| Services |
Medicare Pays |
Seniors Choice Pays |
Hospitalization
First 60 days
61st to 90th day
91st to 150th day
(60 lifetime reserve days)
Additional 500 days
beyond Medicare
|
All but $952
All but $238 per day
All but $476 per day
$0
|
$952 Part A Deductible
$238 per day
$476 per day 100% of Medicare-eligible hospital expenses
for an additional 500 days per person per lifetime.
|
Blood
First 3 pints per
calendar year
Additional Amounts |
$0
100% |
First 3 pints
$0 |
Skilled Nursing Facility
First 20 days
21st thru 100th day
101st day thru 365th day
|
All approved amounts
All but $119 per day
$0
|
$0
$119 per day
$119 per day
|
| |
|
|
| |
|
|
Part B----Medical Services----Per Calendar Year
* For detailed benefits please refer to Certificate of Insurance.
| Services |
Medicare Pays |
Seniors Choice Pays |
Medical Expenses
First $124 of Medicare
approved amounts
Remainder of Medicare-
eligible expense
Part B excess charges
(above Medicare approved amounts)
|
$0
80%
$0
|
$0
20% of Medicare-eligible expenses after a $124 per calendar
year deductible.
100% of charges in excess of the Medicare approved amount
|
Blood
First 3 pints
Additional Amounts
|
$0
100% |
100% of actual costs
|
Pays Foreign Travel
First $250 each
calendar year
Remainder of charges
|
$0
|
$0
|
| Remainder of Charges |
$0 |
100% of Medicare-eligible expenses up to
a lifetime maximum benefit of $50,000.00 |
Private Duty Nursing
During Hospital Confinement ment
|
$0 |
Cost of $60 per 8-hour shift.
Up to 60 shifts per calendar year. |
Monthly Renewal Rates Effective January 1st, 2006
Prices include $6.00 Administration Fee.
| |
Age |
Total Cost |
| |
65-69 |
215.39 |
| |
70-74 |
258.57 |
| |
75-79 |
298.89 |
| |
80-84 |
324.54 |
| |
85+ |
349.11 |
Part D Drug Plan
The Medicare prescription drug program is one of the most
important changes to Medicare since it was created in 1965. If you’re
one of the 42 million Medicare beneficiaries across the country,
you’re eligible to participate in the Medicare prescription
drug program.
Here’s a look at the Prescription Drug Program’s general
eligibility rules:
The Prescription Drug plan selected for you includes
coverage of both generic and brand name drugs. Understanding the
difference between generic and brand-name drugs may save you money.
The brand name drugs you’re currently taking may be available
in generic versions that do the same but cost less. Another important
factor in choosing a plan is which pharmacies you’ll be able
to use. PacifiCare has a nationwide network of more than 47,000
pharmacies.
We also give you the savings and convenience of
home delivery through our Mail Service Pharmacy. Questions about
Prescription Solutions from PacifiCare?
Just call 1-888-538-9333, 8 a.m – 5 p.m., Monday through
Friday.
You can find a complete formulary listing on www.prescriptionsolutions.com.
If the formulary changes, you will be notified in writing, before
the change. Only Medicare Part D covered drugs will impact your
Medicare Prescription Drug Plan annual out-of-pocket spending. Certain
prescription drugs will have maximum quantity limits. Your provider
must get prior authorization from PacifiCare for certain prescription
drugs.
Please contact PacifiCare for details.
For more information on your plan, please call
1-888-538-9333, 8 a.m. – 5 p.m. PST, Monday through Friday,
for the hearing impaired, please call TTY: 1-800-387-1074.
Prescription Solutions from PacifiCare Medicare
Prescription Drug Plans are offered by PacifiCare Life and Health
Insurance Company (PacifiCare Insurance Company in the State of
New York), which contracts with the federal government. The PacifiCare
Prescription Drug Insurance Plan is underwritten by PacifiCare Life
and Health Insurance Company and provides coverage for outpatient
prescription drugs only. You must continue to pay your Medicare
Part B premium if not otherwise paid for under Medicaid or by another
third-party.
Members may be enrolled in only one Part D Plan
at a time. Members must reside in the service area to be eligible
to enroll. Prescription Solutions from PacifiCare Medicare Part
D plans cover both brand name drugs and generic drugs. Generic drugs
have the same active ingredient formula as a brand name drug. Generic
drugs usually cost less than brand name drugs and are rated by the
Food and Drug Administration (FDA) to be as safe and effective as
brand name drugs. Contact PacifiCare for more information. Enrollees
must use network pharmacies to receive Plan benefits except under
emergency circumstances. Our network includes retail mail service,
long-term care, I/T/U and Home Infusion pharmacies. If you would
like additional information about our mail service pharmacy, please
contact PacifiCare at the number above, or write to us at P.O. Box
509075, San Diego, CA 92150-9075.
People who have low incomes, who live in long-term
care facilities, or who have access to Indian/Tribal/Urban (Indian
Health Service) facilities may have different out-of-pocket drug
costs. Please contact PacifiCare for more details. If members have
qualified for additional assistance for Medicare Prescription Drug
Plan costs, the amount of your premium and cost at the pharmacy
will be less. Once you have enrolled in a Prescription Solutions
from PacifiCare Plan, Medicare will tell us how much assistance
you are receiving, and we will send you information on the amount
you will pay.
If you are not receiving this additional assistance,
you should contact 1-800-MEDICARE (TTY/TDD users should call 1-877-486-2048),
your State Medicaid Office, or the Social Security Administration
at 1-800-772-1213, or the toll-free TTY/TDD number: 1-800-325-0778,
between 7 a.m. and 7 p.m., Monday through Friday, to see if you
might qualify.
Summary of Prescription
Drug Benefits from Pacificare |
| Drug Benefits |
Coverage Limit |
You Pay
|
| Outpatient Prescription
Drugs |
$0–$3,600
Out-of-Pocket* |
Retail: $4.00
Copayment for Generic Drugs per Prescription Unit or thirty
(30)-day supply.
$44.00 Copayment for Brand Name Drugs per
Prescription Unit or thirty (30)-day supply.
Mail Service:
$8.00 Copayment for Generic Drugs drugs
up to a ninety (90)-day supply through our contracted mail
service pharmacy.
$88.00 Copayment for Brand Name drugs up
to a ninety (90)-day supply through our contracted mail service
pharmacy.
|
| Over $3,600 Out-of-Pocket* |
You pay the greater of $2 for
Generic or a preferred Brand Name Drug that is a multisource
drug, and $5 for all other drugs, or 5% coinsurance once your
total out-of-pocket costs reach $3,600.
|
* You have a special
type of plan that uses a Medicare Prescription Drug plan as a foundation
and has additional benefits to give you even more drug coverage.
When you take your prescription to the pharmacy to fill, your pharmacist
will first check if your drug is on our Medicare Prescription Drug
plan formulary. If it is, your drug costs will count toward your
Medicare Prescription Drug Plan out-of-pocket limit. If your drug
is not listed on the formulary, your drug may still be covered under
your Prescription Drug Insurance Plan, and you only pay the required
copay; however, your copay will not count toward your Medicare Prescription
Drug Plan out-of-pocket limit.
The chart below shows how your enhanced benefit works with
the Medicare Prescription Drug Plan:
| |
Medicare Prescription Drug
Standard Benefit |
PacifiCare Prescription
Drug Insurance Plan with Prescription Solutions from PacifiCare |
Outpatient
Benefits
|
Medicare Prescription Drug
Benefits coverage dollar limits |
Without your enhanced benefit plan,
you pay: |
With your enhanced benefit plan, you
pay: |
| Prescription
Drugs |
$0-250 |
$0–250 Deductible of
$250 for drugs on the Medicare Prescription Drug formulary.
|
Retail:
$4.00 Copayment for Generic Drugs per Prescription
Unit or thirty (30)-day supply
$44.00 Copayment for Brand Name Drugs per Prescription
Unit or thirty (30)-day supply.
Mail Service:
$8.00 Copayment for Generic Drugs drugs up to a ninety
(90)-day supply through our contracted mail service pharmacy.
$88.00 Copayment for Brand Name Drugs up to
a ninety (90)-day supply through our contracted mail service
pharmacy. |
| $251-$750 |
When out-of-pocket
drug costs are between $250 and $750 for drugs on the Medicare
Prescription Drug formulary there is a coinsurance of 25%.
|
| $751-$3,600 |
After yearly
out-of-pocket costs reach $750, there is no coverage until yearly
out-of-pocket expenses reach $3,600. |
| Over $3,600 |
After yearly
out-of pocket drug costs reach $3,600, payments are the greater
of $2 for Generic or a preferred Brand Name Drug that is a
multi-source drug and $5 for all other drugs,
or 5% coinsurance. |
You pay the greater
of $2 for Generic or a preferred Brand Name Drug that is a multisource
drug, and $5 for all other drugs, or 5% coinsurance. |
Prescription Drug Plan - Shaklee Rates
Monthly Renewal Rates Effective January 1st, 2006
Prices include $46.90 Prescription Drug Plan
| |
Age |
Total Cost |
| |
65-69 |
262.29 |
| |
70-74 |
305.47 |
| |
75-79 |
345.79 |
| |
80-84 |
371.44 |
| |
85+ |
396.01 |
BELOW IS A DISCOUNT BENEFIT PACKAGE.
YOU CANNOT PURCHASE THIS DISCOUNT PLAN WITH THE INSURED PACIFIC
CARE PART D PRESCRIPTION DRUG BENEFIT.
YOU CAN PURCHASE THE BENEFIT PACKAGE BELOW WITH YOUR SENIOR CHOICE
PLAN IF YOU DO NOT CHOOSE THE INSURED PACIFIC CARE PART D DRUG BENEFIT.
YOU WOULD ADD $12.95 PER MONTH TO YOUR SENIOR CHOICE RATE, (THAT
DOES NOT INCLUDE THE ($46.90) PART D PRESCRIPTION DRUG PROGRAM FROM
PACIFIC CARE.THE PROGRAM BELOW IS NOT INSURANCE,THEY ARE DISCOUNT
BENEFITS.
| |
Age |
Total Cost |
| |
65-69 |
155.09 |
| |
70-74 |
197.01 |
| |
75-79 |
221.25 |
| |
80-84 |
246.74 |
| |
85+ |
282.83 |
| Additional Health Services
Available |
Cost $12.95 |
| Doctors
RX choice prescription drug program |
1st Tier up to $10.00, 2nd Tier up to $20.00,
3rd Tier up to $50.00 and 4th Tier up to 60% savings on all
other drugs |
| Aetna
Dental Access |
As a member of program, you and your family
have access to a national network of over 66,000** available
dental practice locations to choose from nationwide. Participating
dental locations provide savings of 15% to 50% on most dental
services including cleaning, x-rays, fillings, root canals,
crowns, bridges, and orthodontia.
*Anticipated national average dental
charges for the 2006 calendar year based on the comparison of
provider negotiated fees to national average charges. Actual
cost and savings vary by provider and geographical area.
** According to the Aetna enterprise provider data base as of
1-1-2006. |
| Vision |
10% to 60% savings |
| Medstat
Alert |
Allows you to store your Medical Information
to let a medical professional know about you in an emergency. |
The health service programs are NOT insurance,
it is a reduced Fee For Service Program that provides discounts
at certain providers. Members must pay the entire reduced cost for
the health services performed at the time service is rendered unless
other arrangements are made with the provider’s office. The
health service Program does not pay providers.
Click here for Seniors Choice Benefit
Plan
or
Seniors Choice Preferred Plan

|