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Comparison of plans

Woman Swimming

Your playbook

You’ve got options like never before. There are five different kinds of plans — a total of nine plans to choose from. There’s bound to be a plan that fits you. To choose which is best for you, read over the summary of each plan type below. See which one best fits your priorities. Then, follow the directions to choose a specific plan.

We’ve grouped the nine plans into three categories: HMO plans, PPO and similar plans, and network-free plans. Prescription drug coverage is almost the same under each plan, although the formulary for each plan is different.

Which plan type is best for me?

HMO plans:

  • Texas HealthSpring HMO
  • TexanPlus HMO
  • NEW! KelseyCare Advantage HMO
  • BlueCross BlueShield of Texas HMO

Low-cost, great care. These four plans offer you low premiums and copayments – you can pay as little as $3.50 a month for coverage, and copayments for primary care services are between $0 and $25. But you have to stay within a network for services and must select a primary-care physician to coordinate your care.

These are high-quality doctors who will get to know you and your ailments well and who are close by where you live. Service areas vary by plan. Available networks include Kelsey-Seybold, Renaissance, Sadler, Memorial and independent doctors. If you don’t mind having your coverage access limited to a local network of doctors, and you want to save money, compare these different HMO plans.

PPO and POS plans:

  • NEW! Aetna PPO
  • BlueCross BlueShield of Texas PPO
  • NEW! KelseyCare Advantage Plus Choice POS

Room to stretch your wings. These plans give you greater flexibility. You select a network for coverage, but you can go outside that network for a slight increase in cost. You select a primary-care physician but have the freedom to see a doctor outside your network. The KelseyCare Point-of-Service plan lets you go out of network only for specialists.

These plans may cost a little more – although KelseyCare Advantage Plus Choice POS is just $17.24 a month. Copayments for most primary care services in-network are $15-$35. If you want to balance a little more freedom to choose a doctor near your grandkids with paying a little more, compare these three plans.

Insider's tip

You’re used to your BCBSTX HMO or PPO plan. You’re comfortable with the great service you get. Why change? Sure, these plans are cheaper, but what if you don’t like the new plan?

If you find that you don’t like the Medicare plan you’re in, you can go back to BCBSTX HMO or PPO within 90 days. Or, if you like the savings but find the plan you selected just isn’t right for you, you can change to another Medicare plan at the first of the month, any month.

Think of it as taking the new plan out for a test drive. We think you’ll like the road it takes you down.
 
Spotlight: Primer on Medicare
  • There is an annual out-patient deductible and a hospital deductible, and Medicare usually changes them every year.
  • Medicare pays about 80 percent of most Medicare-approved services.
  • Medicare also pays about 80 percent for certain Part B drugs.
  • If you have no other insurance, you pay the annual deductibles plus the 20 percent Medicare doesn’t pay.
  • Coverage for drugs beyond Part B is available only if you buy a Medicare Part D drug plan.

Nationwide coverage:

  • Aetna Private-Fee-For-Service
  • NEW! Medicare supplement plan F

Unfettered freedom! But, as freedom fighters everywhere discover, freedom comes with a price. These plans allow you to go to doctors nationwide, but they have a slightly higher monthly contribution. In the Aetna PFFS, there are no deductibles, and copayments for most services are $15 or less — and in the Medicare supplement plan F, the plan pays most out-of-pocket expenses for most Medicare-approved services not paid by Original Medicare.

Medicare supplement insurance plans, or “Medigap plans,” are Medicare-based. Medicare supplement plans are sold to individuals by many companies in the U.S. There are 12 different supplement plans, each with their own features. Medicare supplement insurance companies can only sell you a “standardized” Medicare supplement plan identified by letters A through L. Each standardized Medicare supplement policy must offer the same basic benefits.

Recently, a few companies have offered these plans through employers. That’s why we can offer this new plan to you now. The cost is the same to you. The advantage is that you can have the monthly premiums deducted from your pension check, and the city handles the administration for you.

The more expensive plans move beyond the basic benefits and cover most time-of-service costs. We’re offering Medicare supplement plan F. For less than $92 a month, you get coverage for nearly everything that Medicare doesn’t cover — leaving you with very little out-of-pocket expenses. The plan costs you less than the BCBSTX PPO and has better benefits, and it is especially beneficial to retirees living outside Texas, or for those who travel.

Medicare is eliminating PFFS plans throughout the United States. On Dec. 31, 2010, the Aetna PFFS will no longer be available to city of Houston retirees and you will need to elect another plan for the future.

 

 

  
 
 
 
 
 

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If there exists a conflict between this Enrollment Guide Website and the official plan documents for each plan, the official plan documents will prevail. The city of Houston reserves the right to change, modify, increase or terminate any benefits.