Medicare HMO Blue, page 2

Medicare HMO BlueSM 2013 Plan Changes

Medicare HMO BlueSM is a Medicare Advantage Prescription Drug employer/union-sponsor plan. The plan service area includes all of Massachusetts except Dukes, Nantucket and Berkshire counties.

Effective January 1, 2013, Medicare HMO Blue standard plan coverage changes are as follows:

2013 Medical Plan Changes Medicare HMO

/ In 2012 / In 2013 /
Outpatient Lab Services and certain Radiology Services / You pay 10% of the cost per visit for laboratory tests, CT scans, MRIs, PET scans, and nuclear cardiac imaging tests (the 10% coinsurance does not apply to interpretation costs). / You pay a $0 co-pay per visit for laboratory tests.
You pay a $100 co-pay for each category of test for CT scans, MRIs, PET scans, and nuclear cardiac imaging tests for each service date. /
Skilled Nursing Facility (SNF) / You pay:
$50 co-pay per day up to a total of $1,000 in each calendar year. / For each benefit period, you pay:
Days 1-20: $50 co-pay per day
Days 21-44: $100 co-pay per day
Days 45-100: $0 co-pay per day
A “benefit period” begins on the first day you are admitted as an inpatient at a Medicare-covered hospital or SNF. The benefit period ends when you haven’t been an inpatient at any hospital or SNF for 60 days in a row. If you go to the hospital (or SNF) after one benefit period has ended, a new benefit period begins. There is no limit to the number of benefit periods you can have. /
Urgently Needed Care / You pay a $15 co-payment for each office visit for primary care, or a $30 co-payment for each office visit for specialty care.
You have coverage for urgently needed care within the United States. . / You pay a $15 co-payment for each office visit to your PCP, or a $30 co-payment for each office visit to other providers. /

2013 Pharmacy Plan Changes

Pharmacy Plan Changes / In 2012 / In 2013
Standard coverage levels are updated as part of annual change / .
After yearly out-of-pocket drug costs reach $4,700, members pay the greater of:
$2.60 co-payment for generic drugs (including brand name drugs treated as generic) and
$6.50 co-payment for all other drugs, or
5% co-insurance
For all employer/union-sponsored plans: Members receive cost-sharing adjustments under the new Medicare Coverage Gap Discount Program. / After yearly out-of-pocket drug costs reach $4,750, members pay the greater of:
$2.65 co-payment for generic drugs (including brand name drugs treated as generic) and
$6.60 co-payment for all other drugs, or
5% co-insurance
For all employer/union-sponsored plans: Members receive cost-sharing adjustments under the new Medicare Coverage Gap Discount program

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