PremierCare Medicare Plans 2009 From FamilyCare Health Plans

The coverage and benefits you deserve are just 3 simple steps away

  1. Call a local FamilyCare expert.
  2. Compare the coverage and benefits you already have or need.
  3. Choose the PremierCare Medicare Plan that gives you the benefits and affordability you want.

Plan Name

PremierCare Advantage Rx

PremierCare Choice Rx

PremierCare Choice

Monthly Premium

$66

$30

$0

Medicare-Covered Benefits

You Pay:

You Pay:

You Pay:

Out-of-Pocket Maximum

$1,500 out-of-pocket maximum

$3,500 out-of-pocket maximum

$3,500 out-of-pocket maximum

Inpatient Hospital Care

$100/day (for 5 days)

$250/day (for 5 days)

$250/day (for 5 days)

Office Visit

$15/visit

$15/visit

$15/visit

Specialist Visit

$25/visit

$30/visit

$30/visit

Outpatient Surgery

No co-payment

No co-payment

No co-payment

Ambulance

$50/trip

$50/trip

$50/trip

Emergency Visit

$50/visit

$50/visit

$50/visit

Urgent Care Visit

$20/visit

$20/visit

$20/visit

X-Rays/Labs

No co-payment

20% of cost/test

20% of cost/test

Prescription Drugs

$0 annual deductible
$5 generic
$30 brand name

$145 annual deductible
$5 generic
$30 brand name

NA

Our Medicare Prescription Drug Benefit is available to members of PremierCare Choice Rx, PremierCare Advantage Rx, and PremierCare Plus.

You are eligible to enroll if you are entitled to Medicare benefits under Part A and enrolled in Part B and reside in our service area.

You may enroll in a plan only during specific times of the year. Please contact our Customer Service Department to obtain more information.

You must receive all routine care from plan providers. If you obtain routine care from out-of-plan providers, neither Medicare nor FamilyCare Health Plans will be responsible for costs.

You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third-party.

For full information on FamilyCare Health Plans Medicare benefits, call our Customer Service Department at 866-225-CARE or TTY 800-735-2900. We are here for you Monday - Friday, 8:00 a.m. to 8:00 p.m. Extended hours during Open Enrollment - contact us for details.

FamilyCare Health Plans is a Medicare Advantage Organization with a Medicare Contract. Our contract with the CMS is renewed annually and the availability of coverage beyond the end of the current contract year is not guaranteed.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:

1-800-MEDICARE (1-800-633-4227)
TTY/TDD users should call 1-877-486-2048
24 hours a day/7 days a week;

The Social Security Administration at
1-800-772-1213 between 7 a.m. and 7 p.m.
Monday through Friday
TTY/TDD users should call 1-800-325-0778;

or your State Medicaid Office