2010 Today's Health HMO Plans
Today’s Health plans are offered in Milwaukee, Ozaukee, Racine and Waukesha counties in Wisconsin.
What plan is right for you?
Compare your plan options. Use the chart below for an overview of Today's Health HMO benefits and copays.
| Today's Health Value (HMO) |
Today's Health Classic powered by CCRx (HMO) |
Today's Health Premier powered by CCRx (HMO) |
|
| Monthly Premium* | $0 | $19 | $59 |
| Monthly Part B Premium Reduction* | $29.80 | $0 | $0 |
| 2010 MEDICARE-COVERED MEDICAL BENEFITS | |||
| Annual Out-of-Pocket Limit | $3,250 | $3,250 | $3,000 |
| Inpatient Hospital Care: | |||
| Initial coverage, you pay: | Days 1-7: $250 per day | Days 1-7: $270 per day | Days 1-7: $195 per day |
| Additional days, you pay: | $0 Days 8-90 | $0 Days 8-90 | $0 Days 8-90 |
| Primary Care Physician (PCP) Copay: | $7 per visit | $0 per visit | $0 per visit |
| Specialist Copay: | $30 per visit | $35 per visit | $30 per visit |
| Outpatient Surgery – Ambulatory / Hospital: | |||
| Ambulatory surgical center: | $100 per visit | $125 per visit | $100 per visit |
| Outpatient hospital facility: | $200 per visit | $225 per visit | $175 per visit |
| Skilled Nursing Facility: | |||
| Initial coverage Days 1-20, you pay: | $0 | $0 | $0 |
| Additional days (21 - 100) each day, you pay: | $125 | $133.50 | $100 |
| Emergency Care: | $50 | $50 | $50 |
| Annual Preventive Services: | Bone Mass Measurement, Colorectal Screening Exam, Pneumonia & Flu Vaccine, Screening Mammogram, Pap Smear & Pelvic Exam, Prostate Screening | ||
| Each visit, you pay: | $0 | $0 | $0 |
| OTHER BENEFITS | |||
| Dental | $15 copay per visit (up to 2 per year). Includes:
|
$15 copay per visit (up to 2 per year). Includes:
|
$15 copay per visit (up to 2 per year). Includes:
|
| Hearing |
|
|
|
| Vision |
|
|
|
| 2010 MEDICARE PART D PRESCRIPTION DRUG COVERAGE | |||
| Phase 1: DEDUCTIBLE |
No Coverage | $0 | $0 |
| Phase 2: INITIAL COVERAGE |
Amount paid for prescriptions by both you and the plan until the combined total (co-pay & coinsurance) reaches $2,830 | ||
| You pay: | 30-day / 90-day supply | ||
| Generic Drugs | No Coverage | $5 / $12.50 | $5 / $12.50 |
| Preferred Brands | No Coverage | $35 / $87.50 | $35 / $87.50 |
| Non-Preferred Brands | No Coverage | $65 / $162.50 | $65 / $162.50 |
| Specialty Drugs | No Coverage | 33% coinsurance | 33% coinsurance |
| Phase 3: GAP COVERAGE |
Amount you pay for prescriptions between the Initial Coverage and until you reach $4,550 in out-of-pocket covered prescription drug costs | ||
| You pay: | 30-day / 90-day supply | ||
| Generic Drugs | No Coverage | 100% | $5 / $12.50 |
| Preferred Brands | No Coverage | 100% | $35 / $87.50† |
| Non-Preferred Brands | No Coverage | 100% | 100% |
| Specialty Drugs | No Coverage | 100% | 100% |
| Phase 4: CATASTROPHIC COVERAGE |
Amount you pay for prescriptions after you reach $4,550 in out-of-pocket covered prescription drug costs | ||
| You pay: | 30-day / 90-day supply | ||
| Generic Drugs | No Coverage | The greater of 5% coinsurance or $2.50 | |
| Brand Drugs | The greater of 5% coinsurance or $6.30 | ||
† Restrictions apply
*You must continue to pay your Medicare Part B premium
The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact the plan.
If you decide to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for it to take effect and you will remain responsible for those premiums.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7days a week);
- The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
- Your State Medicaid Office.
Note: Today's Health has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. We will not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. The pharmacies in our network can change at any time. You can ask for a Pharmacy Directory or visit our website.
For full information on plan benefits, call our Customer Service Department at 1-866-249-8668 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call: 1-800-777-9083) every day.
