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2001 Premium and Selected Benefit Copayments: Tampa Medicare+Choice Plans

(31-day)

$5

$15

Not available

Unlimited

$125/3 months non-formulary generic & all brand

$30

$30

Not available

See above

(31-day)

$7

$20

Not available

Unlimited

$125/3 months non-formulary generic & all brand

$30

$30

Not available

See above

$8

$40

$24

$120

$500/year

Plan has no formulary

$10

Not covered

$30

Not covered

Unlimited

Not covered

Not covered

$5

$15

$15

$45

Unlimited

$50/month formulary & non-formulary brand

$30

$30

$90

$90

See above

$5

$20

$15

$60

Unlimited

$250/6 month formulary & non-formulary brand

$35

$35

$105

$105

See above

No prescription drug coverage

$10

$20 preferred

$20

$40 preferred

$150/3 months generic and preferred & non-preferred brand

$10

$40

$10

$80

See above

Prescription drugs

Formulary drugs

30–31-day supply

Generic copay

Brand copay

90-day mail order

Generic copay

Brand copay

Cap

Generic

Brand

Non-formulary

30–31-day supply

Generic copay

Brand copay

90-day mail order

Generic copay

Brand copay

Cap

$0

$0

$0

$0

$0

$0

$15/physician’s office, $40/non- physician clinic

$10/physician’s office, $40 non-physician clinic

Bone mass measurement

$0

$0

$0

$0

$0

$0

$0

$0

Home health care

$0

$0

$0

$0

$75

$75

$0

$0

$0

$0

$97

$0/day

$90/day

$0/day

$85/day

Skilled nursing facility:Days 1–20

Days 21–100

$0

$200/stay

$150/day

$300/stay

$100/stay

$150/day

$500 per admiss.; $200/day for days 7–30 at network hospital

$500 per admiss.; $200/day for days 7–30 at network hospital

Inpatient hospital care

$10/visit

$15/visit

$25/visit

$10–$15/visit

$10–$15/visit

$25/visit

$40/visit

$40/visit

Outpatient rehabilitation services

$10/service

$15/service

$5–$50

$0

$0

$0

$40/visit

$40/visit

Radiation therapy

$0

$0

$0

$0

$5

$5 X-ray; $50 other radiation services

$0

$0

$0

$0

$0

$0

$0

$40–$350

$0

$40–$200

Diagnostic tests:Clinical lab

X-rays/diagnostic lab

$0

$0

20%

$0

$0

$0

$0

$0

Durable medical equipment

$25

$25

$25

$25

$100

$50

$50

$50

$35

$35

$0

$50

$500

$500

$200

$200

Outpatient visits:Ambulatory surgery

Hospital visit

$5

$10

$10

$15

$15

$20

$10

$15

$10

$15

$10

$25

$15

$15–$400

$10

$5–$200

Doctor visits:Primary care

Specialist

$19

$0

$0

$0

$179

$63

$0

$63

Premium

Yes

No

No

No

No

Yes

No

No

Enrollment limit

Plan Z2

Plan Z1

Plan Y

Plan X2

Plan X1

Plan W

Plan V2

Plan V1

a Plan Y has a $3,500 out-of-pocket limit protection for combined inpatient and outpatient services, not including certain office visit copays, prescription drugs, medical supplies, and selected other benefits.

b $40 specialist per visit copay, except $10/visit to Allergy physicians, $5/specimen to hospital pathologists, $5/interpretation to hospital radiologists, $50/visit to ER physician, $200 for cataract surgery, $50/each allergy skin testing, and 40% of charges for non-plan second medical opinion.

c $50 specialist per visit copay, except $15/visit to Allergy physicians, $15/specimen to all hospital pathologists, $15/interpretation to hospital radiologists, $50/ visit to ER physicians, $400 for cataract surgery, and 50% of charges for non-plan second medical opinion.

d $200 copay for complex procedures, defined as Cardiac Catheterization, MRI, Lithotripsy, Nuclear Stress Test, CAT Scan, and PET Scan; $40 copay for all other simple diagnostic testing procedures; and $50 copay for allergy skin testing.

e $350 copay for complex procedures, defined as Cardiac Catheterization, MRI, Lithotripsy, Nuclear Stress Test, CAT Scan, and PET Scan; $40 copayment for all other simple diagnostic testing procedures; and $50 copay for allergy skin testing.

f $1,000 per admission and $200/day for days 7-30 at non-participating hospitals.

g $1,000 per admission and $300/day for days 7-30 at non-participating hospitals.

h Glucose monitors, test strips, lancets, and self-management training.

Source: G. Dallek and C. Edwards, Restoring Choice to Medicare + Choice: The Importance of Standardizing Health Plan Benefit Packages, The Commonwealth Fund, October 2001.

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