devoted GiveBack great Houston HMO H7993-006 100 250 y No 399 200 1000 18.33 164.9

Humana Gold Plus  HMO H0028-042 135 300 y y 699 200 3000 25


Humana Choice  PPO H5216-043 100 290 Y No 699 No 2500



Humana Choice  PPO H5216-358 100 300 Y No 699 150 1500 13.33 60

KelseyCare Classic HMO H0332-002 120 225 Y y 750 75 3000 13.33


KelseyCare Advantage Gold Freedom HMO-POS H0332-004 120 $225 y y 750 125 2500 31.66


KelseyCare Advantage Signature HMO H0332-009 120 $100 y y 750 125 3000 41.3


Memorial Hermann Advantage HMO HMO H7115-001 125 $250 y y 1400 100 3000 50


Molina Medicare Choic Care HMO H7678-004 100 20% y y No 200 1050 36.66


Molina Medicare Choic Care select HMO H7678-005 95 20% y y No 300 1050 70 100

SCAN Classic HMO H8902-005 90 225 y Y 450 250 unlimit 16.66


SCAN Venture HMO H8902-008 90 225 y y 450 150 No 10 75

AARP Medicare Advantagefrom UHC TX-0006 PPO H1278-014 100 275 y No 99 0 500 13.33


AARP Medicare Advantagefrom UHC TX-001P HMO-POS H4514-014 135 150 y No 99 300 3000 15


AARP Medicare Advantagefrom UHC TX-0015 HMO-POS H4527-037 135 290 y No 99 250 500 13.33


AARP Medicare Advantagefrom UHC TX-0031 PPO H1278-021 100 275 Y No 99 100 No No 51

Wellcare No Premium HMO H0174-010

y y 750 200 3000



Wellcare TexasPlus Class no Premium HMO H4506-003

Y Y 750 200 1500 23


Wellcare GiveBack HMO H0174-019

y No 350 100

105

Wellcare TexasPlus no Premium HMO-POS H4506-029 135 200 y No no 100 1000 13.33


Wellcare No Premium Open PPO H7323-003 100 300 y No 500 100 2000



 

primary care visit 家庭医生
Specialist visit 专科医生
inpatient 住院
outpatient 门诊手术
Home health care 上门服务
Other part B drugs 医院用药
Durable Medical Equipment  医疗器具
over the count OTC
transport 接送
Monthly premium 月费
out-of-pocket limits 最高支付
annual part D deductible 药费首付
Tier 1: Preferred Generic 首选常药
Tier 2: Non-Preferred Generic 常药
Tier 3: Preferred Brand  首选新药
Tier 4: Non-Preferred Brand  新药
Tier 5: Specialty Tier 特种药
Cap coverage 药缺口复盖
Overall Plan rating 评价(1-5)
members in Hirris county H县会员
Chemo Drugs  
Durable Medical Equipment   
Part D drug