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2013 MA Plan Summaries San Diego HMOs

HMO•Premium: $0 •MOOP: $3,400•PCP: $10 Specialist: $25•Hospital: $150 per days 1-8•PDP Benefit: $0/$10/$45/$95/33%•Transportation Benefit, 24 Trips!•$0 Generics in the Coverage Gap!

HMO-POS•Premium: $39•MOOP: $5,000 (in)/$5,000 (out)•PCP: $10 (in)/ $35 (out) Specialist: $25 (in)/$50 (out)•Hospital: $150 per day 1-8(in)/$300 per day 1-8(out) •PDP Benefit: $0/$10/$45/$95/33%•$0 Generics in the Coverage Gap!

HMO-MA only•Premium: $0•MOOP: $1,000•PCP: $0 Specialist: $0•Hospital: $0 per days 1-100•PDP Benefit: not included•Dental•Vision•Fitness Membership

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• Scripps Mercy•Greater Tri Cities IPA• Vantage IPA• PCAMG IPA

San Diego Network, highlights and additions...

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2013 MA Plan Summaries Riverside/San Bernardino HMOs

HMO•Premium: $0•MOOP: $3,400•PCP: $0 Specialist: $5•Hospital: $100 per days 1-5•PDP Benefit: $0/$10/$41/$92/33%•Transportation Benefit, 24 Trips!•$0 Generics in the Coverage Gap!

HMO-POS•Premium: $ 29•MOOP: $3,400•PCP: $0(in)/$35(out) Specialist: $5(in)/$50(out)•Hospital: $100 per days •1-5)/$300 per day 1-8(out)•PDP: $0/$10/$45/$95/33%•$0 Generics in the Coverage Gap!

HMO-MA only•Premium: $0•MOOP: $1,000•PCP: $0 Specialist: $0•Hospital: $0 per days 1-100•PDP Benefit: not included

HMO-SNP•Premium: $ 0•MOOP: $2,400•PCP: $0 Specialist: $0•Hospital: $0 per days 1-100•PDP: 25%/25%/25%/25%/25%

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• Prime Care

• Choice IPA

• Empire IPA

• Vantage IPA

• Anchor IPA

• Emmit IPA

• Riverside Physicians

• Riverside Clinic

San Bernardino Riverside Network, highlights and additions...

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2013 MA Plan Summaries PFFS Expansion

PFFS – MA only•Premium: $49•MOOP: $6,700•PCP: $10 Specialist: $40•Hospital: $220 per days 1-8•PDP Benefit: Not included

PFFS•Premium: $82•MOOP: $6,700• PCP: $10 Specialist: $40•Hospital: $220 per days 1-8•PDP: $4/$8/$35/$70/25%