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2013 Medicare Advantage Plan Benefit Details for the AARP MedicareComplete Choice Essential (Regional PPO)
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2013 Medicare Advantage Plan Details
Medicare Plan Name:AARP MedicareComplete Choice Essential (Regional PPO)
Location:Miami-Dade, Florida 33142     Click to see other locations
Plan ID:R5287 - 002 - 0     Click to see other plans
Member Services:1-800-643-4845 TTY users 711
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the AARP MedicareComplete Choice Essential (Regional PPO) benefit details
— Medicare Plan Features —
Monthly Premium:$0.00 (see Plan Premium Details below)
Annual Deductible:no drug coverage
Health Plan Type:Regional PPO *
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$3,500
Number of Members enrolled in this plan in (R5287 - 002):3,368 members
Plan’s Summary Star Rating: 3 out of 5 Stars.
• Customer Service Rating: 4 out of 5 Stars.
• Member Experience Rating: 3 out of 5 Stars.
• Drug Cost Accuracy Rating: 3 out of 5 Stars.
— Plan Premium Details —
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔100%
Subsidy		75%
Subsidy		50%
Subsidy		25%
Subsidy
Monthly Part D Premium with LIS:$0.00$0.00$0.00$0.00
— Plan Health Benefits —
** Cost **
Premium and Other Important Information
$0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
Some physicians providers and suppliers that are out of a plan’s network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept Medicare "assignment " your coinsurance can be based on the Medicare-approved amount plus an additional amount up to a higher Medicare "limiting charge." If you are a member of a plan that charges a copay for out-of-network physician services the higher Medicare "limiting charge" does not apply. See the publications Medicare You or Your Medicare Benefits available on www.medicare.gov for a full listing of benefits under Original Medicare as well as for explanations of the rules related to "assignment" and "limiting charges" that apply by benefit type. To find out if physicians and DME suppliers accept assignment or participate in Medicare visit www.medicare.go
$3 500 out-of-pocket limit for Medicare-covered services.
$10 000 out-of-pocket limit for Medicare-covered services.
** Doctor and Hospital Choice **
Doctor and Hospital Choice
No referral required for network doctors specialists and hospitals.
You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits.
Plan covers you when you travel in the U.S. or its territories.
** Extra Benefits **
Over-the-Counter Items
The plan does not cover Over-the-Counter items.
Transportation
This plan does not cover supplemental routine transportation.
** Important Information **
Premium and Other Important Information
$0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
Some physicians providers and suppliers that are out of a plan’s network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept Medicare "assignment " your coinsurance can be based on the Medicare-approved amount plus an additional amount up to a higher Medicare "limiting charge." If you are a member of a plan that charges a copay for out-of-network physician services the higher Medicare "limiting charge" does not apply. See the publications Medicare You or Your Medicare Benefits available on www.medicare.gov for a full listing of benefits under Original Medicare as well as for explanations of the rules related to "assignment" and "limiting charges" that apply by benefit type. To find out if physicians and DME suppliers accept assignment or participate in Medicare visit www.medicare.go
$3 500 out-of-pocket limit for Medicare-covered services.
$10 000 out-of-pocket limit for Medicare-covered services.
Doctor and Hospital Choice
No referral required for network doctors specialists and hospitals.
You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits.
Plan covers you when you travel in the U.S. or its territories.
** Inpatient Care **
Inpatient Hospital Care
No limit to the number of days covered by the plan each hospital stay.
For Medicare-covered hospital stays:
  • Days 1 - 5: $295 copay per day
  • Days 6 - 90: $0 copay per day
    • $0 copay for each additional hospital day.
    For hospital stays:
    • Days 1 - 27: $375 copay per day
  • Days 28 and beyond: $0 copay per day
    • Inpatient Mental Health Care
    You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.
    For Medicare-covered hospital stays:
    • Days 1 - 4: $295 copay per day
  • Days 5 - 90: $0 copay per day
    • For hospital stays:
    • Days 1 - 27: $375 copay per day
  • Days 28 - 90: $0 copay per day
    • Skilled Nursing Facility (SNF)
    Plan covers up to 100 days each benefit period
    No prior hospital stay is required.
    For Medicare-covered SNF stays:
    • Days 1 - 20: $50 copay per day
  • Days 21 - 37: $150 copay per day
  • Days 38 - 100: $0 copay per day
    • For each SNF stay:
    • Days 1 - 52: $195 copay per SNF day
  • Days 53 - 100: $0 copay per SNF day
    • Home Health Care
    $0 copay for each Medicare-covered home health visit
    50% of the cost for Medicare-covered home health visits
    Hospice
    You must get care from a Medicare-certified hospice. Your plan will pay for a consultative visit before you select hospice.
    ** Outpatient Care **
    Doctor Office Visits
    $0 copay for each Medicare-covered primary care doctor visit.
    $35 copay for each Medicare-covered specialist visit.
    $40 copay for each Medicare-covered primary care doctor visit
    $45 copay for each Medicare-covered specialist visit
    Chiropractic Services
    $20 copay for each Medicare-covered chiropractic visit
    Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor.
    $45 copay for Medicare-covered chiropractic visits.
    Podiatry Services
    $35 copay for each Medicare-covered podiatry visit
    $35 copay for up to 6 supplemental routine podiatry visit(s) every year
    Medicare-covered podiatry visits are for medically-necessary foot care.
    $45 copay for Medicare-covered podiatry visits
    $45 copay for supplemental routine podiatry visits
    Outpatient Mental Health Care
    $40 copay for each Medicare-covered individual therapy visit
    $30 copay for each Medicare-covered group therapy visit
    $40 copay for each Medicare-covered individual therapy visit with a psychiatrist
    $30 copay for each Medicare-covered group therapy visit with a psychiatrist
    $60 copay for Medicare-covered partial hospitalization program services
    $35 to $45 copay for Medicare-covered Mental Health visits with a psychiatrist
    $35 to $45 copay for Medicare-covered Mental Health visits
    $75 copay for Medicare-covered partial hospitalization program services
    Outpatient Substance Abuse Care
    $40 copay for Medicare-covered individual substance abuse outpatient treatment visits
    $30 copay for Medicare-covered group substance abuse outpatient treatment visits
    $35 to $45 copay Medicare-covered substance abuse outpatient treatment visits
    Outpatient Services
    $250 copay for each Medicare-covered ambulatory surgical center visit
    $250 copay for each Medicare-covered outpatient hospital facility visit
    30% of the cost for Medicare-covered outpatient hospital facility visits
    30% of the cost for Medicare-covered ambulatory surgical center visits
    Ambulance Services
    $225 copay for Medicare-covered ambulance benefits.
    $225 copay for Medicare-covered ambulance benefits.
    Emergency Care
    $65 copay for Medicare-covered emergency room visits
    Worldwide coverage.
    If you are admitted to the hospital within 24-hour(s) for the same condition you pay $0 for the emergency room visit.
    Urgently Needed Care
    $30 to $40 copay for Medicare-covered urgently-needed-care visits
    Outpatient Rehabilitation Services
    $35 copay for Medicare-covered Occupational Therapy visits
    $35 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits
    $45 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits
    $45 copay for Medicare-covered Occupational Therapy visits.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    20% of the cost for Medicare-covered durable medical equipment
    50% of the cost for Medicare-covered durable medical equipment
    Prosthetic Devices
    20% of the cost for Medicare-covered prosthetic devices
    30% of the cost for Medicare-covered prosthetic devices.
    Diabetes Programs and Supplies
    $0 copay for Medicare-covered Diabetes self-management training
    $0 copay for Medicare-covered Diabetes monitoring supplies
    20% of the cost for Medicare-covered Therapeutic shoes or inserts
    30% of the cost for Medicare-covered Diabetes self-management training
    30% of the cost for Medicare-covered Diabetes monitoring supplies
    30% of the cost for Medicare-covered Therapeutic shoes or inserts
    Diagnostic Tests, X-Rays, Lab Services, and Radiology Services
    $10 copay for Medicare-covered lab services
    20% of the cost for Medicare-covered diagnostic procedures and tests
    $16 copay for Medicare-covered X-rays
    20% of the cost for Medicare-covered diagnostic radiology services (not including X-rays)
    20% of the cost for Medicare-covered therapeutic radiology services
    30% of the cost for Medicare-covered therapeutic radiology services
    $21 copay for Medicare-covered outpatient X-rays
    30% of the cost for Medicare-covered diagnostic radiology services
    $10 copay [or 30% of the cost] for Medicare-covered diagnostic procedures tests and lab services
    ** Preventive Services **
    Cardiac and Pulmonary Rehabilitation Services
    $35 copay for Medicare-covered Cardiac Rehabilitation Services
    $35 copay for Medicare-covered Intensive Cardiac Rehabilitation Services
    $35 copay for Medicare-covered Pulmonary Rehabilitation Services
    $45 copay for Medicare-covered Cardiac Rehabilitation Services
    $45 copay for Medicare-covered Intensive Cardiac Rehabilitation Services
    $45 copay for Medicare-covered Pulmonary Rehabilitation Services
    Preventive Services and Wellness/Education Programs
    $0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.
    $0 copay for an annual physical exam
    The plan covers the following supplemental education/wellness programs:
    • Health Club Membership/Fitness Classes
  • Nursing Hotline
    • $0 copay for Additional Preventive Services. Contact plan for details.
    0% to 30% of the cost for Medicare-covered preventive services
    30% of the cost for an annual physical exam
    $0 copay for supplemental education/wellness programs
    30% of the cost for Additional Preventive Services
    Kidney Disease and Conditions
    20% of the cost for Medicare-covered renal dialysis
    $0 copay for Medicare-covered kidney disease education services
    30% of the cost for Medicare-covered kidney disease education services
    20% of the cost for Medicare-covered renal dialysis
    Outpatient Prescription Drugs
    50% of the cost for Medicare Part B drugs out-of-network.
    Most drugs not covered.
    20% of the cost for Medicare Part B chemotherapy drugs and other Part B drugs.
    This plan does not offer prescription drug coverage.
    Dental Services
    $35 copay for Medicare-covered dental benefits
    • $0 copay for up to 1 oral exam(s) every six months
  • $0 copay for up to 1 cleaning(s) every six months
  • $0 copay for up to 1 dental x-ray(s)
    • $45 copay for Medicare-covered comprehensive dental benefits
    $40 copay for supplemental preventive dental benefits
    Hearing Services
    $0 copay for:
    $35 copay for Medicare-covered diagnostic hearing exams
    $0 copay for up to 1 supplemental routine hearing exam(s) every year
    $380 copay for up to 2 inner-ear hearing aid(s) every year
    $330 copay for up to 2 over-the-ear hearing aid(s) every year
    $45 copay for Medicare-covered diagnostic hearing exams.
    $45 copay for supplemental hearing exams.
    $330 to $380 copay for supplemental hearing aids.
    ** Additional Benefits **
    Vision Services
    • $0 copay for one pair of Medicare-covered eyeglasses or contact lenses after cataract surgery.
  • $0 to $35 copay for Medicare-covered exams to diagnose and treat diseases and conditions of the eye.
  • $35 copay for up to 1 supplemental routine eye exam(s) every year
    • $45 copay for Medicare-covered eye exams
    $45 copay for supplemental eye exams
    30% of the cost for Medicare-covered eye wear
    Over-the-Counter Items
    The plan does not cover Over-the-Counter items.
    Transportation
    This plan does not cover supplemental routine transportation.
    Acupuncture
    This plan does not cover Acupuncture.
    ** Inpatient Care **
    Inpatient Hospital Care
    No limit to the number of days covered by the plan each hospital stay.
    For Medicare-covered hospital stays:
    • Days 1 - 5: $295 copay per day
  • Days 6 - 90: $0 copay per day
    • $0 copay for each additional hospital day.
    For hospital stays:
    • Days 1 - 27: $375 copay per day
  • Days 28 and beyond: $0 copay per day
    • ** Outpatient Care **
    Doctor Office Visits
    $0 copay for each Medicare-covered primary care doctor visit.
    $35 copay for each Medicare-covered specialist visit.
    $40 copay for each Medicare-covered primary care doctor visit
    $45 copay for each Medicare-covered specialist visit
    Outpatient Services
    $250 copay for each Medicare-covered ambulatory surgical center visit
    $250 copay for each Medicare-covered outpatient hospital facility visit
    30% of the cost for Medicare-covered outpatient hospital facility visits
    30% of the cost for Medicare-covered ambulatory surgical center visits
    Ambulance Services
    $225 copay for Medicare-covered ambulance benefits.
    $225 copay for Medicare-covered ambulance benefits.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    20% of the cost for Medicare-covered durable medical equipment
    50% of the cost for Medicare-covered durable medical equipment
    Diagnostic Tests, X-Rays, Lab Services, and Radiology Services
    $10 copay for Medicare-covered lab services
    20% of the cost for Medicare-covered diagnostic procedures and tests
    $16 copay for Medicare-covered X-rays
    20% of the cost for Medicare-covered diagnostic radiology services (not including X-rays)
    20% of the cost for Medicare-covered therapeutic radiology services
    30% of the cost for Medicare-covered therapeutic radiology services
    $21 copay for Medicare-covered outpatient X-rays
    30% of the cost for Medicare-covered diagnostic radiology services
    $10 copay [or 30% of the cost] for Medicare-covered diagnostic procedures tests and lab services
    ** Additional Benefits **
    Over-the-Counter Items
    The plan does not cover Over-the-Counter items.
    Transportation
    This plan does not cover supplemental routine transportation.




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    .