Accepted Health Plans | Medicare Plan Comparison
Mercy Your Choice Program | Mercy Choice PPO

Valuable information to help you make the right choice for your Medicare Plan
Be Sure to Compare Costs and Access to Hospitals

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Medicare Advantage Plans with Prescription Drug Coverage
Insurance Company
Plan Name
Type of Plan
Monthly
Premium
Prescription
Drug Cost
Sharing
Doctor Choice
Coverage in
the Gap
Routine
Physical
Exams
Vision
Services
Dental
Services
Mercy
Affiliate
Cost
Cost Share
Anthem Blue Cross and
Blue Shield      		 Anthem Senior Advantage Basic     
H3655-013		 HMO
$0.00
$10 - $30
30%
Plan
Doctors
Only
Some
Generics
x
x
  
X
Anthem Blue Cross and
Blue Shield		 Anthem Senior Advantage Enhanced
H3655-023		 Managed Care Plan
$0.00
$10 - $30
30%
Plan
Doctors
Only
Some
Generics
x
x
  
X
Health Plan Health Plan SecureCare
H3672-013		 Managed Care Plan
$20.00
$7 - $30 - 50%
20% - 50%
Plan
Doctors
Only
All
Generics
x
x
  
X
Humana Insurance
Company		 Humana Gold Choice PFFS
Plan A
H1804-086		 Private Fee for Service
$0.00
$5 - $60
25%

Any
Willing
Doctor
Some
Generics and
Some Brands
x
x
  
X
Humana Insurance
Company		 Humana Gold Choice PFFS
Plan B
H1804-218		 Private Fee for Service
$20.00
$5 - $60
25%
Any
Willing
Doctor
Some
Generics and
Some Brands
x
x
  
X
SummaCare SummaCare Secure Silver Plus
H3660-029		 Managed Care Plan
$0.00
$3-$30 - $60
--
Plan
Doctors
Only
Some
Exceptions
All
Generics
x
x
  
X
SummaCare SummaCare Secure Gold Plus
H3660-028		 Managed Care Plan
$65.00
$3 - $60
--
Plan
Doctors
Only
Some
Exceptions
All
Generics
x
x
  
X
SummaCare SummaCare Secure Platinum
H3660-032-0		 Managed Care Plan
$150.00
$3 - $60
--
Plan
Doctors
Only
Some
Exceptions
All
Generics
x
x
  
X
SecureHorizons
by UnitedHealthcare		 AARP MedicareComplete Plan 2 
Rx H3659-031		 HMO
$0.00
$4 - $28 -$58
33%
Plan
Doctors
Only
No
x
x
for an
extra
cost
X
SecureHorizons
by UnitedHealthcare		 AARP MedicareComplete Plus
Plan1
H3659-033		 HMO-PO Service
$0.00
$4 - $28 -$58
33%
Out of NW
or in
service
area
No
x
x
for an
extra
cost
X
PrimeTime Health Plan  PrimeTime Health Plan Standard 
H3664-011		 Managed Care Plan
$59.00
$0 - $35
--
Plan
Doctors
Only
No
x
x
x
NO
PrimeTime Health Plan  PrimeTime Health Plan Plus 
H3664-001		 HMO
$83.00
$0 - $35
--
Plan
Doctors
Only
No
x
x
x
NO


Preferred Provider Organization Plans with Prescription Drug Coverage
Insurance Company
Plan Name
Type of Plan
Monthly
Premium
Prescription
Drug Cost
Sharing
Doctor Choice
Coverage in
the Gap
Routine
Physical
Exams
Vision
Services
Dental
Services
Mercy
Affiliate
Cost
Cost Share
Anthem Blue Cross and
Blue Shield      		 Anthem Medicare Preferred Standard
H5529 - 001		 Preferred Provider
Organization		 $15.00
$10 - $30
30%
Any Doctor
Some Generics
x
x
 
X
Anthem Blue Cross and
Blue Shield		 Anthem Medicare Preferred Premier
H5529 - 002		 Preferred Provider
Organization		 $33.00
$7 - $27
30%
Any Doctor
Some Generics
x
x
 
X
Anthem Blue Cross and
Blue Shield		 Blue Medicare Access Standard R5941 - 001 Preferred Provider
Organization		 $19.00
$15 and up
30%
Any Doctor
Some Generics
x
x
 
X
Anthem Blue Cross and Blue Shield Blue Medicare Access Premier
R5941 - 002		 Preferred Provider
Organization		 $50.00
$15 and up
30%
Any Doctor
Some Generics
x
x
 
X
Health Plan SecureChoice SecureChoice
H8604-001-0		 PPO $40.00
$7-$30
20%
Any Doctor
All Generics
x
x
 
X
Humana Insurance Company Humana Choice PPO
R5826 - 007		 Preferred Provider
Organization		 $41.00
$5 - $60
25%
Any Doctor
Some Generics
and Brands
x
x
x
X
Medical Mutual of Ohio Standard Managed Care
Plan		 $24.30
$5 - $33
 
Plan Doctors Only
No
x
x
 
X
Medical Mutual of Ohio Value Managed Care
Plan		 $40.80
$5 - $33
 
Plan Doctors Only
(some exceptions)
All Generics
x
x
 
X
Medical Mutual of Ohio Premium Managed Care
Plan		 $69.10
$5 - $33
 
Plan Doctors Only
(some exceptions)
All Generics
x
x
 
X
PrimeTime Health Plan Prime PPO Primtime Health Plan
H3620 - 001		 Preferred Provider
Organization		 $71.00
$0 - $35
 
Any Doctor
No Gap Coverage
x
x
x
NO
PrimeTime Health Plan PrimeTime Health Plan Premier
H3664-012		 Managed Care
Plan		 $125.00
$0 - $35
 
Plan Doctors Only
No Gap Coverage
x
x
x
NO
PrimeTime Health Plan PrimeTime Premier Advantage
H3664-013		 Managed Care
Plan		 $240.00
$0 - $35
 
Plan Doctors Only
All Generics
x
x
x
NO
PrimeTime Health Plan Prime Time Health Plan Essential HMO POS
Option		 $43.00
 
 
Plan Doctors Only
No
x
x
 
NO


Medicare Advantage Only Plans (No Prescription Coverage Included)
Insurance Company
Plan Name
Type of Plan
Monthly
Premium
Prescription
Drug Cost
Sharing
Doctor Choice
Routine
Physical
Exams
Vision
Services
Dental
Services
Mercy
Affiliate
Cost
Cost Share
Health Plan - Hometown
Region		 Health Plan SecureCare
H3672 - 014		 HMO
$0.00
-
-
Plan
Doctors Only
x
x
 
X
Health Plan - Hometown
Region		 SecureChoice PPO
$20.00
-
-
Any
Doctor
x
x
 
X
Humana Insurance Company HumanaChoice PPO
R5826-021		 Regional PPO
$0.00
-
-
Any
Doctor
x
x
x
X
PrimeTime Health Plan Basic - MA Only HMO with POS
option
$0.00
-
-
Plan
Doctors Only
 
 
 
 
SecureHorizons by
UnitedHealthcare		 SecureHorizons MedicareDirect Plan 3
H5435-003		 Private Fee for
Service
$0.00
-
-
Any Willing Doctor
x
 
 
X
SecureHorizons by
UnitedHealthcare		 SecureHorizons MedicareDirect Plan 3A
H5435-019		 Private Fee for
Service
$0.00
-
-
Plan
Doctors Only
x
x
for an extra cost
X
SecureHorizons by
UnitedHealthcare		 AARP MedicareComplete Plan 2
H3659-031-0		 HMO
$0.00
-
-
Plan
Doctors Only
x
x
for an extra cost
X
Medicare Advantage Special Needs Plans (Dual Eligibles - Medicare and Medicaid Eligible)
Insurance Company
Plan Name
Type of Plan
Monthly
Premium
Prescription
Drug Cost
Sharing
Doctor Choice
Routine
Physical
Exams
Vision
Services
Dental
Services
Mercy
Affiliate
Cost
Cost Share
Evercare® Health Plans Evercare Plan IP
H2406-001-0		 SNP: Institutional
$26.80
$5-$35
33%
Any
Doctor
x
x
 
X
SecureHorizons by United-
Healthcare		 Evercare Plan MH
(H3659-059-0)		 SNP: Chronic or
disabling condition
$0.00
 
 
Plan
Doctors Only
 
 
 
 

Medicare Health Plans - Hospital Access
Insurance Company
Doctors
Choice
Mercy
Medical
Center
Affinity
Medical
Affinity
Medical
Massillon
Alliance
Community
Dunlap
Memorial
Joel
Pomerene
Union
Hospital
Wooster
Community
Akron
General
Metro
Health
Summa
Health
System
Twin
City
Cleveland
Clinic
University
Hospitals
Robinson
Memorial
Anthem Blue Cross and Blue Shield Senior Advantage Plan
Doctors
Only
X
x
x
x
 
 
x
x
x
 
x
 
x
 
 
HomeTown Region
SecureCare		 Plan
Doctors
Only
X
x
x
x
x
x
x
x
x
 
 
x
Referral
Referral
x
Humana Insurance
Company		 Plan
Doctors
Only
X
x
x
x
PFFS
x
x
x
x
x
x
x
x
x
x
Medical Mutual Plan
Doctors
Only
X
x
x
x
x
 
x
x
x
 
 
 
x
 
 
PrimeTime
Health Plan		 Plan
Doctors
Only
 
 
 
x
x
x
x
x
 
 
 
 
 
 
 
AARP Medical
Complete		 Plan
Doctors
Only
X
x
 
x
 
 
 
 
 
 
 x
 
 
x 
 
SummaCare Plan
Doctors
Only
X
x
x
x
x
 
 
x
 
 
x
 
x
x
x


Web Sites For Advantage Program Insurance Company Phone Numbers
Humana.com Humana Insurance
Company		 1-800-215-4008
1-800-833-2312
Medmutual.com Medical Mutual of Ohio 1-800-613-2583
Anthem.com Anthem 1-800-467-1199
SummaCare.com SummaCare 1-888-464-8440
330-996-8885
330-966-8440
Healthplan.org Health Plan - HomeTown
Region		 1-877-236-2290
Securehorizons.com Secure Horizons by United
HealthCare		 1-800-504-4848
 
Ohio Senior Health Insurance Information Program (OSHIIP)
Counseling Directory 1-800-686-1578

Carroll County

330-627-7017
Holmes County

330-276-3921
Stark County
330-489-1333
Summit

330-848-7814

A complete Ohio Insurance Shoppers Guide is available from the Ohio Department of Insurance at www.ohioinsurance.gov or by calling
1-800-797-1578.

For more complete information on the plans outlined above, visit www.medicare.gov or www.ohioinsurance.gov.

While Mercy Medical Center has made every effort to provide complete information in this matrix, it is subject to change without our knowledge and we are therefore not responsible for its accuracy. This information is provided for educational use and comparison purposes, and individuals interested in specific plans or programs should contact the respective representative for the most recent information. Mercy Medical Center makes no claims, promises or guarantees about the accuracy, completeness, or adequacy of the contents of this matrix and expressly disclaims liability for errors and omissions in its contents.

A service of Mercy Medical Center. Questions? Call Terri Gursky at 330-489-1215 or 1-800-223-8662