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Medicare Advantage Fact Sheet OUT11240 What is a Medicare Advantage Plan? What do Medicare Advantage Plans cover? How much do Medicare Advantage Plans cost? Medicare Advantage is an alternative to Original Medicare and supplement coverage. Medicare Advantage Plans are also referred to as Medicare Health Plans or Part C. Medicare Part C/Medicare Advantage Plans are offered by private insurance companies. With a Medicare Advantage plan, you receive all of your needed coverage in one plan. Medicare Advantage Plans cover the same services Part A (inpatient) and Part B (outpatient) cover. Most plans also include drug coverage (Part D). Some plans offer extra benefits, like dental and vi- sion. Out-of-Pocket Costs*: Inpatient Care - Up to $1,750* per hospital stay Outpatient Care - $10* Doctor, $40* Specialist, $300* Outpatient Surgery Out-of-Pocket - $6,700* out-of-pocket maximum limit Drug Coverage - $0-$435 deductible plus copays for medications Premium Cost: Medicare Part A - $0 Medicare Part B - $144.60 Medicare Advantage - $29* Monthly Premiums $173.60* *These prices are an average. Price will depend on the plan and company selected. Monthly Premiums: All Medicare Advantage Plan enrollees must continue to pay the Medicare Part B premium, $144.60. Medicare Advantage Plans may also charge an additional premium which will vary based on the plan. Additional Premiums range from $0 - $145. Deductibles/Copays: Medicare Advantage Plans can have a deductible up to $1,000 per year, depending on the plan. With a Medicare Advantage plan you will owe a copay for each service each time you receive it. For Example: Doctor’s Visit - $10*, Specialist - $40*, Outpatient Surgery - $300*, Inpatient Hospital Stay - up to $1,750 per stay*. Other copays will apply. Out-of-Pocket Maximum: All Medicare Advantage plans have an out-of-pocket limit. This is the maximum a person can spend on medical expenses for the year. Once the out-of-pocket amount is reached, the plan covers 100% of cost. Each plan determines their specific out-of-pocket limit. Prescription drug costs never count towards this dollar amount. 6/20

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Page 1: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

Medicare Advantage Fact Sheet

OUT11240

What is a Medicare Advantage Plan?

What do Medicare Advantage Plans cover?

How much do Medicare Advantage Plans cost?

Medicare Advantage is an alternative to Original Medicare and supplement coverage. Medicare Advantage Plans are also referred to as Medicare Health Plans or Part C. Medicare Part C/Medicare Advantage Plans are offered by private insurance companies.

With a Medicare Advantage plan, you receive all of your needed coverage in one plan. Medicare Advantage Plans cover the same services Part A (inpatient) and Part B (outpatient) cover. Most plans also include drug coverage (Part D). Some plans offer extra benefits, like dental and vi-sion.

When can I get a Medicare Advantage Plan

Out-of-Pocket Costs*: Inpatient Care - Up to $1,750* per hospital stay

Outpatient Care - $10* Doctor, $40* Specialist, $300* Outpatient Surgery

Out-of-Pocket - $6,700* out-of-pocket maximum limit

Drug Coverage - $0-$435 deductible plus copays for medications

Premium Cost:

Medicare Part A - $0

Medicare Part B - $144.60

Medicare Advantage - $29*

Monthly Premiums $173.60*

*These prices are an average. Price will depend on the plan and company selected.

Monthly Premiums: All Medicare Advantage Plan enrollees must continue to pay the Medicare Part B premium, $144.60. Medicare Advantage Plans may also charge an additional premium which will vary based on the plan. Additional Premiums range from $0 - $145. Deductibles/Copays: Medicare Advantage Plans can have a deductible up to $1,000 per year, depending on the plan. With a Medicare Advantage plan you will owe a copay for each service each time you receive it. For Example: Doctor’s Visit - $10*, Specialist - $40*, Outpatient Surgery - $300*, Inpatient Hospital Stay - up to $1,750 per stay*. Other copays will apply. Out-of-Pocket Maximum: All Medicare Advantage plans have an out-of-pocket limit. This is the maximum a person can spend on medical expenses for the year. Once the out-of-pocket amount is reached, the plan covers 100% of cost. Each plan determines their specific out-of-pocket limit. Prescription drug costs never count towards this dollar amount.

6/20

Page 2: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

Medicare Advantage Fact Sheet

How do I sign up for a Medicare Advantage Plan?

You can join a Medicare Advantage Plan when you first begin Medicare, whether by age or disa-bility. If you work past age 65 and delay Medicare, you can choose a Medicare Advantage Plan when you retire. Medicare Advantage plans are a one year commitment. Each year the plan can change costs and coverage. Since the plan can change its benefits you also get the chance to make changes. Every year, between October 15 and December 7, you get the opportunity to review Medicare Advantage Plan options. If you enroll in a new plan during this period, it will take effect January 1 of the following year.

When can I get a Medicare Advantage Plan?

Who is eligible for a Medicare Advantage Plan?

Medicare Advantage Plans accept all Medicare beneficiaries, including those on Medicare due to disability. The exception to this rule are those with End-Stage Renal Disease (kidney failure). You must first have Medicare Part A and Part B in order to join a Medicare Advantage Plan. Your options will vary depending on where you live. Many counties in Nebraska do NOT have these plans as an option.

Contact the Nebraska SHIP for a comparison of Medicare Advantage Plan options in your area. Once you have selected a plan, SHIP can assist you in enrolling.

Is there anything else to consider when choosing a Medicare Advantage Plan?

Provider Choice: Medicare Advantage plans are sold by private insurance companies. This means that you must see doctors and other healthcare providers that accept that particular insurance plan. Prior to enrolling, be sure to check with the Advantage Plan to ensure that your providers are in the plan’s network. Supplements: Medicare Supplements are an alternative option to a Medicare Advantage Plan. You should never have both a Medicare Supplement and a Medicare Advantage Plan. The two options will not work together. Choose the option that best meets your needs.

Nebraska SHIP 1033 O Street, Suite 307 - Lincoln, NE 68508

1-800-234-7119 - www.doi.nebraska.gov/SHIP

This project was supported, in part by grant number 90SAPG0078, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201.

Page 3: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 1

Adams County Arthur County Box Butte

AARP Medicare Advantage (HMO-POS) Blue Cross Blue Shield Nebraska MA Access (PPO) UnitedHealthcare MedicareDirect Patriot (PFFS)

AARP Medicare Advantage Choice (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO) UnitedHealthcare MedicareDirect Rx (PFFS)

AARP Medicare Advantage Patriot (PPO) UnitedHealthcare MedicareDirect Patriot (PFFS)

Aetna Medicare Elite (PPO) UnitedHealthcare MedicareDirect Rx (PFFS) Boyd County

Aetna Medicare Premier (HMO) Medica Prime Solution Core (Cost)

Aetna Medicare Premier (PPO) Banner County Medica Prime Solution Premier (Cost)

Blue Cross Blue Shield Nebraska MA Access (PPO) UnitedHealthcare MedicareDirect Patriot (PFFS) Medica Prime Solution Thrift (Cost)

Blue Cross Blue Shield Nebraska MA Core (HMO) UnitedHealthcare MedicareDirect Rx (PFFS)

Medica Prime Solution Core (Cost) Brown County

Medica Prime Solution Premier (Cost) Blaine County No plans available in Brown County

Medica Prime Solution Thrift (Cost) Blue Cross Blue Shield Nebraska MA Access (PPO)

Blue Cross Blue Shield Nebraska MA Core (HMO) Buffalo County

UnitedHealthcare MedicareDirect Patriot (PFFS) AARP Medicare Advantage (HMO-POS)

Antelope County UnitedHealthcare MedicareDirect Rx (PFFS) AARP Medicare Advantage Choice (PPO)

AARP Medicare Advantage (HMO-POS) AARP Medicare Advantage Patriot (PPO)

AARP Medicare Advantage Choice (PPO) Boone County Aetna Medicare Elite (PPO)

AARP Medicare Advantage Patriot (PPO) AARP Medicare Advantage (HMO-POS) Aetna Medicare Premier (HMO)

Aetna Medicare Elite (PPO) AARP Medicare Advantage Choice (PPO) Aetna Medicare Premier (PPO)

Aetna Medicare Premier (HMO) AARP Medicare Advantage Patriot (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO)

Aetna Medicare Premier (PPO) Aetna Medicare Elite (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO)

Blue Cross Blue Shield Nebraska MA Access (PPO) Aetna Medicare Premier (HMO) Medica Prime Solution Core (Cost)

Blue Cross Blue Shield Nebraska MA Core (HMO) Aetna Medicare Premier (PPO) Medica Prime Solution Premier (Cost)

Medica Prime Solution Core (Cost) Blue Cross Blue Shield Nebraska MA Access (PPO) Medica Prime Solution Thrift (Cost)

Medica Prime Solution Premier (Cost) Blue Cross Blue Shield Nebraska MA Core (HMO) UnitedHealthcare MedicareDirect Patriot (PFFS)

Medica Prime Solution Thrift (Cost) Medica Prime Solution Core (Cost) UnitedHealthcare MedicareDirect Rx (PFFS)

Medica Prime Solution Premier (Cost)

Medica Prime Solution Thrift (Cost)

2021 Nebraska Medicare Advantage and Cost Plans Below is a list of counties and the plans available in each county. The following pages contain the plan details for each plan.

Page 4: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 2

Burt County Cass County Chase County

AARP Medicare Advantage (HMO-POS) AARP Medicare Advantage (HMO-POS) Blue Cross Blue Shield Nebraska MA Access (PPO)

AARP Medicare Advantage Choice (PPO) AARP Medicare Advantage Choice (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO)

AARP Medicare Advantage Patriot (PPO) AARP Medicare Advantage Patriot (PPO)

Aetna Medicare Elite (PPO) Aetna Medicare Elite (PPO) Cherry County

Aetna Medicare Premier (HMO) Aetna Medicare Premier (HMO) No plans available in Cherry County

Aetna Medicare Premier (PPO) Aetna Medicare Premier (PPO)

Blue Cross Blue Shield Nebraska MA Access (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO) Cheyenne County

Blue Cross Blue Shield Nebraska MA Choice (HMO-POS) Blue Cross Blue Shield Nebraska MA Choice (HMO-POS) Medica Prime Solution Core (Cost)

Blue Cross Blue Shield Nebraska MA Core (HMO) Blue Cross Blue Shield Nebraska MA Core (HMO) Medica Prime Solution Premier (Cost)

Medica Prime Solution Core (Cost) Humana Gold Plus H0028-011 (HMO) Medica Prime Solution Thrift (Cost)

Medica Prime Solution Premier (Cost) Humana Honor (PPO) UnitedHealthcare MedicareDirect Patriot (PFFS)

Medica Prime Solution Thrift (Cost) Humana Value Plus H5216-171 (PPO) UnitedHealthcare MedicareDirect Rx (PFFS)

HumanaChoice H5216-014 (PPO)

Butler County Medica Advantage Solution H3632-001 (PPO) Clay County

AARP Medicare Advantage (HMO-POS) Medica Advantage Solution with CHI Health (HMO) AARP Medicare Advantage (HMO-POS)

AARP Medicare Advantage Choice (PPO) AARP Medicare Advantage Choice (PPO)

AARP Medicare Advantage Patriot (PPO) Cedar County AARP Medicare Advantage Patriot (PPO)

Aetna Medicare Elite (PPO) AARP Medicare Advantage Choice (PPO) Aetna Medicare Elite (PPO)

Aetna Medicare Premier (HMO) AARP Medicare Advantage Patriot (PPO) Aetna Medicare Premier (HMO)

Aetna Medicare Premier (PPO) Aetna Medicare Elite (PPO) Aetna Medicare Premier (PPO)

Blue Cross Blue Shield Nebraska MA Access (PPO) Aetna Medicare Premier (HMO) Blue Cross Blue Shield Nebraska MA Access (PPO)

Blue Cross Blue Shield Nebraska MA Choice (HMO-POS) Aetna Medicare Premier (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO)

Blue Cross Blue Shield Nebraska MA Core (HMO) Medica Prime Solution Core (Cost) Medica Prime Solution Core (Cost)

Medica Advantage Solution H3632-001 (PPO) Medica Prime Solution Premier (Cost) Medica Prime Solution Premier (Cost)

Medica Advantage Solution with CHI Health (HMO) Medica Prime Solution Thrift (Cost) Medica Prime Solution Thrift (Cost)

Medical Associates Nebraska Senior Plan (Cost)

Below is a list of counties and the plans available in each county. The following pages contain the plan details for each plan.

Page 5: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 3

Colfax County Custer County continued Dixon County

AARP Medicare Advantage (HMO-POS) AARP Medicare Advantage Patriot (PPO) AARP Medicare Advantage Choice (PPO)

AARP Medicare Advantage Choice (PPO) Aetna Medicare Elite (PPO) AARP Medicare Advantage Patriot (PPO)

AARP Medicare Advantage Patriot (PPO) Aetna Medicare Premier (HMO) Aetna Medicare Elite (PPO)

Aetna Medicare Elite (PPO) Aetna Medicare Premier (PPO) Aetna Medicare Premier (HMO)

Aetna Medicare Premier (HMO) Blue Cross Blue Shield Nebraska MA Access (PPO) Aetna Medicare Premier (PPO)

Aetna Medicare Premier (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO) Medica Prime Solution Core (Cost)

Blue Cross Blue Shield Nebraska MA Access (PPO) Medica Prime Solution Core (Cost) Medica Prime Solution Premier (Cost)

Blue Cross Blue Shield Nebraska MA Choice (HMO-POS) Medica Prime Solution Premier (Cost) Medica Prime Solution Thrift (Cost)

Blue Cross Blue Shield Nebraska MA Core (HMO) Medica Prime Solution Thrift (Cost)

Medica Prime Solution Core (Cost)

Medica Prime Solution Premier (Cost) Dakota County Dodge County

Medica Prime Solution Thrift (Cost) AARP Medicare Advantage Choice (PPO) AARP Medicare Advantage (HMO-POS)

AARP Medicare Advantage Patriot (PPO) AARP Medicare Advantage Choice (PPO)

Cuming County Aetna Medicare Elite (PPO) AARP Medicare Advantage Patriot (PPO)

AARP Medicare Advantage (HMO-POS) Aetna Medicare Premier (HMO) Aetna Medicare Elite (PPO)

AARP Medicare Advantage Choice (PPO) Aetna Medicare Premier (PPO) Aetna Medicare Premier (HMO)

AARP Medicare Advantage Patriot (PPO) Humana Gold Plus H0028-011 (HMO) Aetna Medicare Premier (PPO)

Aetna Medicare Elite (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO)

Aetna Medicare Premier (HMO) Dawes County Blue Cross Blue Shield Nebraska MA Choice (HMO-POS)

Aetna Medicare Premier (PPO) Medica Prime Solution Core (Cost) Blue Cross Blue Shield Nebraska MA Core (HMO)

Blue Cross Blue Shield Nebraska MA Access (PPO) Medica Prime Solution Premier (Cost) Bright Advantage (HMO)

Blue Cross Blue Shield Nebraska MA Choice (HMO-POS) Medica Prime Solution Thrift (Cost) Bright Advantage Choice (PPO)

Blue Cross Blue Shield Nebraska MA Core (HMO) Bright Advantage Choice Plus (PPO)

Medica Prime Solution Core (Cost) Dawson County Bright Advantage Plus (HMO)

Medica Prime Solution Premier (Cost) Blue Cross Blue Shield Nebraska MA Access (PPO) Humana Gold Plus H0028-011 (HMO)

Medica Prime Solution Thrift (Cost) Blue Cross Blue Shield Nebraska MA Core (HMO) Humana Honor (PPO)

UnitedHealthcare MedicareDirect Patriot (PFFS) Humana Value Plus H5216-171 (PPO)

Custer County UnitedHealthcare MedicareDirect Rx (PFFS) HumanaChoice H5216-014 (PPO)

AARP Medicare Advantage (HMO-POS) Medica Advantage Solution H3632-001 (PPO)

AARP Medicare Advantage Choice (PPO) Deuel County Medica Advantage Solution with CHI Health (HMO)

No plans available in Deuel county

Below is a list of counties and the plans available in each county. The following pages contain the plan details for each plan.

Page 6: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 4

Douglas County Fillmore County Continued Frontier County continued

AARP Medicare Advantage (HMO-POS) AARP Medicare Advantage Patriot (PPO) Medica Prime Solution Premier (Cost)

AARP Medicare Advantage Choice (PPO) Aetna Medicare Elite (PPO) Medica Prime Solution Thrift (Cost)

AARP Medicare Advantage Patriot (PPO) Aetna Medicare Premier (HMO)

Aetna Medicare Elite (PPO) Aetna Medicare Premier (PPO) Furnas County

Aetna Medicare Premier (HMO) Blue Cross Blue Shield Nebraska MA Access (PPO) Aetna Medicare Elite (PPO)

Aetna Medicare Premier (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO) Aetna Medicare Premier (HMO)

Aetna Medicare Prime (HMO) Medica Prime Solution Core (Cost) Aetna Medicare Premier (PPO)

Blue Cross Blue Shield Nebraska MA Access (PPO) Medica Prime Solution Premier (Cost) Blue Cross Blue Shield Nebraska MA Access (PPO)

Blue Cross Blue Shield Nebraska MA Choice (HMO-POS) Medica Prime Solution Thrift (Cost) Blue Cross Blue Shield Nebraska MA Core (HMO)

Blue Cross Blue Shield Nebraska MA Core (HMO) Medical Associates Nebraska Senior Plan (Cost) Medica Prime Solution Core (Cost)

Bright Advantage (HMO) Medica Prime Solution Premier (Cost)

Bright Advantage Choice (PPO) Franklin County Medica Prime Solution Thrift (Cost)

Bright Advantage Choice Plus (PPO) Aetna Medicare Elite (PPO)

Bright Advantage Plus (HMO) Aetna Medicare Premier (HMO) Gage County

Humana Gold Plus H0028-011 (HMO) Aetna Medicare Premier (PPO) AARP Medicare Advantage (HMO-POS)

Humana Honor (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO) AARP Medicare Advantage Choice (PPO)

HumanaChoice H5216-014 (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO) AARP Medicare Advantage Patriot (PPO)

HumanaChoice H5216-254 (PPO) Medica Prime Solution Core (Cost) Aetna Medicare Elite (PPO)

Medica Advantage Solution H3632-001 (PPO) Medica Prime Solution Premier (Cost) Aetna Medicare Premier (HMO)

Medica Advantage Solution with CHI Health (HMO) Medica Prime Solution Thrift (Cost) Aetna Medicare Premier (PPO)

Blue Cross Blue Shield Nebraska MA Access (PPO)

Dundy County Frontier County Blue Cross Blue Shield Nebraska MA Choice (HMO-POS)

No plans available in Dundy county Aetna Medicare Elite (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO)

Aetna Medicare Premier (HMO) Medica Prime Solution Core (Cost)

Fillmore County Aetna Medicare Premier (PPO) Medica Prime Solution Premier (Cost)

AARP Medicare Advantage (HMO-POS) Blue Cross Blue Shield Nebraska MA Access (PPO) Medica Prime Solution Thrift (Cost)

AARP Medicare Advantage Choice (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO) Medical Associates Nebraska Senior Plan (Cost)

More on next column Medica Prime Solution Core (Cost) More on next column

Below is a list of counties and the plans available in each county. The following pages contain the plan details for each plan.

Page 7: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 5

Garfield County Greeley County Hamilton County

Aetna Medicare Elite (PPO) Aetna Medicare Elite (PPO) AARP Medicare Advantage (HMO-POS)

Aetna Medicare Premier (HMO) Aetna Medicare Premier (HMO) AARP Medicare Advantage Choice (PPO)

Aetna Medicare Premier (PPO) Aetna Medicare Premier (PPO) AARP Medicare Advantage Patriot (PPO)

Blue Cross Blue Shield Nebraska MA Access (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO) Aetna Medicare Elite (PPO)

Blue Cross Blue Shield Nebraska MA Core (HMO) Blue Cross Blue Shield Nebraska MA Core (HMO) Aetna Medicare Premier (HMO)

Medica Prime Solution Core (Cost) Medica Prime Solution Core (Cost) Aetna Medicare Premier (PPO)

Medica Prime Solution Premier (Cost) Medica Prime Solution Premier (Cost) Blue Cross Blue Shield Nebraska MA Access (PPO)

Medica Prime Solution Thrift (Cost) Medica Prime Solution Thrift (Cost) Blue Cross Blue Shield Nebraska MA Core (HMO)

Medica Prime Solution Core (Cost)

Garden County Hall County Medica Prime Solution Premier (Cost)

No plans available in Garden County AARP Medicare Advantage (HMO-POS) Medica Prime Solution Thrift (Cost)

AARP Medicare Advantage Choice (PPO) UnitedHealthcare MedicareDirect Patriot (PFFS)

Gosper County AARP Medicare Advantage Patriot (PPO) UnitedHealthcare MedicareDirect Rx (PFFS)

Aetna Medicare Elite (PPO) Aetna Medicare Elite (PPO)

Aetna Medicare Premier (HMO) Aetna Medicare Premier (HMO) Harlan County

Aetna Medicare Premier (PPO) Aetna Medicare Premier (PPO) Aetna Medicare Elite (PPO)

Blue Cross Blue Shield Nebraska MA Access (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO) Aetna Medicare Premier (HMO)

Blue Cross Blue Shield Nebraska MA Core (HMO) Blue Cross Blue Shield Nebraska MA Core (HMO) Aetna Medicare Premier (PPO)

Medica Prime Solution Core (Cost) Medica Prime Solution Core (Cost) Blue Cross Blue Shield Nebraska MA Access (PPO)

Medica Prime Solution Premier (Cost) Medica Prime Solution Premier (Cost) Blue Cross Blue Shield Nebraska MA Core (HMO)

Medica Prime Solution Thrift (Cost) Medica Prime Solution Thrift (Cost) Medica Prime Solution Core (Cost)

UnitedHealthcare MedicareDirect Patriot (PFFS) UnitedHealthcare MedicareDirect Patriot (PFFS) Medica Prime Solution Premier (Cost)

UnitedHealthcare MedicareDirect Rx (PFFS) UnitedHealthcare MedicareDirect Rx (PFFS) Medica Prime Solution Thrift (Cost)

Grant County Hayes County

Blue Cross Blue Shield Nebraska MA Access (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO)

Blue Cross Blue Shield Nebraska MA Core (HMO) Blue Cross Blue Shield Nebraska MA Core (HMO)

Below is a list of counties and the plans available in each county. The following pages contain the plan details for each plan.

Page 8: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 6

Hitchcock County Jefferson County Kearney County

Blue Cross Blue Shield Nebraska MA Access (PPO) AARP Medicare Advantage (HMO-POS) AARP Medicare Advantage (HMO-POS)

Blue Cross Blue Shield Nebraska MA Core (HMO) AARP Medicare Advantage Choice (PPO) AARP Medicare Advantage Choice (PPO)

AARP Medicare Advantage Patriot (PPO) AARP Medicare Advantage Patriot (PPO)

Holt County Aetna Medicare Elite (PPO) Aetna Medicare Elite (PPO)

Aetna Medicare Elite (PPO) Aetna Medicare Premier (HMO) Aetna Medicare Premier (HMO)

Aetna Medicare Premier (HMO) Aetna Medicare Premier (PPO) Aetna Medicare Premier (PPO)

Aetna Medicare Premier (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO)

Medica Prime Solution Core (Cost) Blue Cross Blue Shield Nebraska MA Core (HMO) Blue Cross Blue Shield Nebraska MA Core (HMO)

Medica Prime Solution Premier (Cost) Medica Prime Solution Core (Cost) Medica Prime Solution Core (Cost)

Medica Prime Solution Thrift (Cost) Medica Prime Solution Premier (Cost) Medica Prime Solution Premier (Cost)

Medica Prime Solution Thrift (Cost) Medica Prime Solution Thrift (Cost)

Hooker County Medical Associates Nebraska Senior Plan (Cost) UnitedHealthcare MedicareDirect Patriot (PFFS)

Blue Cross Blue Shield Nebraska MA Access (PPO) UnitedHealthcare MedicareDirect Rx (PFFS)

Blue Cross Blue Shield Nebraska MA Core (HMO) Johnson County

UnitedHealthcare MedicareDirect Patriot (PFFS) AARP Medicare Advantage (HMO-POS) Keith County

UnitedHealthcare MedicareDirect Rx (PFFS) AARP Medicare Advantage Choice (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO)

AARP Medicare Advantage Patriot (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO)

Howard County Aetna Medicare Elite (PPO) UnitedHealthcare MedicareDirect Patriot (PFFS)

AARP Medicare Advantage (HMO-POS) Aetna Medicare Premier (HMO) UnitedHealthcare MedicareDirect Rx (PFFS)

AARP Medicare Advantage Choice (PPO) Aetna Medicare Premier (PPO)

AARP Medicare Advantage Patriot (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO) Keya Paha

Aetna Medicare Elite (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO) UnitedHealthcare MedicareDirect Patriot (PFFS)

Aetna Medicare Premier (HMO) Medica Prime Solution Core (Cost) UnitedHealthcare MedicareDirect Rx (PFFS)

Aetna Medicare Premier (PPO) Medica Prime Solution Premier (Cost)

Blue Cross Blue Shield Nebraska MA Access (PPO) Medica Prime Solution Thrift (Cost) Kimball County

Blue Cross Blue Shield Nebraska MA Core (HMO) Medical Associates Nebraska Senior Plan (Cost) No plans in Kimball County

Medica Prime Solution Core (Cost)

Medica Prime Solution Premier (Cost)

Medica Prime Solution Thrift (Cost)

Below is a list of counties and the plans available in each county. The following pages contain the plan details for each plan.

Page 9: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 7

Knox County Lincoln County McPherson County

AARP Medicare Advantage Choice (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO)

AARP Medicare Advantage Patriot (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO) Blue Cross Blue Shield Nebraska MA Core (HMO)

Aetna Medicare Elite (PPO) UnitedHealthcare MedicareDirect Patriot (PFFS)

Aetna Medicare Premier (HMO) Logan County UnitedHealthcare MedicareDirect Rx (PFFS)

Aetna Medicare Premier (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO)

Blue Cross Blue Shield Nebraska MA Access (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO) Merrick County

Blue Cross Blue Shield Nebraska MA Core (HMO) UnitedHealthcare MedicareDirect Patriot (PFFS) AARP Medicare Advantage (HMO-POS)

Medica Prime Solution Core (Cost) UnitedHealthcare MedicareDirect Rx (PFFS) AARP Medicare Advantage Choice (PPO)

Medica Prime Solution Premier (Cost) AARP Medicare Advantage Patriot (PPO)

Medica Prime Solution Thrift (Cost) Loup County Aetna Medicare Elite (PPO)

Medica Prime Solution Core (Cost) Aetna Medicare Premier (HMO)

Lancaster County Medica Prime Solution Premier (Cost) Aetna Medicare Premier (PPO)

AARP Medicare Advantage (HMO-POS) Medica Prime Solution Thrift (Cost) Blue Cross Blue Shield Nebraska MA Access (PPO)

AARP Medicare Advantage Choice (PPO) UnitedHealthcare MedicareDirect Patriot (PFFS) Blue Cross Blue Shield Nebraska MA Core (HMO)

AARP Medicare Advantage Patriot (PPO) UnitedHealthcare MedicareDirect Rx (PFFS) Medica Prime Solution Core (Cost)

Aetna Medicare Elite (PPO) Medica Prime Solution Premier (Cost)

Aetna Medicare Premier (HMO) Madison County Medica Prime Solution Thrift (Cost)

Aetna Medicare Premier (PPO) AARP Medicare Advantage (HMO-POS) UnitedHealthcare MedicareDirect Patriot (PFFS)

Blue Cross Blue Shield Nebraska MA Access (PPO) AARP Medicare Advantage Choice (PPO) UnitedHealthcare MedicareDirect Rx (PFFS)

Blue Cross Blue Shield Nebraska MA Choice (HMO-POS) AARP Medicare Advantage Patriot (PPO)

Blue Cross Blue Shield Nebraska MA Core (HMO) Aetna Medicare Elite (PPO) Morrill County

Humana Gold Plus H0028-011 (HMO) Aetna Medicare Premier (HMO) UnitedHealthcare MedicareDirect Patriot (PFFS)

Humana Honor (PPO) Aetna Medicare Premier (PPO) UnitedHealthcare MedicareDirect Rx (PFFS)

Humana Value Plus H5216-171 (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO)

HumanaChoice H5216-014 (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO)

HumanaChoice H5216-254 (PPO) Medica Prime Solution Core (Cost)

Medica Advantage Solution H3632-001 (PPO) Medica Prime Solution Premier (Cost)

Medica Advantage Solution with CHI Health (HMO) Medica Prime Solution Thrift (Cost)

Medical Associates Nebraska Senior Plan (Cost)

Below is a list of counties and the plans available in each county. The following pages contain the plan details for each plan.

Page 10: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 8

Nance County Nuckolls County Continued Pawnee County Continued

Aetna Medicare Elite (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO) Blue Cross Blue Shield Nebraska MA Core (HMO)

Aetna Medicare Premier (HMO) Medica Prime Solution Core (Cost) Medica Prime Solution Core (Cost)

Aetna Medicare Premier (PPO) Medica Prime Solution Premier (Cost) Medica Prime Solution Premier (Cost)

Blue Cross Blue Shield Nebraska MA Access (PPO) Medica Prime Solution Thrift (Cost) Medica Prime Solution Thrift (Cost)

Blue Cross Blue Shield Nebraska MA Core (HMO) Medical Associates Nebraska Senior Plan (Cost) Medical Associates Nebraska Senior Plan (Cost)

Medica Prime Solution Core (Cost)

Medica Prime Solution Premier (Cost) Otoe County Perkins County

Medica Prime Solution Thrift (Cost) AARP Medicare Advantage (HMO-POS) Blue Cross Blue Shield Nebraska MA Access (PPO)

UnitedHealthcare MedicareDirect Patriot (PFFS) AARP Medicare Advantage Choice (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO)

UnitedHealthcare MedicareDirect Rx (PFFS) AARP Medicare Advantage Patriot (PPO) UnitedHealthcare MedicareDirect Patriot (PFFS)

Aetna Medicare Elite (PPO) UnitedHealthcare MedicareDirect Rx (PFFS)

Nemaha County Aetna Medicare Premier (HMO)

Aetna Medicare Elite (PPO) Aetna Medicare Premier (PPO) Phelps County

Aetna Medicare Premier (HMO) Blue Cross Blue Shield Nebraska MA Access (PPO) Aetna Medicare Elite (PPO)

Aetna Medicare Premier (PPO) Blue Cross Blue Shield Nebraska MA Choice (HMO-POS) Aetna Medicare Premier (HMO)

Blue Cross Blue Shield Nebraska MA Access (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO) Aetna Medicare Premier (PPO)

Blue Cross Blue Shield Nebraska MA Core (HMO) Medica Prime Solution Core (Cost) Blue Cross Blue Shield Nebraska MA Access (PPO)

Medica Prime Solution Core (Cost) Medica Prime Solution Premier (Cost) Blue Cross Blue Shield Nebraska MA Core (HMO)

Medica Prime Solution Premier (Cost) Medica Prime Solution Thrift (Cost) Medica Prime Solution Core (Cost)

Medica Prime Solution Thrift (Cost) Medical Associates Nebraska Senior Plan (Cost) Medica Prime Solution Premier (Cost)

Medica Prime Solution Thrift (Cost)

Nuckolls County Pawnee County

AARP Medicare Advantage (HMO-POS) AARP Medicare Advantage (HMO-POS)

AARP Medicare Advantage Choice (PPO) AARP Medicare Advantage Choice (PPO)

AARP Medicare Advantage Patriot (PPO) AARP Medicare Advantage Patriot (PPO)

Aetna Medicare Elite (PPO) Aetna Medicare Elite (PPO)

Aetna Medicare Premier (HMO) Aetna Medicare Premier (HMO)

Aetna Medicare Premier (PPO) Aetna Medicare Premier (PPO)

Blue Cross Blue Shield Nebraska MA Access (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO)

More in next Column More in next Column

Below is a list of counties and the plans available in each county. The following pages contain the plan details for each plan.

Page 11: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 9

Pierce County Polk County Continued Saline County Continued

AARP Medicare Advantage (HMO-POS) AARP Medicare Advantage Patriot (PPO) Medica Prime Solution Core (Cost)

AARP Medicare Advantage Choice (PPO) Aetna Medicare Elite (PPO) Medica Prime Solution Premier (Cost)

AARP Medicare Advantage Patriot (PPO) Aetna Medicare Premier (HMO) Medica Prime Solution Thrift (Cost)

Aetna Medicare Elite (PPO) Aetna Medicare Premier (PPO) Medical Associates Nebraska Senior Plan (Cost)

Aetna Medicare Premier (HMO) Blue Cross Blue Shield Nebraska MA Access (PPO)

Aetna Medicare Premier (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO)

Blue Cross Blue Shield Nebraska MA Access (PPO) Sarpy County

Blue Cross Blue Shield Nebraska MA Core (HMO) Red Willow County AARP Medicare Advantage (HMO-POS)

Medica Prime Solution Core (Cost) No plans available in Red Willow County AARP Medicare Advantage Choice (PPO)

Medica Prime Solution Premier (Cost) AARP Medicare Advantage Patriot (PPO)

Medica Prime Solution Thrift (Cost) Richardson County Aetna Medicare Elite (PPO)

No plans available in Richardson County Aetna Medicare Premier (HMO)

Platte County Aetna Medicare Premier (PPO)

AARP Medicare Advantage (HMO-POS) Rock County Aetna Medicare Prime (HMO)

AARP Medicare Advantage Choice (PPO) Medica Prime Solution Core (Cost) Blue Cross Blue Shield Nebraska MA Access (PPO)

AARP Medicare Advantage Patriot (PPO) Medica Prime Solution Premier (Cost) Blue Cross Blue Shield Nebraska MA Choice (HMO-POS)

Aetna Medicare Elite (PPO) Medica Prime Solution Thrift (Cost) Blue Cross Blue Shield Nebraska MA Core (HMO)

Aetna Medicare Premier (HMO) Bright Advantage (HMO)

Aetna Medicare Premier (PPO) Saline County Bright Advantage Choice (PPO)

Blue Cross Blue Shield Nebraska MA Access (PPO) AARP Medicare Advantage (HMO-POS) Bright Advantage Choice Plus (PPO)

Blue Cross Blue Shield Nebraska MA Core (HMO) AARP Medicare Advantage Choice (PPO) Bright Advantage Plus (HMO)

Medica Prime Solution Core (Cost) AARP Medicare Advantage Patriot (PPO) Humana Gold Plus H0028-011 (HMO)

Medica Prime Solution Premier (Cost) Aetna Medicare Elite (PPO) Humana Honor (PPO)

Medica Prime Solution Thrift (Cost) Aetna Medicare Premier (HMO) Humana Value Plus H5216-171 (PPO)

Aetna Medicare Premier (PPO) HumanaChoice H5216-014 (PPO)

Polk County Blue Cross Blue Shield Nebraska MA Access (PPO) HumanaChoice H5216-254 (PPO)

AARP Medicare Advantage (HMO-POS) Blue Cross Blue Shield Nebraska MA Choice (HMO-POS) Medica Advantage Solution H3632-001 (PPO)

AARP Medicare Advantage Choice (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO) Medica Advantage Solution with CHI Health (HMO)

More plans in next column More plans in next column

Below is a list of counties and the plans available in each county. The following pages contain the plan details for each plan.

Page 12: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 10

Saunders Seward County Continued Stanton County

AARP Medicare Advantage (HMO-POS) Blue Cross Blue Shield Nebraska MA Core (HMO) AARP Medicare Advantage (HMO-POS)

AARP Medicare Advantage Choice (PPO) Medica Prime Solution Core (Cost) AARP Medicare Advantage Choice (PPO)

AARP Medicare Advantage Patriot (PPO) Medica Prime Solution Premier (Cost) AARP Medicare Advantage Patriot (PPO)

Aetna Medicare Elite (PPO) Medica Prime Solution Thrift (Cost) Aetna Medicare Elite (PPO)

Aetna Medicare Premier (HMO) Medical Associates Nebraska Senior Plan (Cost) Aetna Medicare Premier (HMO)

Aetna Medicare Premier (PPO) Aetna Medicare Premier (PPO)

Blue Cross Blue Shield Nebraska MA Access (PPO) Sheridan County Blue Cross Blue Shield Nebraska MA Access (PPO)

Blue Cross Blue Shield Nebraska MA Choice (HMO-POS) UnitedHealthcare MedicareDirect Patriot (PFFS) Blue Cross Blue Shield Nebraska MA Core (HMO)

Blue Cross Blue Shield Nebraska MA Core (HMO) UnitedHealthcare MedicareDirect Rx (PFFS) Medica Prime Solution Core (Cost)

Humana Honor (PPO) Medica Prime Solution Premier (Cost)

Humana Value Plus H5216-171 (PPO) Sherman County Medica Prime Solution Thrift (Cost)

HumanaChoice H5216-014 (PPO) AARP Medicare Advantage (HMO-POS) UnitedHealthcare MedicareDirect Patriot (PFFS)

Medica Advantage Solution H3632-001 (PPO) AARP Medicare Advantage Choice (PPO) UnitedHealthcare MedicareDirect Rx (PFFS)

Medica Advantage Solution with CHI Health (HMO) AARP Medicare Advantage Patriot (PPO)

Aetna Medicare Elite (PPO) Thayer County

Scotts Bluff County Aetna Medicare Premier (HMO) AARP Medicare Advantage (HMO-POS)

UnitedHealthcare MedicareDirect Patriot (PFFS) Aetna Medicare Premier (PPO) AARP Medicare Advantage Choice (PPO)

UnitedHealthcare MedicareDirect Rx (PFFS) Blue Cross Blue Shield Nebraska MA Access (PPO) AARP Medicare Advantage Patriot (PPO)

Blue Cross Blue Shield Nebraska MA Core (HMO) Aetna Medicare Elite (PPO)

Seward County Medica Prime Solution Core (Cost) Aetna Medicare Premier (HMO)

AARP Medicare Advantage (HMO-POS) Medica Prime Solution Premier (Cost) Aetna Medicare Premier (PPO)

AARP Medicare Advantage Choice (PPO) Medica Prime Solution Thrift (Cost) Blue Cross Blue Shield Nebraska MA Access (PPO)

AARP Medicare Advantage Patriot (PPO) UnitedHealthcare MedicareDirect Patriot (PFFS) Blue Cross Blue Shield Nebraska MA Core (HMO)

Aetna Medicare Elite (PPO) UnitedHealthcare MedicareDirect Rx (PFFS) Medica Prime Solution Core (Cost)

Aetna Medicare Premier (HMO) Medica Prime Solution Premier (Cost)

Aetna Medicare Premier (PPO) Sioux County Medica Prime Solution Thrift (Cost)

Blue Cross Blue Shield Nebraska MA Access (PPO) No plans Available in Sioux County Medical Associates Nebraska Senior Plan (Cost)

Blue Cross Blue Shield Nebraska MA Choice (HMO-POS)

More in next Column

Below is a list of counties and the plans available in each county. The following pages contain the plan details for each plan.

Page 13: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 11

Thomas County Washington County continued Webster County Continued

Blue Cross Blue Shield Nebraska MA Access (PPO) Aetna Medicare Premier (HMO) Blue Cross Blue Shield Nebraska MA Core (HMO)

Blue Cross Blue Shield Nebraska MA Core (HMO) Aetna Medicare Premier (PPO) Medica Prime Solution Core (Cost)

UnitedHealthcare MedicareDirect Patriot (PFFS) Blue Cross Blue Shield Nebraska MA Access (PPO) Medica Prime Solution Premier (Cost)

UnitedHealthcare MedicareDirect Rx (PFFS) Blue Cross Blue Shield Nebraska MA Choice (HMO-POS) Medica Prime Solution Thrift (Cost)

Blue Cross Blue Shield Nebraska MA Core (HMO)

Thurston County Humana Gold Plus H0028-011 (HMO) Wheeler County

AARP Medicare Advantage (HMO-POS) Humana Honor (PPO) Aetna Medicare Elite (PPO)

AARP Medicare Advantage Choice (PPO) Humana Value Plus H5216-171 (PPO) Aetna Medicare Premier (HMO)

AARP Medicare Advantage Patriot (PPO) HumanaChoice H5216-014 (PPO) Aetna Medicare Premier (PPO)

Medica Prime Solution Core (Cost) Medica Advantage Solution H3632-001 (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO)

Medica Prime Solution Premier (Cost) Medica Advantage Solution with CHI Health (HMO) Blue Cross Blue Shield Nebraska MA Core (HMO)

Medica Prime Solution Thrift (Cost) Medica Prime Solution Core (Cost)

Wayne County Medica Prime Solution Premier (Cost)

Valley County Aetna Medicare Elite (PPO) Medica Prime Solution Thrift (Cost)

Aetna Medicare Elite (PPO) Aetna Medicare Premier (HMO) UnitedHealthcare MedicareDirect Patriot (PFFS)

Aetna Medicare Premier (HMO) Aetna Medicare Premier (PPO) UnitedHealthcare MedicareDirect Rx (PFFS)

Aetna Medicare Premier (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO)

Blue Cross Blue Shield Nebraska MA Access (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO) York County

Blue Cross Blue Shield Nebraska MA Core (HMO) Medica Prime Solution Core (Cost) AARP Medicare Advantage (HMO-POS)

Medica Prime Solution Core (Cost) Medica Prime Solution Premier (Cost) AARP Medicare Advantage Choice (PPO)

Medica Prime Solution Premier (Cost) Medica Prime Solution Thrift (Cost) AARP Medicare Advantage Patriot (PPO)

Medica Prime Solution Thrift (Cost) Aetna Medicare Elite (PPO)

Webster County Aetna Medicare Premier (HMO)

Washington County AARP Medicare Advantage (HMO-POS) Aetna Medicare Premier (PPO)

AARP Medicare Advantage (HMO-POS) AARP Medicare Advantage Choice (PPO) Blue Cross Blue Shield Nebraska MA Access (PPO)

AARP Medicare Advantage Choice (PPO) AARP Medicare Advantage Patriot (PPO) Blue Cross Blue Shield Nebraska MA Core (HMO)

AARP Medicare Advantage Patriot (PPO) Aetna Medicare Elite (PPO) Medica Prime Solution Core (Cost)

Aetna Medicare Elite (PPO) Aetna Medicare Premier (HMO) Medica Prime Solution Premier (Cost)

More on next Column Aetna Medicare Premier (PPO) Medica Prime Solution Thrift (Cost)

Blue Cross Blue Shield Nebraska MA Access (PPO) Medical Associates Nebraska Senior Plan (Cost)

More on next Column

Below is a list of counties and the plans available in each county. The following pages contain the plan details for each plan.

Page 14: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 12

Nebraska Sample MA Plan

(PPO) A1234-567

Phone Number 555-555-555

Regional Counties Offered Butler, Lancaster, Saline,

Saunders, Seward

Plan Overview

Monthly Premium $0

Medical Deductible $0

Out-of-pocket Limit $4,500

Benefits and Costs

Primary Doctor Copay $5

Specialist Doctor Copay $45

Urgent Care Copay $30-$40

Labs/Test/X-rays Copay $10 / $30 /$14

Physical Therapy Copay $40

Emergency Room Copay $90

Ground Ambulance Copay $225

Inpatient Hospital Copay $395 per day for days 1-4

$0 days 5-90

Potential Total = $1,580

Outpatient Hospital Copay $295 - $395

Skilled Nursing Facility Care

Copay

$0/day 1-20, $160/day 21-

51, $0/day 52-100

Out-of-pocket limit = $4,900

Extra Benefits

Dental Coverage Yes - up to $1,500

Vision Coverage Yes - up to $200

Additional Benefits Hearing, Fitness, OTC

Prescription Coverage

Drug Coverage Included Yes - copays apply

Your Total Drug Cost $___________________

Understanding Medicare Advantage Plan Benefits

Plan Name, Plan Type and Number

HMO - This type of plan has a network of providers

(doctors, hospitals, specialist, etc.). Enrollees must use

in-network providers in order for the plan to cover the

service, some plans may offer exceptions to this policy.

PPO - This type of plan has a network of providers.

Enrollees who use in-network providers typically pay

less out-of-pocket. If an out-of-network provider is

used, the service will be more expensive.

PFF - This type of plan does NOT have a network of

providers. Enrollees must check with their providers

before each visit to ensure they will accept the plan.

Cost - This type of plan has a network of providers.

Enrollees who use in-network providers typically pay

less out-of-pocket. If an out-of-network provider is

used, standard Medicare Parts A and B costs apply.

Plan Overview

Monthly Premium - The dollar amount you owe to

have this insurance. Part B premiums are paid in

addition to this monthly premium.

Medicare Deductible - The amount you pay for health

care services before your insurance begins to pay.

Reach out to the plan for details on what applies to

the deductible. Prescription drug costs do not count

towards this deductible.

Out-of-Pocket Limit - The most you could pay for cov-

ered services in the year. After you spend this amount

on deductibles, copayments, and coinsurance, your

plan pays 100% of the costs of covered benefits.

The out-of-pocket limit doesn't include monthly

premiums or the cost of prescriptions.

Benefits and Costs

Copays - A set amount that you pay for a specific health

care service. Each service has its own unique copay.

Typically you pay copays after your deductible has been

met.

Coinsurance - A percentage you pay for a specific

health care service. Typically you pay coinsurance after

your deductible has been met.

Extra Benefits

Dental Coverage– Coverage for dental expenses. The

amount listed is the total the plan will pay for dental

care in the calendar year. Some plans require the use

of network dentists, others offer reimbursement for

any dentist. Contact plan for details.

Vision Coverage - Coverage for vision expenses. The

amount listed is the total the plan will pay for vision

care in the calendar year. Some plans require the use

of network providers, others offer reimbursement for

any provider. Contact plan for details.

Additional Benefits - Benefits often include assistance

with hearing services including hearing aids, fitness

benefits such as a gym membership, and over-the-

counter (OTC) medication. Contact the plan for a full

list of their specific additional benefits.

Prescription Coverage

Most Medicare Advantage plans have prescription

coverage included, therefore you cannot purchase a

separate Part D plan. In some instances, such as a Cost

Plan, a Part D plan may be added. Deductibles, copays

and coinsurance will apply to prescriptions and do not

count towards the Medical Deductible or out-of-pocket

limit.

Page 15: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 13

AARP Medicare Advantage

(HMO-POS) H2802-001

AARP Medicare Advantage

Choice (PPO) H1278-001

AARP Medicare Advantage

Choice (PPO) H1278-007

AARP Medicare Advantage

Patriot (PPO) H1278-018

AARP Medicare Advantage

Patriot (PPO) H1278-019

Phone Number 800-555-5757 800-555-5757 800-555-5757 800-555-5757 800-555-5757

Regional Counties Offered See County List See County List See County List See County List See County List

Plan Overview

Monthly Premium $0 $19 $0 $0 (Part B Premium reduction $25) $0 (Part B Premium reduction $25)

Medical Deductible $0 $0 $0 $0

Out-of-pocket Limit $4,900 $3,900 in / $8,000 out $3,900 in / $10,000 out $6,700 in / $10,000 out $6,700 in / $10,000 out

Benefits and Costs

Primary Doctor Copay $5 $0 $0 $10 $10

Specialist Doctor Copay $45 $35 $30 $45 $45

Urgent Care Copay $30-$40 $30-$40 $30-$40 $30-$40 $30-$40

Labs/Test/X-rays Copay $0 / $30 /$15 $0/ $30/$15 $0/ $30/$15 $0 / $30 /$15 $0 / $30 /$15

Physical Therapy Copay $40 $35 $30 $40 $40

Emergency Room Copay $90 $90 $90 $90 $90

Ground Ambulance Copay $250 $250 $250 $250 $250

Inpatient Hospital Copay $395 per day for days 1-4

$0 days 5-90+

Potential Total = $1,580

$395 per day for days 1-4

$0 days 5-90+

Potential Total = $1,580

$370 per day for days 1-5

$0 days 6-90+

Potential Total = $1,850

$295 per day for days 1– 6

$0 days 7-90+

Potential Total = $1,770

$295 per day for days 1– 6

$0 days 7-90+

Potential Total = $1,770

Outpatient Hospital Copay $0 - $395 per visit $0 - $395 per visit $0 - $400 per visit $0-$295 per visit $0-$295 per visit

Skilled Nursing Facility

Care Copay

$0/day 1-20, $184/day 21-

47, $0/day 48-100

Out-of-pocket limit = $4,900

$0/day 1-20, $184/day 21-

42, $0/day 43-100

Out-of-pocket limit = $3,900

$0/day 1-20, $184/day 21-

42, $0/day 43-100

Out-of-pocket limit = $3,900

$0/day 1-20, $184/day 21-

57, $0/day 58-100

Out-of-pocket limit = $6,700

$0/day 1-20, $184/day 21-

57 $0/day 58 -100

Out-of-pocket limit = $6,700

Extra Benefits

Dental Coverage Yes - up to $1,000 Yes - up to $1,500 Yes - up to $1,500 Yes - up to $1,500 Yes - up to $1,500

Vision Coverage Yes - up to $200 Yes - up to $300 Yes - up to $300 Yes - up to $300 Yes - up to $300

Additional Benefits Hearing, Fitness, OTC Hearing, Fitness, OTC Hearing, Fitness, OTC Hearing, Fitness, OTC Hearing, Fitness, OTC

Prescription Coverage

Drug Coverage Included Yes - copays apply Yes - copays apply Yes - copays apply No prescription coverage No prescription coverage

Your Total Drug Cost $___________________ $___________________ $___________________ $___________________ $___________________

Page 16: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 14

Aetna Medicare Elite

(PPO) H1608-038

Aetna Medicare Premier

(HMO) H7149-001

Aetna Medicare Premier

(PPO) H1608-012

Aetna Medicare Prime

(HMO) H7149-004

BlueCross Blue Shield MA

Access (PPO) H8181-001

Phone Number 855-335-1407 855-335-1407 855-335-1407 855-335-1407 844-899-6060

Regional Counties Offered See County List See County List See County List See County List See County List

Plan Overview

Monthly Premium $0 $0 $33 $0 $26

Medical Deductible $1,000* (specific services) $0 $0 $0 $0

Out-of-pocket Limit $6,100 in / $8,000 out $5,900 $6,100 in / $11,300 out $5,000 $4,500 in / $6,900 out

Benefits and Costs

Primary Doctor Copay $0 $0 $15 $0 $5

Specialist Doctor Copay $35 $40 $40 $35 $30

Urgent Care Copay $65 $65 $65 $65 $65

Labs/Test/X-rays Copay $0 / $35 / $20 $0/ $40 / $15 $0/ $40 / $20 $0/ $35 / $10 $0/ $20-350 / $15-350

Physical Therapy Copay $40 $40 $40 $40 $40

Emergency Room Copay $90 $90 $90 $90 $90

Ground Ambulance Copay $350 $350 $350 $300 Not listed

Inpatient Hospital Copay $390 per day for days 1-5

$0 days 6-90 (plus deductible)

Potential Total = $2,950*

$390 per day for days 1-5

$0 days 6-90

Potential Total = $1,950

$390 per day for days 1-5

$0 days 6-90

Potential Total = $1,950

$390 per day for days 1-5

$0 days 6-90

Potential Total = $1,950

$420 per day for days 1-4

$0 days 5-90+

Potential Total = $1,680

Outpatient Hospital Copay $300 - $400 per visit* $300 - $400 per visit $250 - $350 per visit $250 - $350 per visit $350 per visit

Skilled Nursing Facility

Care Copay

$0 day 1-20,

$184 per day/days 21-100*

Out-of-pocket limit = $6,100

$0 day 1-20,

$184 per day/days 21-100

Out-of-pocket limit = $5,900

$0 day 1-20,

$184 per day/days 21-100

Out-of-pocket limit = $6,100

$0 day 1-20,

$184 per day/days 21-100

Out-of-pocket limit = $5,000

$0 day 1-20, $179 /day 21-

46, $0/day 47-100

Out-of-pocket limit = $4,500

Extra Benefits

Dental Coverage Yes - up to $1,000 Yes - up to $1,300 Yes - up to $500 Yes - up to $1,000 Yes - up to $1,350

Vision Coverage Yes - up to $310 Yes - up to $270 Yes - up to $100 Yes - up to $100 Yes - up to $200

Additional Benefits Hearing, Fitness, OTC Hearing, Fitness, OTC Hearing, Fitness, OTC Hearing, Fitness, OTC Hearing, Fitness, OTC

Prescription Coverage

Drug Coverage Included Yes - copays apply Yes - copays apply Yes - copays apply Yes - copays apply Yes - copays apply

Your Total Drug Cost $___________________ $___________________ $___________________ $___________________ $___________________

Page 17: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 15

BlueCross Blue Shield MA

Choice (HMO-POS)

H3170-002

BlueCross Blue Shield MA

Core (HMO) H3170-003-1

BlueCross Blue Shield MA

Core (HMO) H3170-003-2

Bright Advantage (HMO)

H7853-007

Bright Advantage Choice

Plus (PPO) H5841-010

Phone Number 844-899-6060 844-899-6060 844-899-6060 833-412-6737 833-412-6737

Regional Counties Offered See County List See County List See County List See County List See County List

Plan Overview

Monthly Premium $44 $0 $0 $0 $39

Medical Deductible $0 $0 $0 $0 $0

Out-of-pocket Limit $5,700 in / $6,700 out $6,250 $6,250 $4,700 $4,500 in / $10,000 out

Benefits and Costs

Primary Doctor Copay $10 $10 $5 $0 $0

Specialist Doctor Copay $40 $45 $45 $10 $10

Urgent Care Copay $65 $65 $65 $35 $35

Labs/Test/X-rays Copay $10-350 / $20-350 / $20-350 $10-395 / $20-395 / $20-395 $10-395 / $20-395 / $20-395 $0 / $0-$100 / $0 $10 / $0-$125 / $20

Physical Therapy Copay $40 $40 $40 $20 $20

Emergency Room Copay $90 $90 $90 $90 $90

Ground Ambulance Copay $325 $325 $325 $200 $225

Inpatient Hospital Copay $420 per day for days 1-4

$0 days 5-100

Potential Total = $1,680

$420 per day for days 1-4

$0 days 5-90

Potential Total = $1,680

$420 per day for days 1-4

$0 days 5-90

Potential Total = $1,680

$300 per day for days 1-6

$0 days 7-90+

Potential Total = $1,800

$350 per day for days 1-5

$0 days 6-90

Potential Total = $1,750

Outpatient Hospital Copay $200 per visit $395 per visit $395 per visit $250 per visit $325 per visit

Skilled Nursing Facility

Care Copay

$0 day 1-20, $184 /day 21-

57, $0/day 58-100

Out-of-pocket limit = $5,700

$0 day 1-20, $184 /day 21-

54, $0/day 55-100

Out-of-pocket limit = $5,900

$0 day 1-20, $184 /day 21-

54, $0/day 55-100

Out-of-pocket limit = $6,250

$0 day 1-20,

$178 per day/days 21-100

Out-of-pocket limit = $4,700

$0 day 1-20,

$178 per day/days 21-100

Out-of-pocket limit = $4,500

Extra Benefits

Dental Coverage Yes - up to $700 Yes - up to $650 Yes - up to $650 Additional $18 premium Yes - up to $1,500

Vision Coverage Yes - up to $100 Yes - up to $100 Yes - up to $100 Yes Yes

Additional Benefits Hearing, Fitness, OTC Hearing, Fitness, OTC Hearing, Fitness, OTC Hearing, Fitness Hearing, Fitness

Prescription Coverage

Drug Coverage Included Yes - copays apply Yes - copays apply Yes - copays apply Yes - copays apply Yes - copays apply

Your Total Drug Cost $___________________ $___________________ $___________________ $___________________ $___________________

Page 18: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 16

Bright Advantage Choice

(PPO) H5841-005

Bright Advantage Plus

(HMO) H7853-008

Humana Gold Plus (HMO)

H0028-011

Humana Honor (PPO)

H5216-086

Humana Value Plus (PPO)

H5216-171

Phone Number 833-412-6737 833-412-6737 800-833-2364 800-833-2364 800-833-2364

Regional Counties Offered See County List See County List See County List See County List See County List

Plan Overview

Monthly Premium $0 (Part B Premium Reduction $25) $39 $0 $0 (Part B Premium Reduction) $27.80

Medical Deductible $100 $0 $0 $0 Unavailable

Out-of-pocket Limit $4,500 in / $10,000 out $3,900 $3,850 $6,700 in / $10,000 out $6,700 in/$10,000 out

Benefits and Costs

Primary Doctor Copay $0 $0 $0 $10 $20

Specialist Doctor Copay $30 $0 $45 $45 $50

Urgent Care Copay $35 $35 $0-$45 $10-$45 $20-$50

Labs/Test/X-rays Copay $10 / $0-$125 / $20 $0 /$0-$100 / $0 $0-$25 / $0-$95 / $0-$95 $0-$40/ $0-$50 /$10-$50 $0/ $0-$50 / $20-$50

Physical Therapy Copay $20 $20 $40 $40 20% Coinsurance

Emergency Room Copay $90 $90 $90 $90 $90

Ground Ambulance Copay $225 $200 per visit $290 $290 20% Coinsurance

Inpatient Hospital Copay $250 per day for days 1-5

$0 days 6-90+

Potential Total = $1,750

$325 per day for days 1-5

$0 days 6-90

Potential Total = $1,625

$350 per day for days 1-5

$0 days 6-90+

Potential Total = $1,750

$295 per day for days 1-6

$0 days 7-90 +

Potential Total = $1,770

$2,019 per stay

Outpatient Hospital Copay $300 $275 $45-$250 per visit $45-$250 per visit $50 or 20% per visit

Skilled Nursing Facility

Care Copay

$0 day 1-20,

$184 per day/days 21-100

Out-of-pocket limit = $4,500

$0 day 1-20,

$178 per day/days 21-100

Out-of-pocket limit = $3,900

$0 day 1-20,

$184 per day/days 21-100

Out-of-pocket limit = $6,700

$0 day 1-20,

$184 per day/days 21-100

Out-of-pocket limit = $6,700

$0 day 1-20,

$184 per days 21-100

Out-of-pocket limit = $6,700

Extra Benefits

Dental Coverage Additional $22 premium Yes - up to $1,500 Yes - up to $1,000 Yes - up to $1,000 Yes - up to $2,000

Vision Coverage Yes Yes Yes - up to $100 Yes - up to $100 Yes - up to $100

Additional Benefits Hearing, Fitness Hearing, Fitness, OTC Hearing, Fitness, OTC Hearing, Fitness, OTC Hearing, Fitness, OTC

Prescription Coverage

Drug Coverage Included Yes - copays apply Yes - copays apply Yes - copays apply No prescription coverage Yes - copays apply

Your Total Drug Cost $___________________ $___________________ $___________________ $___________________ $___________________

Page 19: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 17

Humana Choice (PPO)

H5216-254

Humana Choice (PPO)

H5216-014

Medica Advantage Solution

(HMO) HO798-001

Medica Advantage Solution

(PPO) H3632-001

Medica Prime Solution Core

(Cost) H2450-046

Phone Number 800-833-2364 800-833-2364 800-906-5432 800-906-5432 800-906-5432

Regional Counties Offered See County List See County List See County List See County List See County List

Plan Overview

Monthly Premium $0 $59 $0 $39 $69

Medical Deductible $0 $0 $0 $0 $0

Out-of-pocket Limit $4,050 in / $6,700 out $6,700 in / $10,000 out $5,500 $5,500 in /$7$10,000 out $4,000

Benefits and Costs

Primary Doctor Copay $0 $15 $0 $0 $0

Specialist Doctor Copay $45 $45 $50 $35 $20

Urgent Care Copay $0-$45 $15-$45 $0-$45 $0-35 $0-$20

Labs/Test/X-rays Copay $0-$45 / $0-$95 /$0-$95 $0-$40 / $0-$95 /$15-$95 $0 / 20% / 20% $0 / 15% / 15% $0 / $10 / $10

Physical Therapy Copay $40 $40 $40 $35 $20

Emergency Room Copay $90 $90 $90 $90 $50

Ground Ambulance Copay $290 $290 $200 $200 $50

Inpatient Hospital Copay $350 per day for days 1-5

$0 days 6-90+

Potential Total = $1,750

$360 per day for days 1-5

$0 days 6-90+

Potential Total = $1,800

$350 per day for days 1-5

$0 days 6-90+

Potential Total = $1,750

$325 per day for days 1-5

$0 days 6-90

Potential Total = $1,625

$350 per stay

Outpatient Hospital Copay $45-$350 per visit $45-$250 per visit $295 per visit $250 per visit $100 per visit

Skilled Nursing Facility

Care Copay

$0 day 1-20,

$184 per day/days 21-100

Out-of-pocket limit = $4,050

$0 day 1-20,

$184 per day/days 21-100

Out-of-pocket limit = $6,700

$0 day 1-20,

$184 per day/days 21-100

Out-of-pocket limit = $5,500

$0 day 1-20,

$184 per day/days 21-100

Out-of-pocket limit = $5,500

$0 day 1-20,

$50 day/days 21-100

Out-of-pocket limit = $4,000

Extra Benefits

Dental Coverage Yes - up to $1,000 Additional premium Yes - up to $400 Yes - up to $750 Yes - up to $300

Vision Coverage Yes - up to $100 Additional premium Yes - up to $100 Yes - up to $150 Yes - up to $100

Additional Benefits Hearing, Fitness, OTC Fitness, OTC Hearing, Fitness, OTC Hearing, Fitness, OTC Hearing, Fitness

Prescription Coverage

Drug Coverage Included Yes - copays apply Yes - copays apply Yes - copays apply Yes - copays apply No prescription coverage

Your Total Drug Cost $___________________ $___________________ $___________________ $___________________ $___________________

Page 20: Medicare Advantage Fact Sheet...Medicare Advantage Fact Sheet How do I sign up for a Medicare Advantage Plan? You can join a Medicare Advantage Plan when you first begin Medicare,

2021 Nebraska Medicare Advantage and Cost Plan Options Page 18

Medica Prime Solution

Premier (Cost)

H2450-043

Medica Prime Solution

Thrift (Cost) H2450-030

Medicare Associates

Nebraska Senior Plan (Cost)

H1651-026

UnitedHealthcare Medicare

Direct Patriot (PFFS)

H5435-001

UnitedHealthcare

MedicareDirect Rx (PFFS)

H5435-024

Phone Number 800-906-5432 800-906-5432 800-747-8900 800-555-5757 800-555-5757

Regional Counties Offered See County List See County List See County List See County List See County List

Plan Overview

Monthly Premium $125 $34 $147 $40 $64

Medical Deductible $0 $50 $0 $0 $0

Out-of-pocket Limit $3,000 $6,700 Not Applicable $6,700 $6,700

Benefits and Costs

Primary Doctor Copay $0 20% $0 $25 $25

Specialist Doctor Copay $0 20% $0 $50 $50

Urgent Care Copay $0 $25 $0 $40 $40

Labs/Test/X-rays Copay $0 0 /20% /20% $0 $0/$25/$15 $0/ $25 / $15

Physical Therapy Copay $0 20% $0 $40 $40

Emergency Room Copay $0 $50 $0 $90 $90

Ground Ambulance Copay $0 20% $0 $250 $250

Inpatient Hospital Copay $100 per stay

$300/day for days 1-4; $0/

day for days 5-90

Potential Total = $1,200

$0 $395 per day for days 1-4

$0 days 5-90

Potential Total = $1,580

$395 per day for days 1-4

$0 days 5-90

Potential Total = $1,580

Outpatient Hospital Copay $0 per visit 20% per visit $0 per visit $0-395 per visit $0-$395 per visit

Skilled Nursing Facility

Care Copay

$0 day 1-20,

$25 day/days 21-100

Potential Total = $2,000

$0 day 1-20, $176.50 day/

days 21-100

Out-of-pocket limit = $6,700

$0 $0/day 1-20, $184/day 21-

57, $0/day 58-100

Out-of-pocket limit = $6,700

$0/day 1-20, $184/day 21-

57, $0/day 58-100

Out-of-pocket limit = $6,700

Extra Benefits

Dental Coverage Yes - up to $400 No No No No

Vision Coverage Yes - up to $20 No No No No

Additional Benefits Hearing, Fitness No No No No

Prescription Coverage

Drug Coverage Included No prescription coverage No prescription coverage No prescription coverage No prescription coverage Yes - copays apply

Your Total Drug Cost $___________________ $___________________ $___________________ $___________________ $___________________


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