Questions to consider when choosing your Medicare Advantage plan

It’s the Medicare Annual Enrollment Period. There will be a lot of information to review about the options available to you. We know, it can be confusing.

Now is the perfect time to see if your current plan is still right for you, or perhaps your healthcare needs have changed and your coverage should change, too. We’re here to help you make a choice that balances your health needs with what you can afford.

SummaCare offers all-in-one plans

SummaCare offers five “all-in-one” Medicare Advantage plans starting at $0—with medical, prescription drugs, dental, vision and other healthcare coverage in one convenient plan. They are:

Quartz (HMO) is a $0 premium plan for the budget-conscious individual who wants good coverage without a monthly premium.

Topaz (HMO) is $17 per month and is an excellent choice for health-conscious individuals seeking key supplemental benefits.

Ruby (HMO) is $55 per month and is for those who want even lower out-of-pocket costs with enhanced supplemental benefits.

Sapphire (HMO-POS) is $85 per month and is a strong choice for those seeking coverage for out-of-network services, low out-of-pocket costs and enhanced supplemental benefits.

Emerald (HMO-POS) is $159 per month and is for those who need out-of-network coverage, all the supplemental benefits SummaCare Medicare Advantage plans offer, plus $0 copays for primary care provider and specialist office visits.

In addition, SummaCare offers Amber (HMO), a $0 premium medical-only plan that offers rich benefits. It is ideal for veterans and others who receive prescription drug coverage from a non-Medicare source.

How do I know which one is right for me?

Start by considering some common questions that may help you decide which plan is the right one for YOU.

1. Do you want a plan with a lower monthly premium?

If having a $0 monthly premium is the most important factor for you, consider Quartz. You will get a lot of benefits at no added cost, including:

• $0 Primary care provider (PCP) visits
• $0 - $15 Lab and diagnostic procedures
• $0 Copay on preventive dental, preventive hearing and vision exams
• $0 Dental cleanings, fluoride treatment, X-rays and exams
• $0 copay for tier 1, 2 and 6 drugs at preferred pharmacies

Your annual maximum out-of-pocket for in-network services is $5,200; annual dental maximum is $2,000; Part D deductible is $410 (Tiers 3-5); and you get $25 quarterly over-the-counter allowance and a $100 annual vision hardware allowance.

If you’re able to pay a low monthly premium, consider Topaz at $17 per month. You will get similar $0 benefits as Quartz, but your annual maximum out-of-pocket for in-network services is $4,650; dental max is $3,000; Part D deductible is $365 (Tiers 3-5); and you get $40 quarterly over-the-counter allowance and a $200 annual vision hardware allowance.

Check out this article that really lets you compare these low-cost options.

2. Do you prefer lower out-of-pocket costs when you receive care?

If you want lower out-of-pocket costs and do not need out-of-network services (available on Sapphire and Emerald), consider Ruby. You get $0 PCP visits; labs ($0-$8), X-ray ($0-$110) and diagnostic procedures ($0-$125); and $0 copay on preventive dental, preventive hearing and vision exams.

Your annual maximum out-of-pocket for in-network services is $4,200; dental max is $2,000; Part D deductible is $200 (Tiers 3-5); and you get $30 quarterly over-the-counter allowance, a $175 allowance for home safety devices and a $250 annual vision hardware allowance.

With a $55 monthly premium, you get lower out-of-pocket costs and more allowances for extras with Ruby.

3. How often do you visit doctors or specialists?

All our Medicare Advantage plans offer $0 PCP visits, but specialist visits, including podiatry, have a $35 copay* for most plans. That can add up quickly if you see a lot of specialists.

Take a look at Emerald, our only plan that offers specialist visits for a $0 copay and a few other benefits that are important if you’ve got other health or safety risks.

Emerald is our only plan to offer the Personal Emergency Response System (PERS), through ConnectAmerica, a mobile device worn as a pendant or around the wrist which offers access to emergency assistance 24/7/365 at the press of a button, whether or not you are at home. The device is GPS-enabled and has optional fall detection capabilities. Coverage includes the mobile device, charging cradle and monthly monitoring in the home.

And, Emerald does not require a diagnosis for home safety devices (grab bars, etc.) for up to $250 of equipment/year.

If you see multiple doctors or specialists, Emerald may be right for you. Without the right coverage, medical expenses like specialist visits can add up fast.

4. Do you want coverage for out-of-network services?

Some want the flexibility to go to the providers and hospitals they want – without consideration of network status.

Two plans provide you with coverage for out-of-network hospitals and providers: Sapphire ($85 premium) and Emerald ($159 premium). Both plans offer $0 PCP visits. Emerald offers $0 lab services and specialist visits, while Sapphire covers lab services for $0-$6 and specialist visits for $35.

Both plans offer built-in protection with an annual out-of-pocket maximum for in-network services. Sapphire members’ out-of-pocket max is $3,800, while Emerald members’ is $3,000.

On both plans, members pay the full cost of tier 3, 4 and 5 drugs until you reach the plan’s deductible. Part D deductible for Sapphire members is $100, while for Emerald members it is $50.

Members of both plans get an annual vision hardware allowance with freedom to purchase anywhere—Sapphire members get a $275 allowance, while Emerald members get $310 allowance. And you also get a quarterly over-the-counter allowance of $40 (Sapphire) and $55 (Emerald).

Both Sapphire and Emerald give you flexibility and rich supplemental benefits.

5. Are supplemental benefits important to you?

All our Medicare Advantage plans come with supplemental benefits. But if you want even more “extras”, consider Ruby, Sapphire or Emerald.

They offer additional benefits like:

• $0 rides (Ruby—6 one way trips; Sapphire—10 one way trips; Emerald—12 one way trips)
• Home safety device allowance** (Ruby—$175 Sapphire—$225; Emerald—$250, with no diagnosis required)
• Meals after a hospital stay***
• PAPA Pals companionship and help with everyday tasks (Ruby—20 hours; Sapphire—20 hours; Emerald—50 hours)

All three give you so many extras!

6. Do you already receive prescription drug coverage from another source?

Amber (HMO) is a $0 premium medical-only plan that offers rich benefits. It is ideal for veterans and others who receive prescription drug coverage from a non-Medicare source.

You get $0 PCP visits, $5 laboratory services, $0 copay on preventive dental, preventive hearing and vision exams; $0 dental cleanings, fluoride treatment, X-rays and exams; and $0 transportation (up to 50 one way trips).

Your annual maximum out-of-pocket for in-network services is $3,450; dental max is $2,000; and you get $90 quarterly over-the-counter allowance and a $300 annual vision hardware allowance.

To help make life at home easier, you get 28 meals (two per day) annually following an inpatient hospital stay or an A1C greater than 8; 50 one-way rides; and up to 90 hours of companionship or help with everyday tasks with Papa Pals.

Even more benefits will help keep you healthy

As a member of any SummaCare Medicare Advantage plan, you’ll also enjoy:

• Coverage when you travel to any Medicare-approved provider in Arizona, Florida, North Carolina****, South Carolina**** and Texas – ideal for snowbirds!
• Worldwide emergency, urgent care coverage and ambulatory services
• A vast network with more than 28,000 providers and 80 hospitals
• Hearing aid coverage that includes one hearing aid for each ear every year (with applicable copays)
• Over the counter (OTC) quarterly allowance through SummaCare’s &more card to use at in-network retailers nationwide

You’ll also gain access to extras to support your health and help you stay active:

• Fitness benefit —Your SilverSneakers® gym membership provides access to thousands of participating in-person gyms nationwide, a fitness app to access fitness programs on the go, plus On-Demand video workouts that let you work out comfortably at home
• Telehealth and 24/7 nurse line — Visit with your primary care provider, specialists or behavioral health specialists online plus get access to 24/7 nurse support
• Chronic condition support — Get no-cost tools and resources to help you manage chronic conditions including diabetes, depression, heart or kidney conditions or asthma

What do I do now?

With the Medicare Annual Enrollment Period (AEP), you have from October 15 to December 7 to change your Medicare coverage, switch between Original Medicare and Medicare Advantage, or adjust your Part D prescription drug plans. The choice is yours—and we’re here to help you make the right one. To learn more about SummaCare’s Medicare Advantage plans, contact a SummaCare Medicare Advantage Advisor at 888.464.8440 or visit summacare.com/medicare to compare plans.

*$30 specialist copay for Amber

**Members who have had a diagnosis of any of the following: history of hip replacement, history of knee replacement, history of femur fractures or a diagnosis of falls within the past 12-months, as documented by a provider, are eligible for home and bathroom safety devices; Emerald members are exempt from this requirement.

***14 meals (two per day) annually following an inpatient discharge and/or an A1C>8

****Visitor/Travel coverage in North Carolina and South Carolina not included for Amber, Sapphire and Emerald

SummaCare is an HMO and HMO-POS plan with a Medicare contract. Enrollment in SummaCare depends on contract renewal. Other providers are available in our network. This information is not a complete description of benefits. Call 888.464.8440 (TTY 711) for more information. &more Benefits Prepaid Mastercard® is issued by Avidia Bank, pursuant to a license from Mastercard Incorporated. Use of this card is subject to the terms and conditions of the Cardholder Agreement. Out-of-network/non-contracted providers are under no obligation to treat Plan members except in emergency situations. Please call our Member Services number or see your Evidence of Coverage for more information, including cost-sharing that applies to out-of-network services. SummaCare Medicare Advantage plan members shown. Members were not compensated for their appearance. H3660_SCMCWeb