Reminder: Medicare Advantage HMO and PPO benefits changes

Home

Administrative

Billing & Reimbursement

TitleWeb
Reminder: Medicare Advantage HMO and PPO benefits changes

December 29, 2011

[

Effective January 1, 2012, there were several changes to our current Medicare Advantage HMO and PPO plans in addition to the introduction of our new limited network HMO plan, Keystone 65 Select HMO. The following tables highlight some of these changes. Please note that this is a list of our significant benefits changes, not a comprehensive list of all benefits changes.

Keystone 65 Preferred HMO benefits changes

Keystone 65 Preferred HMO Benefit 2011 Changes for 2012 Smoking and tobacco use cessation counseling Not covered Covered; no copayment Diabetes screening Not covered Covered; no copayment Inpatient hospital care $175 copayment per day, days 1-8; $1,400 maximum per stay $190 copayment per day, days 1-8; $1,520 maximum per stay Skilled nursing facility care $20 copayment per day for days 1-20;
$100 copayment per day for days 21-100 $30 copayment per day for days 1-20;
$110 copayment per day for days 21-1000 Physician services, including doctor's office visit $15 copayment for each primary care physician office visit $10 copayment for each primary care physician office visit Outpatient hospital services $150 copayment in ambulatory surgical center;
$300 copayment in outpatient hospital facility $100 copayment in ambulatory surgical center;
$350 copayment in outpatient hospital facility Urgently needed care $15 - $40 copayment $10 - $40 copayment Radiation therapy $25 copayment per visit $40 copayment per visit Complex radiology $80 copayment for complex radiology, which includes MRI/MRA, CTA/CT scans, PET scans, and nuclear cardiology studies $100 copayment for complex radiology, which includes MRI/MRA, CTA/CT scans, PET scans, and nuclear cardiology studies

Personal Choice 65^SM PPO benefits changes

Benefit	In-network		Out-of-network
Benefit	2011	Changes for 2012	2011	Changes for 2012
Smoking and tobacco use cessation counseling	Not covered	Covered; no copayment	Not covered	Covered; no copayment
Diabetes screening	Not covered	Covered; no copayment	Not covered	Covered; no copayment
Primary care visit	$20 copayment	$10 copayment	Member responsible for 30% of charges after $500 deductible is met	Member responsible for 30% of charges after $500 deductible is met
Outpatient hospital services	$125 copayment in ambulatory surgical center $250 copayment in outpatient hospital facility	$100 copayment in ambulatory surgical center $350 copayment in outpatient hospital facility	Member responsible for 30% of charges after $500 deductible is met	Member responsible for 30% of charges after $500 deductible is met
Ambulance services	$100 copayment	$75 copayment	$100 copayment	$75 copayment
Urgently needed care	$20 - $40 copayment	$10 - $40 copayment	$20 - $40 copayment	$10 - $40 copayment

Optional supplemental benefits package available to Keystone 65 Select HMO members

Our new Keystone 65 Select HMO members have the option to purchase the Choice Program, an optional supplemental benefits package, for an additional $10 a month. The optional supplemental benefits package covers vision, dental, and hearing, as these benefits are not included for Keystone 65 Select HMO members. See the table below for details about the supplemental benefits package.

Covered services	Member pays
Dental services ? Preventive dental
One exam and cleaning every six months	$15 copayment
Hearing services
Non-Medicare-covered routine hearing exams, including fitting and evaluation for two hearing aids, covered every three years	$45 copayment for non-Medicare-covered hearing exams and evaluation
Hearing aids, covered every three years	Up to $500 for two hearing aids every three years
Vision care
Non-Medicare-covered routine eye exams, every two years	$0 copayment for routine eye exams, once every two years
Eyewear not covered by Medicare, every two years	$100 for eyewear every two years