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

Updated December 2008

Stark County Fast Facts:
Ohio has 107 Medicare Health plans available.
Stark County has 39 Medicare Health plans to choose from and 9 Special Needs plans
15 Plans have a zero dollar premium
36 Medicare Plans have a premium of $50.00 or less

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Plan Comparison
Medicare Plans with Prescription Drug Coverage
Plan Name and ID Numbers Plan Type Monthly Premium Drug Cost Doctor Choice Vision Services Dental Services Routine Physical exams RX GAP Max Out Of Pocket
AARP MedicareComplete Plan 1 (H3659 - 003)
SecureHorizons by nitedHealthcare
 HMO $0 $4
$28
$58
33%		 Plan Doctors Only Covered Covered(for an extra cost) Yes Many Generics 2550
AARP MedicareComplete Plan 2 (H3659 - 031)
SecureHorizons by UnitedHealthcare
 HMO $0 $4
$28
$58
33%		 Plan Doctors Only Covered Covered(for an extra cost) Yes No 2950
Advantage Plan Freedomx
(H4836 - 002)
Advantage Plan from Medical Mutual of Ohio
 Private Fee for Service $90.00 $8
$42
$92
33%		 Any Willing Doctor Covered Not Covered Yes No 2000
Advantage PlaNoptimumx
(H9313 - 012)
Advantage Plans from Medical Mutual of Ohio
 HMO with POS Option $62 $8
$42
$92
33%		 Plan Doctors Only (some exceptions) Covered Not Covered Yes All generics 3000
Advantage Plan Premiumx
(H9313 - 011)
Advantage Plans from Medical Mutual of Ohio
 HMO with POS Option $44.00 $8
$42
$92
33%		 Plan Doctors Only (some exceptions) Covered Not Covered Yes All generics 3000
Advantage Plan Securex
(H9313 - 007)
Advantage Plans from Medical Mutual of Ohio
 HMO with POS Option $0 $8
$42
$92
33%		 Plan Doctors Only (some exceptions) Not Covered Not Covered No No 1500
Advantage Plan Standardx
(H9313 - 010)
Advantage Plans from Medical Mutual of Ohio
 HMO $22.00 $8
$42
$92
33%		 Plan Doctors Only Covered Not Covered Yes No 4000
Advantra Freedom-Freedom 5
(H5227 - 001)
Advantra® Freedom
 Private Fee for Service $0 $7
$30
$73
33%		 Any Willing Doctor Covered Covered Yes No 3350
Advantra Freedom-Freedom 5 Plus-GAP
(H5227 - 004)
Advantra® Freedom
 Private Fee for Service $0 $5
$37
$70
30%		 Any Willing Doctor Covered Covered Yes Preferred generics  
Anthem Medicare Preferred Standard
(H5529 - 001)
Anthem Blue Cross and Blue Shield
 Local Preferred Provider Organization $27.00 $10
$35
$75
33%		 Any Doctor Covered Covered Yes Many generics 4500
Anthem Senior Advantage Basic
(H3655 - 013)
Anthem Blue Cross and Blue Shield
 HMO $0
$15
$35
$75
33%		 Plan Doctors Only Covered Not Covered Yes Many generics $3,500
Anthem Senior Advantage Enhanced
(H3655 - 023)
Anthem Blue Cross and Blue Shield
 HMO $0
$15
$35
$75
33%		 Plan Doctors Only Covered Not Covered Yes Many generics 3500
Blue Medicare Access Premier(R5941 - 002)Anthem Blue Cross and Blue Shield
 Preferred Provider Organization $49.00
$15
$35
$75
33%		 Any Doctor Covered Covered Yes Many generics 3750
Blue Medicare Access Standard
(R5941 - 001)
Anthem Blue Cross and Blue Shield
 Preferred Provider Organization $19.00
$15
$35
$75
33%		 Any Doctor Covered Covered Yes Many generics 4500
Concert
(H4577 - 029)
WellCare
 Private Fee for Service $0 $3
$28
$58
33%		 Any Willing Doctor Covered Covered Yes No 3750
Health Plan SecureCare
(H3672 - 013)
The Health Plan
 HMO $20 $7
$30
50%
20%		 Plan Doctors Only Covered Not Covered Yes All generic 3250
Humana Gold Choice PFFS H1804-086
(H1804 - 086)
Humana Insurance Company
 Private Fee for Service $48.00 $7
$40
$65
33%		 Any Willing Doctor Not Covered Not Covered Yes Few Generic Few Brand 6000
Humana Gold Choice PFFS H1804-218
(H1804 - 218)
Humana Insurance Company
 Private Fee for Service $78 $7
$40
$65
33%		 Any Willing Doctor Not Covered Not Covered Yes Few Generic Few Brand 6000
HumanaChoicePPO
PPO R5826-007
(R5826 - 007)
Humana Insurance Company
 Preferred Provider Organization $33.00 $7
$40
$65
33%		 Any Doctor Not Covered Covered Yes Few Generic Few Brand 5000
PrimeTime Health Plan Essential
(H3664 - 016)
PrimeTime Health Plan
 HMO with POS Option $47 $4
$25
$45
25%		 Plan Doctors Only (some exceptions) Covered Covered Yes No 5000
PrimeTime Health Plan Plus
(H3664 - 001)
PrimeTime Health Plan
 HMO with POS Option $65.00 $4
$25
$45
25%		 Plan Doctors Only (some exceptions) Covered Covered Yes No 3500
PrimeTime Health Plan Premier
(H3664 - 012)
PrimeTime Health Plan
 HMO with POS Option $141.00 $4
$25
$45
25%		 Plan Doctors Only (some exceptions) Covered Covered Yes All generic 3500
PrimeTime Health Plan Prime PPO
(H3620 - 001)
PrimeTime Health Plan
 Local Preferred Provider Organization $78.00 $4
$25
$45
25%		 Any Doctor Covered Covered Yes No 3500
PrimeTime Health Plan Standard
(H3664 - 011)
PrimeTime Health Plan
 HMO with POS Option $47 $4
$25
$45
25%		 Plan Doctors Only (some exceptions) Covered Covered Yes No 3500
Health Plan SecureChoice
(H8604 - 001)
Health Plan SecureChoice
 Local Preferred Provider Organization $40.00 $7
$30
50%
20%		 Any Doctor Covered Not Covered Yes All generic 3750
Health Plan SecureFreedom
(H6621 - 001)
Health Plan SecureFreedom
 Private Fee for Service $95.00 $7
$30
50%
20%		 Any Willing Doctor Covered Not Covered Yes All generic 4250
SecureHorizons MedicareDirect Rx
Plan 55
(H5435 - 024)
SecureHorizons MedicareDirect
 Private Fee for Service $0 $5
$35
$65
33% 		Any Willing Doctor Covered Not Covered Yes No gap coverage 3600
SummaCare Secure Gold Plus
(H3660 - 028)
SummaCare
HMO with POS Option $75.00 3
$30
$60
30%		 Plan Doctors Only (some exceptions) Covered Not Covered Yes Many generics 2000
SummaCare Secure Platinum
(H3660 - 032)
SummaCare
HMO with POS Option $175.00 $3
$30
$60
30%		 Plan Doctors Only (some exceptions) Covered Not Covered Yes Many generics 0
SummaCare Secure Silver Plus
(H3660 - 029)
SummaCare
HMO with POS Option $0.00 $3
$30
$60
30%		 Plan Doctors Only (some exceptions) Covered Not Covered Yes Many generics 3000
WellCare Value
(H0117 - 005)
WellCare
 HMO $0 0
$39
$69
33%		 Plan Doctors Only Covered Covered Yes All generics 3000


Medicare Special Needs Plans in STARK, Ohio
Plan Name and ID Numbers Company Name Plan Type Monthly Premium Drug Cost Special Rules for Enrolling Doctor Choice Vision Services Dental Services Routine Physical exams RX GAP Max Out Of Pocket
Buckeye Community Health Plan
(H0908 - 001)
Advantage by Buckeye Community Health Plan
 Advantage by Buckeye Community Health Plan SNP: Dual Eligible $28.40 $0 Generics For people who are eligible for both Medicare and Medicaid. Plan Doctors Only Not Covered Not Covered      
CareSource Advantage
(H6178 - 001)
CareSource
 CareSource SNP: Dual Eligible $28.40 $0 Generics For people who are eligible for both Medicare and Medicaid. Plan Doctors Only Covered Not Covered      
Evercare Plan DH
(H3659 - 056)
SecureHorizons by UnitedHealthcare
 SecureHorizons by UnitedHealthcare SNP: Dual Eligible 0 / or $22.80 25% For people who are eligible for both Medicare and Medicaid. Plan Doctors Only Covered Covered Yes No  
Evercare Plan IP
(H2406 - 001)
Evercare® Health Plans
 Evercare® Health Plans SNP: Institutional 0 / or $28.40 $5 $41 $85 33% For people in certain long-term care facilities. Any Doctor Covered Not Covered Yes Yes  
Evercare Plan MH
(H3659 - 059)
SecureHorizons by UnitedHealthcare
 SecureHorizons by UnitedHealthcare SNP: Chronic or disabling condition $0 $5 $37 $71 33% For people with certain chronic or disabling conditions. Plan Doctors Only Covered Covered Yes Yes  
Gateway Health Plan Medicare Assured
(H8031 - 001)
Gateway Health Plan Medicare Assured
 Gateway Health Plan Medicare Assured SNP: Dual Eligible $28.40 $0 Generics For people who are eligible for both Medicare and Medicaid. Plan Doctors Only Covered Not Covered      
HumanaChoicePPO PPO
SNP-OA R5826-054 (R5826 - 054)
Humana Insurance Company
 Humana Insurance Company SNP: Chronic or disabling condition $42.00 $7 $40 $65 $33% For people with certain chronic or disabling conditions. Any Doctor Not Covered Covered Yes Few Generic Few Brand  
WellCare Access
(H0117 - 007)
WellCare
 WellCare SNP: Dual Eligible 0 $0 Generics For people who are eligible for both Medicare and Medicaid. Plan Doctors Only Covered Covered      
WellCare Select
(H0117 - 009)
WellCare
 WellCare SNP: Dual Eligible $0 $0 Generics For people who are eligible for both Medicare and Medicaid. Plan Doctors Only Covered Covered      



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    
The Health Plan HomeTown Region
 Plan Doctors Only x x x x x x x x x   BCH WRH x PPO PFFS PPO PFFS 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 x x x x x
PrimeTime Health Plan
 Plan Doctors Only       x 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
Well Care
   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 1-800-803-5169
SummaCare.com SummaCare 1-888-464-8440
Healthplan.org Health Plan - HomeTown
Region		 1-877-236-2290
Securehorizons.com Secure Horizons by United
HealthCare		 1-800-504-4848
WellCare.com Wellcare AARP Medicare Complete 1-866-360-8153
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