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 65SM PPO benefits
changes
|
|
|
|
|
|
|
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
|
Note: Vision, dental, and
hearing are still included in the benefits packages for Keystone 65 Preferred
HMO and Personal Choice 65 PPO members.
Please contact your Network Coordinator
if you have any questions about these 2012 benefits changes for Medicare
Advantage HMO and PPO members.
]