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pdfCreated 7/31/09
DI
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Created 7/31/09
DI1A
No Schooling Completed
Nursery School to 8TH Grade
9TH-12TH Grade, No Diploma
High School Graduate (High School Diploma or the
Equivalent)
Vocational/Technical/Business/Trade School Certificate
or Diploma (Beyond the High School Level)
Some College, But No Degree
Associate Degree
Bachelor's Degree
Master's, Professional, or Doctorate Degree
Created 08/1/06
DI2
Annual Income
Monthly Breakdown
F. $25,000 - 29,999
F. $2,084 - 2,499
G. $30,000 – 39,999
G. $2,500 – 3,333
H. $40,000 - 49,999
H. $3,334 – 4,166
I.
I.
$50,000 +
$4,167 +
Created 07/25/02
DI3
Annual Income
Monthly Breakdown
A. Less than $5,000
A. Less than $417
B. $5,000 - 9,999
B. $417 - 833
C. $10,000 - 14,999
C. $834 - 1,249
D. $15,000 - 19,999
D. $1,250 - 1,666
E. $20,000 - 24,999
E. $1,667 - 2,083
Created 1/2/04
DM1
Health Services Covered by
Discount or Savings Membership
Prescription Drugs
Optical or Eye Care or Vision
Dental or Periodontal or Dentures or Orthodontia
Hearing Aids
Home Health Equipment or Supplies
Nutritional Supplements or Vitamins
Alternative Medical Care
Hospital Expenses
Created 01/04/01
DU
Dental Providers
Dentists
Dental Surgeons
Endodontists
Periodontists
Dental Hygienists
Created 12/31/08
ENS
Iraq or Afghanistan Conflict (2001 – Present)
Persian Gulf War (Aug 1990 - March 1991)
Vietnam Era (Aug 1964 - May 1975)
Korean Conflict (June 1950 - Jan 1955)
World War II (Sept 1940 - July 1947)
World War I (1917 - 1918)
Peace Time (All Other Times)
Created 7/31/09
HA1
One-Family, Detached
Two-Family or Duplex
Apartment or Condominium Building
Mobile Home, Trailer
Rowhouse, Townhouse
“Mother-in-law” Apartment
Created 7/31/09
HA2
Retirement Community
Senior Citizens Housing
Assisted Living Facility
Continuing Care Community
Staged Living Community
Retirement Apartments
Church-Provided Housing
Personal or Residential Care Home
Created 07/28/01
HA3
Prepared Meals
Housekeeping, Maid, or Cleaning Services
Laundry Services
Help with Medications
Transportation
Recreational Services
Created 7/31/09
HF1
No Difficulty At All
A Little Difficulty
Some Difficulty
A Lot of Difficulty
Not Able To Do It
Created 7/31/09
HF2
More Than Once a Week
About Once a Week
2-3 Times a Month
About Once a Month
Every 2-3 Months
Once or Twice a Year
Not At All
Created 7/31/09
HF3
What You Know about Managing Your Diabetes
Just about everything you need to know
Most of what you need to know
Some of what you need to know
A little of what you need to know
Almost none of what you need to know
Created 7/31/09
HF4
All of the Time
Most of the Time
Some of the Time
A Little of the Time
None of the Time
Created 7/31/09
HF5
Every Day or More
Once Every Other Day
Once Every 3-4 Days
Once Every 5-6 Days or Less
Never
Created 7/31/09
HF6
Type 1 ("Insulin-dependent", "Juvenile-onset")
Type 2 (“Non-insulin-dependent”, “Adult-onset”)
Borderline
Pre-diabetes
Gestational (Pregnancy-related)
Created 7/31/10
HF7
Created 01/04/01
HH1
In-Home Help by Health Or Medical Professionals
Nurse (Visiting nurse, Private duty nurse, etc.)
Doctor
Social Worker
Therapist
Hospice Worker
Created 01/04/01
HH2
Medical or Nursing Treatment
Applying Sterile Bandages or Dressings
Giving Medications
Taking Blood Pressure
Giving Shots or Injections
Created 01/04/01
HH3
Help With Daily Needs
Using The Telephone
Doing Housework
Preparing Meals
Created 01/04/01
HH4
Help With Personal Care
Bathing
Showering
Dressing
Eating
Walking
Using the Toilet
Created 01/04/01
HH5
Personal Care or Help With Daily Needs
From Persons Who Do Not Live With You
Home Health Aides
Homemakers
Friends
Neighbors
Relatives
HIMC
Health Insurance
1.
Original Medicare
(Fee for service)
2.
Medicare Advantage
(Managed Care Plans)
3.
Medicare Prescription Drug Plans
(Part D)
4.
Medicaid
All part of the Medicare
Program
State program for medical care
5. TRICARE
Sponsored by the
Department of Defense
6. Other State Public Plans
State-sponsored program for Rx
and other care
7. Medigap or Supplemental Private Plans
Covers expenses not covered by
Medicare
HIMC
(Back)
•
Medicare-sponsored health insurance:
– Original Medicare fee-for-service, where you go to any doctor you choose
– Medicare Advantage, or Medicare managed care, such as an HMOs (health
maintenance organizations), PPOs (Preferred Provider Organizations), or PFFS
(Private Fee For Service), where you go to a doctor that is part of the insurance
company's network of participating doctors) – Medicare Advantage plans cover
doctor visits and often cover prescribed medicines
– Medicare Prescription Drug Coverage plans, or Medicare Part D plans – these
plans cover only prescribed medicines
•
Medicaid – a major public health insurance plan for limited income persons. The
•
TRICARE – a regionally managed health care program provided by the Department
•
Public plans other than Medicaid – these plans might include state, county, or city-
•
Medicaid program is a federally assisted, state-run program.
of Defense for active duty and retired members of the uniformed services, their
families, and survivors.
based programs such as a pharmacy program, where the local government provides
discounts for the cost of prescribed medicines. Eligibility for these plans varies
across states and across plans.
Medigap or Supplemental plans – these plans can be purchased directly from
an insurance company itself or through an employer, union, or other group such as
AARP. They generally cover whatever health care costs are not covered by
Medicare. They do not cover prescribed medicines.
Created 7/31/10
HIMC1
Medicare Advantage Plans - Alabama (AL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Blue Advantage (Blue Cross Blue Shield of Alabama)
C. CIGNA Medicare Access (CIGNA Health Care)
D. HealthSpring (HealthSpring of Alabama, Inc.)
E. Humana Gold/HumanaChoicePPO (Humana Insurance
Company)
F. SecurityChoice (Unicare Life & Health Ins. Company)
G. Sterling (Sterling Life Insurance Company)
H. Today's Options (Universal American)
I.
VIVA Medicare Plus (VIVA Health)
J.
Windsor Medicare Extra (Windsor Health Plan, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Alaska (AK)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. SecurityChoice (Unicare Life & Health Ins. Company)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Arizona (AZ)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Abrazo Advantage (Abrazo Advantage Health Plan)
C. Aetna Golden/Medicare Open Plan (Aetna)
D. ANY, ANY, ANY Plan (Universal Health Care Insurance
Company)
E. CareMore Health Plan (CareMore Health Plan of
Arizona)
F. CIGNA Medicare Access (CIGNA Health Care)
G. Desert Canyon Community Care (Arcadian Health Plan,
Inc.)
H. Health Net (Health Net of Arizona Inc.)
I.
Humana Gold/HumanaChoicePPO (Humana Insurance
Company)
J.
MediSunONE (Banner Health)
K. SCAN Health Plan Arizona (SCAN – Senior Care Action
Network)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Arizona (AZ)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
L. SecurityChoice (Unicare Life & Health Ins. Company)
M. Today’s Options (Universal American)
N. University Physicians/Maricopa Care (UPH/MIHS)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Arkansas (AR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A.
AARP MedicareComplete (United Healthcare)
B.
AR BlueCross – Medi-Pak Advantage (Arkansas Blue Cross)
C.
Care Improvement PPO (XL Health Corporation)
D.
CIGNA Medicare Access (CIGNA Health Care)
E.
Humana Gold/HumanaChoicePPO (Humana Insurance
Company)
F.
Mercy Medicare ADVANTAGE (Mercy Health System)
G. Physicians Health Choice (Physicians Health Choice)
H.
SecureHorizons MedicareDirect (United Healthcare)
I.
SecurityChoice (Unicare Life & Health Ins. Company)
J.
Sterling (Sterling Life Insurance Company)
K.
Texarkana/Arkansas Community Care (Arcadian Health
Plans, Inc.)
L.
Today’s Options (Universal American)
M. Windsor Medicare Extra (Windsor Health Group, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans - California (CA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Advantage 1 (MD Care Health Plan)
C. Aetna Golden/Medicare Open Plan (Aetna)
D. Arcadian Community Care (Arcadian Health Plan)
E. Arta Gold (Arta Medicare Health Plan)
F. Blue Cross Senior Secure (Anthem Blue Cross)
G. Blue Shield 65 Plus (Blue Shield of California)
H. Care1st Medicare Advantage Plan/Dual Plus (Care 1st
Health Plan)
I.
CareMore (CareMore Health Plan)
J.
CCHP Senior Program (Chinese Community Health
Plan)
K. Central Health Medicare Plan (Central Health Plan of
California)
L. CIGNA Medicare Access (CIGNA Health Care)
Created 7/31/10
HIMC1
Medicare Advantage Plans - California (CA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
M. Citizens Choice Healthplan (Citizens Choice
Healthplan)
N. Easy Choice (Easy Choice Health Plans)
O. Freedom Blue (Anthem Blue Cross Life & Health
Insurance Company)
P. GEMCare Medicare Plus (Golden Empire Managed
Care)
Q. Golden Plan (Golden State Medicare Health Plan)
R. Health Net (Health Net)
S. Humana Gold (Humana Insurance Company)
T. Inter Valley Health Plan (Inter Valley Health Plan)
U. Molina Medicare Options (Molina Healthcare of
California)
V. My Choice (SCAN Health Plan)
Created 7/31/10
HIMC1
Medicare Advantage Plans - California (CA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
W. Partnership (Partnership Health Plan)
X. Salud con Health Net (Health Net of California)
Y. SCAN Health Plan (SCAN – Senior Care Action
Network)
Z. SecureHorizons MedicareDirect (United Healthcare)
AA. Senior Advantage (Kaiser Permanente)
BB. SmartValue (AnthemBlue Cross)
CC. StartSmart (CareMore Health Plan)
DD. Sterling (Sterling Life Insurance Company)
EE. Today’s Options (Universal American)
FF. WHA Care + Plan (Western Health Advantage)
Created 7/31/10
HIMC1
Medicare Advantage Plans Colorado (CO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A.
AARP MedicareComplete (United Healthcare)
B.
Aetna Golden/Medicare Open Plan (Aetna Medicare)
C.
CIGNA Medicare Access Plus (CIGNA Health Care)
D.
Colorado Access Advantage (Colorado Access)
E.
Denver Health Medicare (Denver Health Medical Plan)
F.
Evercare (Unitedhealthcare)
G. Gold Plan/Green Plan/Plus Plan (Rocky Mountain Health
Plans)
H.
HumanaGold/HumanaChoiocePPO (Humana Insurance)
I.
RMHP/AB Basic Plan (Rocky Mountain Health Plans)
J.
SecureHorizons Medicare Direct (United Healthcare)
K.
Senior Advantage (Kaiser Permanente)
L.
SmartValue/SureValue (Anthem Blue Cross and Blue Shield)
M. Sterling (Sterling Life Insurance Company)
N.
Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Connecticut (CT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Aetna Golden/ Medicare Open Plan (Aetna
Medicare)
C. ConnectiCare (Health Plan of Greater New York)
D. Health Net (Health Net of Connecticut)
E. MediBlue HMO (Anthem Blue Cross and Blue Shield)
F. SecurityChoice (Unicare Life & Health Ins. Company)
G. SmartValue (Anthem Blue Cross and Blue Shield)
H. Today’s Options (Universal American)
I.
WellCare (WellCare Health Plans, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans - District of Columbia (DC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. Aetna Golden/Aetna Medicare Plan (Aetna)
B. Bravo (Bravo Health)
C. Kaiser Permanente Medicare Plus (Kaiser Permanente)
D. SecurityChoice (Unicare Life & Health Ins. Company)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Delaware (DE)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. Aetna Medicare Plan (Aetna)
B. Bravo Liberty (Bravo Health)
C. SecurityChoice (Unicare Life & Health Ins. Company)
D. Sterling (Sterling Life Insurance Company)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Florida (FL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Advantage (Quality Health Plans)
C. Advantra Plan (Summit Health Plan, Inc.)
D. Aetna Medicare (Aetna)
E. Amerivantage (AMERIGROUP Community Care)
F.
ANY, ANY, ANY Plan (Universal Health Care)
G. AvMed Medicare Preferred (SantaFe HealthCare)
H. BlueMedicare (Health Options, Inc./Blue Cross and Blue
Shield of Florida)
I.
Capital Health Plan (Capital Health Plan)
J.
Care Centers/CareComplete/Direct/Free/Needs/One
(CarePlus Health Plans)
K. CIGNA Medicare Access (CIGNA Health Care)
L.
Citrus Care/Saver (Citrus Health Care, Inc.)
M. FHCP Medvantage (Florida Health Care Plan, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Florida (FL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
N. Freedom (Freedom Health, Inc.)
O. Health First (Health First Medicare Plans)
P. HealthSpring HealthyAdvantage/HealthyLiving (HealthSpring
of Florida)
Q. Healthy Advantage (HealthSun Health Plans, Inc.)
R. HumanaChoice/Humana Gold (Humana Medical Plan, Inc.)
S. JacksonHealth for Life (JMH Health Plan)
T.
Leon Cares (Leon Medical Centers Health Plans)
U. Medica HealthCare Plans MedicareMax (Medica HealthCare
Plans)
V. Medicare Masterpiece (Universal Health Care, Inc.)
W. MediMax (HealthSun Health Plans, Inc.)
X. Molina Medicare Options (Molina Healthcare of Florida)
Y. Optimum (Optimum Healthcare, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Florida (FL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
Z.
Physicians Health Choice (Physicians Health Choice)
AA. Preferred Care Partners (Preferred Care Partners, Inc.)
BB. PUP (Physicians United Plan)
CC. SecurityChoice (Unicare Life & Health Ins. Company)
DD. Sterling (Sterling Life Insurance Company)
EE. Summit Ideal/Plus/Value (Summit Health Plans, Inc.)
FF. SunPlus Advantage Plan (HealthSun Health Plans, Inc.)
GG. Today’s Options (Universal American)
HH. VISTA Platinum (VISTA Healthplan of South Florida)
II.
WellCare (WellCare Health Plans, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Georgia (GA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Advantra Silver/Gold/Freedom (Coventry Health
Plan)
C. Aetna Golden/Aetna Medicare Plan (Aetna)
D. ANY, ANY, ANY Plan (Universal Health Care)
E. Blue Value (Blue Cross Blue Shield Healthcare
Plan of Georgia)
F. Care Improvement Plus (Care Improvement Plus)
G. CIGNA Medicare Access (CIGNA Health Care)
H. HealthSpring HealthyAdvantage/Healthy Living
(HealthSpring Life & Health)
I.
Humana Gold/HumanaChoicePPO (Humana
Insurance Company)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Georgia (GA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
J. Kaiser Permanente Senior Advantage (Kaiser
Foundation Health Plan, Inc.)
K. Patriot Plus (AMERICA'S 1ST CHOICE HEALTH
PLANS, INC.)
L. Secure Horizons Medicare Direct (United
Healthcare)
M. SmartValue (Blue Cross Blue Shield of Georgia)
N. Southeast Community Care (Southeast
Community Care)
O. Sterling (Sterling Life Insurance Company)
P. Today’s Options (Universal American)
Q. WellCare (Wellcare Health Plans, Inc.)
Created 12/31/08
HIMC1
Medicare Advantage Plans - Hawaii (HI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. 65C Plus (HMSA's 65C Plus)
B. AARP MedicareComplete (United Healthcare)
C. AlohaCare (AlohaCare)
D. CIGNA Medicare Access (CIGNA Health Care)
E. Humana Gold Choice/HumanaChoicePPO (Humana
Insurance Company)
F. Kaiser Permanente Senior Advantage (Kaiser
Permanente Senior Advantage)
G. Ohana (WellCare)
H. SecureHorizons MedicareComplete (United Healthcare)
I.
SecurityChoice (Unicare Life & Health Ins. Company)
J.
Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Idaho (ID)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete Choice (United Healthcare)
B. Humana Gold Choice/HumanaChoicePPO (Humana
Insurance Company)
C. Regence MedAdvantage (Regence BlueShield of
Idaho)
D. Secure Blue/Flexi Blue/True Blue (Blue Cross of Idaho
Hlth Services Inc.)
E. Secure Horizons Medicare Direct (United Healthcare)
F. SecurityChoice (Unicare Life & Health Ins. Company)
G. Sierra Optima Select (Sierra Health and Life Insurance
Co.)
H. Sterling (Sterling Life Insurance Company)
I.
Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Illinois (IL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Advantra (Group Health Plan, Inc.)
C. Aetna Medicare (Aetna)
D. CIGNA Medicare Access (CIGNA Health Care)
E. Essence Advantage (Essence Healthcare)
F. GoldAdvantage (Group Health Plan)
G. Health Alliance Medicare (Health Alliance Medical
Plans)
H. HealthSpring Healthy Advantage/Healthy Living
(Healthspring, Inc.)
I.
Humana Gold/HumanaChoicePPO (Humana Insurance
Company)
J.
PersonalCare Advantra Gold/Silver (PersonalCare
Advantra)
K. SecureHorizons Medicare Direct (United Healthcare)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Illinois (IL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
L. SecurityChoice (Unicare Life & Health Ins. Company)
M. Sterling (Sterling Life Insurance Company)
N. Today’s Options (Universal American)
O. WellCare (WellCare Health Plans, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Indiana (IN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete Choice (United Healthcare)
B. ADVANTAGE (ADVANTAGE Health Solutions, Inc.)
C. Blue Medicare Access/Anthem Senior
Advantage/Medicare Preferred/SmartValue (Anthem
Blue Cross and Blue Shield)
D. CIGNA Medicare Access (CIGNA Health Care)
E. Clarian Medicare (Clarian Health Plans, Inc.)
F. Essence Advantage (Essence Healthcare)
G. Humana Gold/HumanaChoice (Humana Insurance
Company)
H. Platinum Select (Welborn Health Plans)
I.
Secure Horizons Medicare Direct (United Healthcare)
J.
SecurityChoice (Unicare Life and Health Ins. Company)
K. Sterling (Sterling Life Insurance Company)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Indiana (IN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
L. Today’s Options (Universal American)
M. WellCare (WellCare Health Plans, Inc.)
N. Wishard Complete Care (ADVANTAGE Health
Solutions, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Iowa (IA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Advantra/Advantra Freedom (Coventry Health Care)
C. Avera Advantage (Universal American)
D. Humana Gold Choice/HumanaChoicePPO (Humana
Insurance Company)
E. MedicareBlue PPO (Wellmark Blue Cross and Blue
Shield)
F. SecureHorizons MedicareDirect (United Healthcare)
G. SecurityChoice (Unicare Life & Health Ins. Company)
H. Sterling (Sterling Life Insurance Company)
I.
Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Kansas (KS)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Advantra (Coventry Health Care)
C. Humana Gold/HumanaChoicePPO/MyCare
(Humana Insurance Company)
D. SecurityChoice (Unicare Life & Health Ins.
Company)
E. Sterling (Sterling Life Insurance Company)
F. Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Kentucky (KY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Blue Medicare Access/Anthem Senior
Advantage/Medicare Preferred/SmartValue (Anthem
Blue Cross and Blue Shield)
C. Essence Advantage (Essence Healthcare)
D. HumanaChoice/Humana Gold (Humana Insurance
Company)
E. SecureHorizons MedicareDirect (United Healthcare)
F. SecurityChoice (Unicare Life & Health Ins. Company)
G. Sterling (Sterling Life Insurance Company)
H. Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Louisiana (LA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AAA Vantage (Vantage Health Plan, Inc.)
B. ANY, ANY, ANY Plan (Universal Health Care)
C. Arcadian Community Care (Arcadian Health Plan)
D. Choices/HealthCare Select (Peoples Health)
E. CIGNA Medicare Access (CIGNA Health Care)
F. Humana Gold/HumanChoicePPO/MyCare (Humana
Health Benefit Plan of LA, Inc.)
G. SecureHorizons MedicareDirect MEDICARE
COMPLETE (United Healthcare)
H. SecurityChoice (Unicare Life & Health Ins. Company)
I.
Sterling (Sterling Life Insurance Company)
J.
Today’s Options (Universal American)
K. WellCare (WellCare Health Plans, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Maine (ME)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP/MedicareComplete Choice (United Healthcare)
B. Aetna Medicare Open Plan/Aetna Golden (Aetna)
C. CIGNA Medicare Access (CIGNA Health Care)
D. First Seniority Freedom (HARVARD PILGRIM HEALTH
CARE INC.)
E. Martin’s Point Generations Advantage (Martin’s Point
Health Care)
F. Northeast Community Care (Arcadian Health Plan)
G. SecureHorizons Medicare Direct (United Healthcare)
H. SmartValue (Anthem Blue Cross and Blue Shield)
I.
Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans Maryland (MD)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. Aetna Medicare (Aetna)
B. Amerivantage (AMERIGROUP Community Care)
C. ANY, ANY, ANY Plan (Universal Health Care)
D. Bravo (Bravo Health)
E. Kaiser Permanente Medicare Plus (Kaiser Foundation
Health Plan, Inc.)
F. SecurityChoice (Unicare Life & Health Ins. Company)
G. Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans Massachusetts (MA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Blue Medicare/Medicare Blue (Blue Cross Blue
Shield of Massachusetts)
C. CIGNA Medicare Access (CIGNA Health Care)
D. Fallon Senior Plan (Fallon Community Health
Plan)
E. First Seniority Freedom (HARVARD PILGRIM
HEALTH CARE, INC.)
F. HNE Medicare (Health New England, Inc.)
G. Humana Gold Choice (Humana Insurance
Company)
H. SecurityChoice (Unicare Life & Health Ins.
Company)
Created 7/31/10
HIMC1
Medicare Advantage Plans Massachusetts (MA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
I.
Senior Whole Health (Senior Whole Health)
J. Today’s Options (Universal American)
K. Tufts Medicare Preferred (Tufts Health Plan)
Created 7/31/10
HIMC1
Medicare Advantage Plans Michigan (MI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. Alliance Medicare/HAP Senior Plus (Health Alliance
Plan of Michigan)
B. BCN Advantage (Blue Care Network)
C. Great Lakes Personal Care (Great Lakes Health Plan)
D. HealthPlus (HealthPlus of Michigan)
E. Healthy Advantage (Molina Healthcare of Michigan)
F. Humana Gold Choice/HumanaChoicePPO (Humana
Insurance Company)
G. Medicare Plus Blue (Blue Cross Blue Shield of
Michigan)
H. Molina Medicare Options (Molina Healthcare of
Michigan)
I.
Paramount Elite (ProMedica Health System)
J.
PriorityMedicare (PriorityHealth)
Created 7/31/10
HIMC1
Medicare Advantage Plans Michigan (MI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
K. SecureHorizons MedicareDirect (United Healthcare)
L. SecurityChoice (Unicare Life & Health Ins. Company)
M. Sterling (Sterling Life Insurance Company)
N. Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Minnesota (MN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. Avera Advantage (Universal American)
B. HealthPartners Freedom/Liberty/Classic (HealthPartners)
C. Humana Gold/HumanaChoice (Humana Insurance
Company)
D. Medica (Medica Health Plans)
E. MedicareBlue PPO/VantageBlue (Blue Cross and Blue
Shield of Minnesota)
F.
MHP North Star/North Star Advantage (Metropolitan
Health Plan)
G. Secure Horizons/SecureHorizons MedicareDirect (United
Healthcare)
H. SecurityChoice (Unicare Life and Health Ins. Company)
I.
Sterling (Sterling Life Insurance Company)
J.
Today’s Options (Universal American)
K. UCare (UCare Minnesota)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Mississippi (MS)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. ANY, ANY, ANY Plan (Universal Health Care)
B. HealthSpring (HealthSpring, Inc.)
C. Humana Gold/HumanaChoicePPO (Humana Insurance Company)
D. SecurityChoice (Unicare Life & Health Ins. Company)
E. Today’s Options (Universal American)
F. Windsor Medicare Extra (Windsor Health Group Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Missouri (MO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Advantra/Advantra Freedom (Coventry Health Care)
C. Anthem Senior Advantage/Medicare Preferred (Anthem
Blue Cross and Blue Shield)
D. Care Improvement Plus (Care Improvement Plus)
E. CIGNA Medicare Access (CIGNA Health Care)
F.
Essence Advantage (Essence Healthcare)
G. Gold Advantage/Advantra (Group Health Plan, Inc.)
H. Humana Gold/HumanaChoicePPO/MyCare (Humana
Insurance Company)
I.
Mercy MedicareADVANTAGE (Mercy Health Plans of
Missouri, Inc.)
J.
Ozark Health Plan (Ozark Health Plan)
K. SecureHorizons MedicareDirect (United Healthcare)
L.
SmartValue (Blue Cross Blue Shield of Missouri)
M. Sterling (Sterling Life Insurance Company)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Missouri (MO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
N. Today’s Options (Universal American)
O. WellCare (WellCare Health Plans, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans Montana (MT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. Humana Gold Choice (Humana Insurance Company)
B. MedicareBlue PPO (Blue Cross and Blue Shield of
Montana)
C. New West Medicare (New West Health Services)
D. SecureHorizons MedicareDirect (United Healthcare)
E. SecurityChoice (Unicare Life & Health Ins. Company)
F. Sterling (Sterling Life Insurance Company)
G. Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans North Carolina (NC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Advantra (Coventry Health Care)
C. Ambassador/Patriot/Presidential (AMERICA’S 1ST
CHOICE INSURANCE COMPANY OF NC, INC.)
D. Blue Medicare HMO/PPO (PARTNERS National Health
Plans, a BCBSNC Company)
E. CIGNA Medicare Access (CIGNA Health Care)
F.
Humana Gold Choice/HumanaChoicePPO (Humana
Insurance Company)
G. SecurityChoice (Unicare Life & Health Ins. Company)
H. Southeast Community Care (Southeast Community Care)
I.
Sterling (Sterling Life Insurance Company)
J.
Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - North Dakota (ND)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. Avera Advantage (Universal American)
B. Humana Gold Choice (Humana Insurance Company)
C. Medica Advantage/Prime (Medica Health Plans)
D. MedicareBlue (Blue Cross Blue Shield of North Dakota)
E. SecureHorizons Medicare Direct (United Healthcare)
F. SecurityChoice (Unicare Life & Health Ins. Company)
G. Sterling (Sterling Life Insurance Company)
H. Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Nebraska (NE)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Advantra/Advantra Freedom (Coventry Health Care)
C. Avera Advantage (Universal American)
D. Humana GoldHumanaChoice (Humana Insurance
Company)
E. MedicareBlue PPO (Blue Cross and Blue Shield of
Nebraska)
F. SecureHorizons MedicareDirect (United Healthcare)
G. SecurityChoice (Unicare Life and Health Ins.
Company)
H. Sterling (Sterling Life Insurance Company)
I.
Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Nevada (NV)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A.
Aetna Medicare Open Plan/Aetna Golden (Aetna)
B.
Anthem Medicare Preferred (Anthem Blue Cross and Blue
Shield)
C.
ANY, ANY, ANY Plan (Universal Health Care)
D.
Caremore (CareMore Health Plan of Nevada)
E.
Humana Gold Choice (Humana Insurance Company)
F.
Pacificare (UnitedHealthcare)
G. SecureHorizons MedicareDirect (United Healthcare)
H.
SecurityChoice (Unicare Life & Health Ins. Company)
I.
Senior Care Plus (Hometown Health Plan, Inc.)
J.
Senior Dimensions/Sierra VillageHealth (Health Plan of
Nevada, Inc.)
K.
Sierra Nevada Spectrum/Sierra Spectrum/Sierra Optima
(Sierra Health & Life Ins., Inc.)
L.
SmartValue (Anthem Blue Cross and Blue Shield)
M. Sterling (Sterling Life Insurance Company)
N.
Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - New Hampshire (NH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. CIGNA Medicare Access (CIGNA Health Care)
B. First Seniority Freedom (HARVARD PILGRIM HEALTH CARE INC.)
C. Humana Gold Choice (Humana Insurance Company)
D. Northeast Community Care (Northeast Community Care)
E. SecureHorizons MedicareDirect (United Healthcare)
F. SecurityChoice (Unicare Life & Health Ins. Company)
G. SmartValue (Anthem Blue Cross and Blue Shield)
H. Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans –
New Jersey (NJ)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Aetna Golden/Aetna Medicare Open Plan (Aetna)
C. AmeriHealth 65 (AmeriHealth)
D. Amerivantage (AMERIGROUP Community Care)
E. Bravo (Bravo Health)
F. HealthFirst NJ (HealthFirst NJ)
G. Horizon Medicare Blue (Horizon Blue Cross Blue Shield
of New Jersey, Inc.)
H. SecurityChoice (Unicare Life & Health Ins. Company)
I.
Sterling (Sterling Life Insurance Company)
J.
Today’s Options (Universal American)
K. WellCare (WellCare Health Plans, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans New Mexico (NM)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Amerivantage (AMERIGROUP Community Care of New
Mexico)
C. CIGNA Medicare Access (CIGNA Health Care)
D. Humana Gold Choice/HumanaChoicePPO (Humana
Insurance Company)
E. Lovelace Senior Plan (Lovelace Health Plan)
F. Molina Medicare Options (Molina Healthcare of New
Mexico, Inc.)
G. Physicians Health Choice (PHYSICIANS HEALTH
CHOICE OF NEW MEXICO)
H. Presbyterian MediCare PPO/Presbyterian Senior Care
Plan (Presbyterian Medi-Care Health Plan)
I.
SecureHorizons MedicareDirect (United Healthcare)
Created 7/31/10
HIMC1
Medicare Advantage Plans New Mexico (NM)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
J.
SecurityChoice (Unicare Life & Health Ins. Company)
K. Sterling (Sterling Life Insurance Company)
Created 7/31/10
HIMC1
Medicare Advantage Plans - New York (NY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Advantage NY (QUALITY HEALTH PLANS)
C. Aetna Golden/Aetna Medicare Plan (Aetna)
D. Amerivantage (AMERIGROUP Community Care)
E. Blue Choice Senior/Medicare Blue/Senior Choice (Excellus
Health Plan, Inc.)
F.
BlueCross BlueShield Forever Blue/Senior Blue (Blue
Cross Blue Shield)
G. CCM Direct (Comprehensive Care Management)
H. CDPHP (Capital District Physician’s Health Plan)
I.
CIGNA Medicare Access (CIGNA Health Care)
J.
Elderplan (Elderplan, Inc.)
K. Empire BlueCross BlueShield (Empire Healthchoice
Assurance)
L.
Essence Advantage (Essence Healthcare)
M. Fidelis Medicare Advantage (New York State Catholic Hlth.
Plan Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans – New York (NY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
N. GHI Medicare PPO (EmblemHealth)
O. GoldAnywhere/GoldValue (MVP HEALTH CARE)
P. Health Plus Elite (Health Plus Elite)
Q. HealthFirst (Healthfirst Medicare Plan)
R. HIP VIP (EmblemHealth)
S. Humana Gold/HumanaChoice (Humana Insurance
Company of New York)
T.
Independent Health (Independent Health)
U. Liberty Health Advantage (Liberty Health System)
V. MediBlue (Empire BlueCross BlueShield)
W. MetroPlus (MetroPlus Health Plan)
X. MVP Health Care (MVP Health Plan)
Y. Northeast Community Care (Northeast Community Care)
Z.
Preferred Care Gold (MVP Health Care)
AA. SecureHorizons MedicareDirect (United Healthcare)
Created 7/31/10
HIMC1
Medicare Advantage Plans – New York (NY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
BB. SecurityChoice (Unicare Life & Health Ins. Company)
CC. Sterling (Sterling Life Insurance Company)
DD. Today's Options (Universal American)
EE. Touchstone Health Medicare (Touchstone Health)
FF. Univera Medicare (Excellus Health Plan, Inc.)
GG. VNS CHOICE Medicare (VNS CHOICE Medicare)
HH. WellCare (WellCare Health Plans, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Ohio (OH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A.
AARP MedicareComplete (United Healthcare)
B.
Advantage Plan (Advantage Plans from Medical Mutual of
Ohio)
C.
Advantra (Coventry Health Care)
D.
Aetna Medicare Plan (Aetna Medicare)
E.
Anthem Senior Advantage/Medicare Preferred/Blue
Medicare Access (Anthem Blue Cross and Blue Shield)
F.
CareSource (CareSource)
G. CIGNA Medicare Access (CIGNA Health Care)
H.
Health Plan SecureCare (The Health Plan)
I.
HumanaChoicePPO/Humana Gold (Humana Insurance
Company)
J.
Kaiser Permanente Medicare Plus (Kaiser Foundation
Health Plan of Ohio)
K.
MediGold (MediGold)
L.
Molina Medicare Options (Molina Healthcare of Ohio)
M. Paramount Elite (Pro Media Health System)
N.
PrimeTime Health Plan (PrimeTime Health Plan)
Created 7/31/10
HIMC1
Medicare Advantage Plans – Ohio (OH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
O. SecureChoice/SecureFreedom (Union Security Insurance
Company)
P.
Sterling (Sterling Life Insurance Company)
Q. SummaCare Secure (Summa Health System)
R.
Today’s Options (Universal American)
S.
Trihealth Seniorlink (Trihealth)
T.
UPMC For Life (UPMC Health Plan)
U.
WellCare (WellCare Health Plans, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans Oklahoma (OK)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A.
AARP MedicareComplete (United Healthcare)
B.
Aetna Medicare (Aetna)
C.
Arcadian Health Plan (Arcadian Health Plan, Inc.)
D.
Generations Healthcare (Martins Point Health Care)
E.
Humana Gold Choice/HumanaChoicePPO (Humana
Insurance Company)
F.
Medicare Blue PPO (Blue Cross and Blue Shield of
Oklahoma)
G. SecureHorizons Medicare Direct (United Healthcare)
H.
SecurityChoice (Unicare Life & Health Ins. Company)
I.
Senior Health Plan (CommunityCare Senior Health Plan)
J.
Sterling (Sterling Life Insurance Company)
K.
Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Oregon (OR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP Medicare Complete (United Healthcare Open
Plan)
B. ATRIO MyAdvantage/ATRIO Tuality (ATRIO Health
Plans)
C. CareOregon Advantage (CareOregon, Inc.)
D. CareSource (CareSource)
E. CIGNA Medicare Access (CIGNA Health Care)
F. Clear Choice (Clear One Health Plans)
G. Explorer (Clear One Health Plans)
H. Health Net (Health Net)
I.
Health Net Healthy Heart (Health Net)
J.
Humana Gold Choice (Humana Insurance Company)
K. Kaiser Permanente Senior Advantage (Kaiser
Permanente)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Oregon (OR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
L. Marion Polk Community Health Plan
Advantage/Physicians Choice (Marion Polk
Community Health Plan Advantage)
M. ODS Advantage PPO (ODS Health Plan, Inc.)
N. PremierCare (FamilyCare Health Plans, Inc.)
O. Providence Medicare (Providence Health Plan)
P. Regence MedAdvantage (Regence BlueCross
BlueShield of Oregon)
Q. Samaritan Advantage (Samaritan Advantage Health
Plan)
R. SecureHorizons MedicareDirect (United Healthcare)
S. SecurityChoice (Unicare Life & Health Ins. Company)
T. Sterling (Sterling Life Insurance Company)
U. Today’s Options (Universal American)
V. Trillium Advantage (Trillium Community Health Plan)
Created 7/31/10
HIMC1
Medicare Advantage Plans Pennsylvania (PA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A.
AARP MedicareComplete (United Healthcare)
B.
Advantra (Coventry Health Care)
C.
Aetna Medicare (Aetna)
D.
ANY, ANY, ANY Plan (Universal Health Care)
E.
Bravo (Bravo Health)
F.
CIGNA Medicare Access (CIGNA Health Care)
G.
FreedomBlue (Highmark Inc.)
H.
Geisinger Gold (Geisinger Gold)
I.
Humana Gold Choice/HumanaChoicePPO (Humana
Insurance Company)
J.
Keystone 65/Personal Choice 65 (Independence Blue
Cross)
K.
SecureHorizons MedicareComplete/MedicareDirect
(United Healthcare)
L.
SecurityBlue (Keystone Health Plan West, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans –
Pennsylvania (PA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
M.
SecurityChoice (Unicare Life & Health Ins. Company)
N.
Senior Partners (Health Partners, Inc.)
O.
SeniorBlue (Keystone Health Plan Central, Inc.
/Capital Advantage Insurance Company)
P.
Sterling (Sterling Life Insurance Company)
Q.
Today's Options (Universal American)
R.
Unison Advantage (Unison Health Plan)
S.
UPMC for Life (UPMC Health Plan)
Created 7/31/10
HIMC1
Medicare Advantage Plans Puerto Rico (PR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A.
AHM/American Health (American Health Medicare)
B.
Auxilio Platino (Triple-S, Inc.)
C.
Dorado/Elite Dorado (Preferred Medicare Choice, Inc.)
D.
First Care+Plus/First+Plus (First Medical Health Plan, Inc.)
E.
Humana Gold/HumanaChoicePPO (Humana Health
Plans/Humana Insurance of Puerto Rico, Inc.)
F.
MAPFRE Medicare Excel (MAPFRE LIFE INSURANCE
COMPANY)
G.
MCS Classicare (MCS Life Insurance Company)
H.
Medicare y Mucho Más (Medicare y Mucho Más)
I.
PMC Max (Preferred Medicare Choice, Inc.)
J.
Triple-S Medicare (Triple-S Salud)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Rhode Island (RI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (SecureHorizons/United Healthcare)
B. BlueCHiP for Medicare (Blue Cross and Blue Shield of Rhode
Island)
C. SecurityChoice (Unicare Life & Health Ins. Company)
Created 7/31/10
HIMC1
Medicare Advantage Plans South Carolina (SC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A.
AARP MedicareComplete (United Healthcare)
B.
Ambassador/Patriot Plus/Presidential (AMERICA'S 1ST CHOICE
HEALTH PLANS)
C.
ANY, ANY, ANY Plan (Universal Health Care)
D.
Care Improvement Plus (Care Improvement Plus)
E.
CIGNA Medicare Access (CIGNA Health Care)
F.
Guardian Tribute (Guardian Healthcare, Inc.)
G.
Humana Gold/HumanaChoicePPO (Humana Insurance
Company)
H.
Medicare Blue (Blue Cross Blue Shield of South Carolina)
I.
SecureHorizons MedicareDirect (United Healthcare)
J.
SecurityChoice (Unicare Life & Health Ins. Company)
K.
Southeast Community Care (Arcadian Health Plan)
L.
Sterling (Sterling Life Insurance Company)
M.
Today’s Options (Universal American)
N.
Windsor Medicare Extra (Windsor Health Group, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans South Dakota (SD)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. Advantra Freedom/Platinum (Coventry Health Care)
B. Avera Advantage (Universal American)
C. Humana Gold/Humana Choice (Humana Insurance
Company)
D. Medica Prime (Medica Insurance Company)
E. MedicareBlue PPO (Wellmark Blue Cross Blue
Shield of South Dakota)
F. SecureHorizons MedicareDirect (United Healthcare)
G. SecurityChoice (Unicare Life & Health Ins. Company)
H. Sterling (Sterling Life Insurance Company)
Created 7/31/10
HIMC1
Medicare Advantage Plans Tennessee (TN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Aetna Medicare (Aetna)
C. Amerivantage (AMERIGROUP Community Care)
D. BlueAdvantage (BlueCross BlueShield of Tennessee)
E. CIGNA Medicare Access (CIGNA Health Care)
F. Healthspring (Healthspring of Tennesee)
G. HumanaChoicePPO/Humana Gold (Humana Insurance
Company)
H. SecureHorizons MedicareDirect (United Healthcare)
I.
SecurityChoice (Unicare Life & Health Ins. Company)
J.
Sterling (Sterling Life Insurance Company)
K. Today’s Options (Universal American)
L. Windsor Medicare Extra (Windsor Health Group, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Texas (TX)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A.
AARP MedicareComplete (United Healthcare)
B.
Advantra/Advantra Freedom (Coventry Health Care)
C.
Aetna Medicare (Aetna)
D.
Amerivantage (AMERIGROUP Community Care)
E.
ANY, ANY, ANY Plan (Universal Health Care Insurance
Company, Inc.)
F.
Arkansas Community Care (Texarkana Community Care)
G. Bravo (Bravo Health)
H.
Care Improvement Plus (Care Improvement)
I.
Care N’Care (Care N’Care Health Plan)
J.
CIGNA Medicare Access (CIGNA Health Care)
K.
Fidelis Secure (Fidelis SecureCare of Texas)
L.
FirstCare Advantage (FirstCare Health Plans)
M. HealthSpring HealthyAdvantage (HealthSpring Medicare
Advantage PPO)
N.
HumanaChoicePPO/Humana Gold (Humana Insurance
Company)
O. KelseyCare Advantage (KelseyCare-Seybold)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Texas (TX)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
P.
Medicare Masterpiece (Universal HMO of Texas, Inc.)
Q. Molina Medicare Options (Molina Healthcare of Texas, Inc.)
R.
Physicians Health Choice (PHYSICIANS HEALTH CHOICE)
S.
SecureHorizons MedicareDirect (United Healthcare)
T.
SecurityChoice (Unicare Life & Health Ins. Company)
U.
SeniorCare Sr (Scott and White Health Plan SeniorCare)
V.
Sterling (Sterling Life Insurance Company)
W. Texan Plus (Texas First Health Plans SelectCare of Texas,
LLC)
X.
Texarkana Community Care (Texarkana Community Care,
Inc.)
Y.
Texas Community Care (Arcadian Health Plan)
Z.
Today’s Options (Universal American)
AA. WellCare (WellCare Health Plans, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Utah (UT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A.
AARP MedicareComplete (United Healthcare)
B.
Altius Advantra (Coventry Health Care)
C.
ANY, ANY, ANY Plan (Universal Health Care)
D.
Healthy Advantage/Molina Medicare Options (Molina
Healthcare of Utah)
E.
HumanaChoicePPO/Humana Gold (Humana Insurance
Company)
F.
MedAdvantage (Regence BlueCross BlueShield of Utah)
G. SecureHorizons MedicareDirect (United Healthcare)
H.
SecurityChoice (Unicare Life & Health Ins. Company)
I.
Sierra Spectrum/Sierra Optima (Sierra Health & Life Ins., Inc.)
J.
Sterling (Sterling Life Insurance Company)
K.
Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Vermont (VT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. CIGNA Medicare Access (CIGNA Health Care)
C. Humana Gold Choice (Humana Insurance Company)
D. SecureHorizons MedicareDirect (United Healthcare)
E. SecurityChoice (Unicare Life & Health Ins. Company)
F. Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Virginia (VA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A.
AARP MedicareComplete (United Healthcare)
B.
Aetna Medicare (Aetna)
C.
Anthem Medicare Preferred/SmartValue (Anthem Blue Cross and
Blue Shield)
D.
Carilion Clinic (Carilion Clinic Medicare Health Plan)
E.
CIGNA Medicare Access (CIGNA Health Care)
F.
Humana Gold/HumanaChoicePPO (Humana Insurance
Company)
G.
Kaiser Permanente Medicare Plus (Kaiser Foundation Health
Plan, Inc.)
H.
Optima Medicare (Optima Health)
I.
SecureHorizons MedicareDirect (United Healthcare)
J.
SecurityChoice (Unicare Life and Health Ins. Company)
K.
Southeast Community Care (Arcadian Health Plan)
L.
Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans Washington (WA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Asuris TruAdvantage (Asuris Northwest Health)
C. ChoicePartners Medicare (Molina Healthcare of
Washington, Inc.)
D. CIGNA Medicare Access (CIGNA Health Care)
E. Columbia/Spokane Community Care (Arcadian Health
Plan)
F. Community HealthFirst (Community HealthFirst
Medicare Advantage Plan)
G. Essence Advantage (Essence HealthCare)
H. Evercare (Unitedhealthcare)
I.
Group Health Cooperative/Options Clear Care (Group
Health Cooperative)
J.
Health Net (Health Net, Inc.)
K. Health Net Healthy Heart (Health Net, Inc.)
Created 7/31/10
HIMC1
Medicare Advantage Plans Washington (WA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
L. Humana Gold/HumanaChoice (Humana Insurance
Company)
M. Kaiser Permanente Senior Advantage (Kaiser
Permanente)
N. Molina Medicare Options (Molina Healthcare of
Washington, Inc.)
O. Partners (Puget Sound Health Partners)
P. Providence Medicare (Providence Health Plan)
Q. Regence MedAdvantage (Regence BlueCross
BlueShield/Regence BlueShield)
R. SecureHorizons MedicareDirect (United Healthcare)
S. SecurityChoice (Unicare Life & Health Ins. Company)
T. Sterling (Sterling Life Insurance Company)
U. Today’s Options (Universal American)
Created 7/31/10
HIMC1
Medicare Advantage Plans West Virginia (WV)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. CIGNA Medicare Access (CIGNA Health Care)
B. FreedomBlue (Highmark Health Insurance Company)
C. Health Plan SecureCare/SecureChoice/Freedom (The
Health Plan)
D. Humana Gold Choice/HumanaChoicePPO (Humana
Insurance Company)
E. SecurityChoice (Unicare Life & Health Ins. Company)
F. Sterling (Sterling Life Insurance Company)
G. Today’s Options (Universal American)
H. UPMC For Life (UPMC Health Plan)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Wisconsin (WI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A.
AARP MedicareComplete (United Healthcare)
B.
Advocare (Security Health Plan of Wisconsin, Inc.)
C.
Anthem Medicare (Anthem Blue Cross and Blue Shield)
D.
Gundersen Lutheran Senior (Gundersen Lutheran Health
Plan, Inc.)
E.
HealthPartners Wisconsin Freedom Plan (HealthPartners
Freedom Plan)
F.
HumanaChoicePPO/Humana Gold Choice (Humana
Insurance Company)
G. iCare (Independent Care Health Plan)
H.
Medica Advantage Solution/Prime Solution (Medica Insurance
Company)
I.
Network/Network Platinum (NHIC-Network Health Insurance
Corp.)
J.
SecureHorizons MedicareDirect (United Healthcare)
K.
SmartValue/SecurityChoice/Medicare Preferred (Blue Cross
Blue Shield of Wisconsin)
L.
Sterling (Sterling Life Insurance Company)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Wisconsin (WI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
M. Today’s Health (Today’s Health)
N.
Today’s Options (Universal American)
O. UCare for Seniors (UCare)
Created 7/31/10
HIMC1
Medicare Advantage Plans - Wyoming (WY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. Altius Advantra (Coventry Health Care)
B. Humana Gold Choice (Humana Insurance Company)
C. MedicareBlue PPO (Blue Cross Blue Shield of Wyoming)
D. SecureHorizons MedicareDirect (United Healthcare)
E. SecurityChoice (Unicare Life & Health Ins. Company)
F. Sterling (Sterling Life Insurance Company)
G. WINhealth Standard/Green Plan (WINhealth Partners)
Created 3/1/09
HIMC2A
Lower Cost
To Get Rx Coverage
To Get Benefit Coverage Other Than RX
Your Doctor is a Member of This Plan
Your Current/Former Employer Pays Premium
Spouse's Current/Former Employer Pays Premium
Previous Plan Was Bought By Or Merged With Current Plan
Better Selection Of Providers or Quality of Care
Recommendation or Reputation
You Wanted a Choice of Doctors
Created 1/1/10
HI3
Sample Medicaid Card - Alabama (AL)
Created 1/1/10
HI3
Sample Medicaid Card - Alaska (AK)
Created 1/1/10
HI3
Sample Medicaid Card - Arizona (AZ)
Created 1/1/10
HI3
Sample Medicaid Card - Arkansas (AR)
Created 1/1/10
HI3
Sample Medicaid Card - California (CA)
Created 1/1/10
HI3
Sample Medicaid Card - Colorado (CO)
Created 1/1/10
HI3
Sample Medicaid Card - Connecticut (CT)
Created 1/1/10
HI3
Sample Medicaid Card - District of Columbia (DC)
Created 1/1/10
HI3
Sample Medicaid Card - Delaware (DE)
Created 1/1/10
HI3
Sample Medicaid Card - Florida (FL)
Created 1/1/10
HI3
Sample Medicaid Card - Georgia (GA)
Created 1/1/10
HI3
Sample Medicaid Card - Hawaii (HI)
Created 1/1/10
HI3
Sample Medicaid Card - Idaho (ID)
Created 1/1/10
HI3
Sample Medicaid Card - Illinois (IL)
Created 1/1/10
HI3
Sample Medicaid Card - Indiana (IN)
Created 1/1/10
HI3
Sample Medicaid Card - Iowa (IA)
Created 1/1/10
HI3
Sample Medicaid Card - Kansas (KS)
Created 1/1/10
HI3
Sample Medicaid Card - Kentucky (KY)
Created 1/1/10
HI3
Sample Medicaid Card - Louisiana (LA)
Created 1/1/10
HI3
Sample Medicaid Card - Maine (ME)
This card is not proof of eligibility,
Verify eligibility before providing services.
Important Information - If found, please destroy this card.
If you are a Member: Keep this card with you at all times. You must show this card to providers to get MaineCare
services. Contact your eligibility worker at the Department of Health and Human Services (DHHS) office nearest your
home if the information on this card is wrong or if this card is lost, stolen or damaged. For questions about covered
services or managed care, contact MaineCare Member Services at 1-800-977-6740, press option 2 or if you are deaf or
hard of hearing and have a TTY machine, call 1-800-977-6741.
If you are a Provider: Providers without point of service eligibility verification systems will need to call the MaineCare
member eligibility Voice Response System to verify eligibility. In Maine call 1-800-452-4694, outside Maine call 1-207287-3081. Office of MaineCare Services, DHHS, 11 State House Station, Augusta, Maine 04333-0011.
Out-of-state requests require prior authorization before rendering services. For any Out-of-state emergency services
contact MaineCare’s authorized agent within one business day of providing services at 1-866-543-2387.t
Created 1/1/10
HI3
Sample Medicaid Card - Maryland (MD)
Created 1/1/10
HI3
Sample Medicaid Card - Massachusetts (MA)
Created 1/1/10
HI3
Sample Medicaid Card - Michigan (MI)
Created 1/1/10
HI3
Sample Medicaid Card - Minnesota (MN)
Created 1/1/10
HI3
Sample Medicaid Card - Mississippi (MS)
Created 1/1/10
HI3
Sample Medicaid Card - Missouri (MO)
Created 1/1/10
HI3
Sample Medicaid Card - Montana (MT)
Created 1/1/10
HI3
Sample Medicaid Card - North Carolina (NC)
Created 1/1/10
HI3
Sample Medicaid Card - North Dakota (ND)
Created 1/1/10
HI3
Sample Medicaid Card - Nebraska (NE)
Created 1/1/10
HI3
Sample Medicaid Card - Nevada (NV)
Created 1/1/10
HI3
Sample Medicaid Card - New Hampshire (NH)
Created 1/1/10
HI3
Sample Medicaid Card - New Jersey (NJ)
Created 1/1/10
HI3
Sample Medicaid Card - New Mexico (NM)
Created 1/1/10
HI3
Sample Medicaid Card - New York (NY)
Created 1/1/10
HI3
Sample Medicaid Card - Ohio (OH)
[Card image varies by Medicaid plan name.]
Created 1/1/10
HI3
Sample Medicaid Card - Oklahoma (OK)
Created 1/1/10
HI3
Sample Medicaid Card - Oregon (OR)
Created 1/1/10
HI3
Sample Medicaid Card - Pennsylvania (PA)
Created 1/1/10
HI3
Sample Medicaid Card – Puerto Rico (PR)
[Card image varies by Medicaid plan name.]
Created 1/1/10
HI3
Sample Medicaid Card - Rhode Island (RI)
Created 1/1/10
HI3
Sample Medicaid Card - South Carolina (SC)
Created 1/1/10
HI3
Sample Medicaid Card - South Dakota (SD)
Created 1/1/10
HI3
Sample Medicaid Card - Tennessee (TN)
[Card image varies by Medicaid plan name.]
Created 1/1/10
HI3
Sample Medicaid Card - Texas (TX)
Created 1/1/10
HI3
Sample Medicaid Card - Texas (TX)
(continued)
Created 1/1/10
HI3
Sample Medicaid Card - Utah (UT)
Created 1/1/10
HI3
Sample Medicaid Card - Vermont (VT)
Created 1/1/10
HI3
Sample Medicaid Card - Virginia (VA)
COMMONWEALTH OF VIRGINIA
DEPARTMENT OF MEDICAL ASSISTANCE SERVICES
002286
999999999999
V I RG I N I A J. R E C I P I E N T
DOB: 05/09/1964
22
F
CARD# 00001
Created 1/1/10
HI3
Sample Medicaid Card - Washington (WA)
Created 1/1/10
HI3
Sample Medicaid Card - West Virginia (WV)
Created 1/1/10
HI3
Sample Medicaid Card - Wisconsin (WI)
Created 1/1/10
HI3
Sample Medicaid Card - Wyoming (WY)
Created 1/1/10
HI4
MEDICAID HMOs - ALABAMA (AL)
None Available
Created 1/1/10
HI4
MEDICAID HMOs - ALASKA (AK)
None Available
Created 1/1/10
HI4
MEDICAID HMOs - ARIZONA (AZ)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
Arizona Physicians IPA (APIPA)
Bridgeway Acute Plan
Care First Arizona
Cochise Health Systems
Health Choice Arizona
Maricopa Health Plan
Mercy Care Plan
Phoenix Health Plan
Pima Health Plan
Senior Care Action Network (SCAN) Long Term Care
University Family Care
Yavapal Long Term Care
Created 1/1/10
HI4
MEDICAID HMOs - ARKANSAS (AR)
None Available
Created 1/1/10
HI4
MEDICAID HMOs - CALIFORNIA (CA)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
Alameda Alliance for Health
AltaMed
Anthem Blue Cross Partnership Plan
CalOptima
Care First Partner Plan
CenCal Health
Center for Elders Independence
Central Coast Alliance for Health
Community Eldercare of San Diego
Community Health Group Partnership Plan
Contra Costa Health Plan
Health Net Community Solutions
Health Plan of San Joaquin
Health Plan of San Mateo
Inland Empire Health Plan
Created 1/1/10
HI4
MEDICAID HMOs - CALIFORNIA (CA)
(continued)
P.
Q.
R.
S.
T.
U.
V.
W.
X.
Y.
Z.
AA.
Kaiser Permanente
Kern Family Health Care
L.A. Care Health Plan
Molina Healthcare of California Partner Plan
On Lok Lifeways (PACE)
Partnership Health Plan of California
Positive HealthCare
San Francisco Health Plan
Santa Clara Family Health Plan
Senior Care Action Network (SCAN) Health Plan
Sutter Senior Care
Western Health Advantage Community Health Plan
Created 1/1/10
HI4
MEDICAID HMOs - COLORADO (CO)
A.
B.
C.
D.
E.
F.
G.
Behavioral Healthcare Incorporated
Colorado Access Health Plan
Colorado Health Network
Denver Health Medicaid Choice Plan
Foothills Behavioral Health
Northeast Behavioral Health
Rocky Mountain Health Plan
Created 1/1/10
HI4
MEDICAID HMOs - CONNECTICUT (CT)
A.
B.
C.
Aetna Better Care Program
Americhoice - United Health Care
Community Healthcare Network
Created 1/1/10
HI4
MEDICAID HMOs - DISTRICT OF COLUMBIA (DC)
A.
B.
C.
D.
DC Chartered Health Plan
Health Right
Health Services for Children with Special Needs
Unison
Created 1/1/10
HI4
MEDICAID HMOs - DELAWARE (DE)
A.
B.
C.
Americhoice - United Health Care
Delaware Physicians Care Inc. - Aetna
State Primary Care
Created 1/1/10
HI4
MEDICAID HMOs - FLORIDA (FL)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
Amerigroup Florida
Buena Vista Medicaid Vista Health Plan
Citrus Health Care
Freedom Health
HealthEase of Florida
Humana Family
Jackson Memorial Health Plan
Molina Healthcare of Florida
Personal Health Plan
Preferred Medical Plan
Prestige Health Choice
Staywell Health Plan of Florida
Sunshine State Health Plan
Total Health Choice
United HealthCare of Florida
Created 1/1/10
HI4
MEDICAID HMOs - FLORIDA (FL)
(continued)
P.
Q.
Universal Health Care
Vista HealthPlan of South Florida
Created 1/1/10
HI4
MEDICAID HMOs - GEORGIA (GA)
A.
B.
C.
AmeriGroup Community Care
Peach State Health Plan
WellCare
Created 1/1/10
HI4
MEDICAID HMOs - HAWAII (HI)
A.
B.
Hawaii Pacific Health
Humana
Created 1/1/10
HI4
MEDICAID HMOs - IDAHO (ID)
A.
Healthy Connections
Created 1/1/10
HI4
MEDICAID HMOs - ILLINOIS (IL)
A.
B.
C.
Family Health Network
Harmony Health Plan
Meridian Health Plan
Created 1/1/10
HI4
MEDICAID HMOs - INDIANA (IN)
A.
B.
C.
D.
E.
F.
Advantage Health Solutions
Anthem
Enhanced Service Plan
Managed Health Services (MHS)
MDwise
Molina Healthcare, Inc.
Created 1/1/10
HI4
MEDICAID HMOs - IOWA (IA)
None Available
Created 1/1/10
HI4
MEDICAID HMOs - KANSAS (KS)
A.
B.
C.
D.
E.
Cenpatico Behavioral Health
Children's Mercy Family Health Partners
Kansas City Solutions
Unicare Health Plan of Kansas
Value Opinions
Created 1/1/10
HI4
MEDICAID HMOs - KENTUCKY (KY)
A.
B.
Kentucky Medicaid Health Care Partnership Program
(KMPACC)
Passport Health Plan
Created 1/1/10
HI4
MEDICAID HMOs - LOUISIANA (LA)
None Available
Created 1/1/10
HI4
MEDICAID HMOs - MAINE (ME)
None Available
Created 1/1/10
HI4
MEDICAID HMOs - MASSACHUSETTS (MA)
A.
B.
C.
D.
Boston Medical Center HealthNet Plan (BMCHP)
Fallon Community Health Plan (FCHP)
NeighborHood Health Plan
Network Health Plan (NH)
Created 1/1/10
HI4
MEDICAID HMOs - MARYLAND (MD)
A.
B.
C.
D.
E.
F.
G.
Amerigroup
Diamond Plan
Jai Medical Systems
Maryland Physicians Care
Med-Star Family Choice
Priority Partners
UnitedHealthcare (Americhoice)
Created 1/1/10
HI4
MEDICAID HMOs - MICHIGAN (MI)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
BlueCaid
Care Source of Michigan
Great Lakes Health Plan, Inc.
Health Plan of Michigan, Inc.
HealthPlus Partners, Inc.
McLaren Health Plan
Midwest Health Plan
Molina Healthcare of Michigan
OmniCare Health Plan, Inc.
PHP-MM Family Care
Priority Health Government Programs, Inc.
ProCare
Total Health Care
Upper Peninsula Health Plan
Created 1/1/10
HI4
MEDICAID HMOs - MINNESOTA (MN)
A.
B.
C.
D.
E.
F.
G.
H.
I.
Blue Plus
First Plan of Minnesota
HealthPartners
Itasca Medical Care
Medica
Metropolitan Health Plan
PrimeWest Health Systems
South Country Health Alliance
Ucare Minnesota
Created 1/1/10
HI4
MEDICAID HMOs - MISSISSIPPI (MS)
None Available
Created 1/1/10
HI4
MEDICAID HMOs - MISSOURI (MO)
A.
B.
C.
D.
E.
F.
Blue-Advantage Plus of Kansas City
Children's Mercy Family Health Partners
Harmony Health Plan of Missouri
HealthCare USA
Missouri Care
Molina HealthCare of Missouri
Created 1/1/10
HI4
MEDICAID HMOs - MONTANA (MT)
None Available
Created 1/1/10
HI4
MEDICAID HMOs - NEBRASKA (NE)
A.
B.
Magellan Behavioral Health
Share Advantage
Created 1/1/10
HI4
MEDICAID HMOs - NEW HAMPSHIRE (NH)
None Available
Created 1/1/10
HI4
MEDICAID HMOs - NEW JERSEY (NJ)
A.
B.
C.
D.
E.
AmeriChoice of New Jersey Inc
Amerigroup New Jersey, Inc.
Health Net of New Jersey, Inc.
Horizon New Jersey Health
University Health Plans, Inc.
Created 1/1/10
HI4
MEDICAID HMOs - NEW MEXICO (NM)
A.
B.
C.
D.
E.
Amerigroup of New Mexico
Blue Cross/Blue Shield of New Mexico
Lovelace Community Health
Molina Healthcare of New Mexico
Presbyterian Health Plan
Created 1/1/10
HI4
MEDICAID HMOs - NEVADA (NV)
A.
B.
Amerigroup
Health Plan of Nevada
Created 1/1/10
HI4
MEDICAID HMOs - NEW YORK (NY)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
Aetna Health Inc.
Affinity Health Plan
AmeriGroup New York Inc.
Atlantis Health Plan
Broome Max (Broome County)
Capital District Physicians Health Plan Inc.
CenterCare Inc.
Cigna Health Care of New York
Community Choice Health Plan of Westchester County Inc.
Community Premier Plus Inc.
Elderplan Inc.
Empire Health Choice HMO Inc.
Excellis Health Plan Inc.
GHI HMO Select Inc.
Health First PHSP Inc.
Created 1/1/10
HI4
MEDICAID HMOs - NEW YORK (NY)
(continued)
P.
Q.
R.
S.
T.
U.
V.
W.
X.
Y.
Z.
AA.
AB.
AC.
Health Insurance Plan of Greater New York
Health Net of New York
Health Now New York Inc.
Health Plus Prepaid Health Services Plan Inc.
Hudson Health Plan Inc.
Independent Health Association Inc.
Managed Health Inc.
Metro Health Plan Inc. Special Needs Plan (HIV)
Metro Plus Health Plan Inc.
MVP Health Plan Inc.
Neighborhood Health Providers LLC
New York Presbyterian Community Health Plan Inc.
New York Presbyterian System Select Health Plan LLC
New York State Catholic Health Plan Inc.
Created 1/1/10
HI4
MEDICAID HMOs - NEW YORK (NY)
(continued)
AD.
AE.
AF.
AG.
AH.
AI.
AJ.
AK.
AL.
AM.
Oxford Health Plans of NY Inc.
PCMP II-Gold Choice
SCHC Total Care Inc. (Syracuse Area)
Senior Whole Health of New York Inc.
Southern Tier Pediatrics
Southern Tier Priority Health Care
United Health Care of New York Inc.
Univera Community Health Inc.
VIDA Care Inc.
Well Care of New York Inc.
Created 1/1/10
HI4
MEDICAID HMOs - NORTH CAROLINA (NC)
None Available
Created 1/1/10
HI4
MEDICAID HMOs - NORTH DAKOTA (ND)
None Available
Created 1/1/10
HI4
MEDICAID HMOs - OHIO (OH)
A.
B.
C.
D.
E.
F.
G.
AmeriGroup Community Care
Buckeye Community Health Plan
Care Source
Molina Healthcare of Ohio
Paramount Advantage
Unison Health Plan of Ohio
Wellcare of Ohio
Created 1/1/10
HI4
MEDICAID HMOs - OKLAHOMA (OK)
A.
SoonerCare Choice
Created 1/1/10
HI4
MEDICAID HMOs - OREGON (OR)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
Care Oregon
Cascade Comprehensive Care, Inc. (CCC)
Central Oregon Independent Health Solutions, Inc.
(COIHS)
Doctors of the Oregon Coast South
Douglas County Independent Physicians Association
(DCIPA)
Family Care Inc.
InterCommunity Health Network (IHN)
Kaiser Permanente Oregon Plus
Lane Individual Practice Association, Inc. (LIPA)
Marion/Polk Community Health Plan (MPCHP)
Mid-Rogue Independent Physicians Association Holding
Company
ODS Community Health, Inc.
Created 1/1/10
HI4
MEDICAID HMOs - OREGON (OR)
(continued)
M.
N.
O.
Oregon Health Management Services (OHMS)
Providence Health Assurance
Tuality Health Alliance
Created 1/1/10
HI4
MEDICAID HMOs - PENNSYLVANIA (PA)
A.
B.
C.
D.
E.
F.
G.
H.
Aetna
AmeriChoice of Pennsylvania
Gateway Health Plan
Health America
Health Partners
Keystone Health Plan
Unison Health Plan
University of Pennsylvania Managed Care (UPMC) Health
Plan
Created 1/1/10
HI4
MEDICAID HMOs - PUERTO RICO (PR)
A.
B.
C.
D.
CCC
Cooperativa de Seguros de Vida de Puerto Rico (COSVI)
Humana Puerto Rico
IMCS
Created 1/1/10
HI4
MEDICAID HMOs - RHODE ISLAND (RI)
A.
B.
C.
Blue Cross Blue Shield of Rhode Island
Neighborhood Health Plan of Rhode Island
United Healthcare of New England
Created 1/1/10
HI4
MEDICAID HMOs - SOUTH CAROLINA (SC)
A.
B.
C.
D.
E.
F.
Absolute Total Care
Blue Choice Health Plan of South Carolina
Carolina Crescent Health Plan
First Choice by Select Health of South Carolina
South Carolina Solutions (PCCM)
Unison Health Plan
Created 1/1/10
HI4
MEDICAID HMOs - SOUTH DAKOTA (SD)
None Available
Created 1/1/10
HI4
MEDICAID HMOs - TENNESSEE (TN)
A.
B.
C.
D.
AmeriChoice
AmeriGroup
BlueCare
TennCare Select
Created 1/1/10
HI4
MEDICAID HMOs - TEXAS (TX)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
Aetna Medicaid
AmeriGroup Community Care
Community First Health Plans
Community Health Choice
Driscoll Children's Health Plan
El Paso First Premier Plan
First Care STAR
Molina Healthcare of Texas
Parkland HEALTHFirst
Superior HealthPlan
Texas Children's Health Plan
Unicare Health Plans of Texas
United Healthcare - TX
Created 1/1/10
HI4
MEDICAID HMOs - UTAH (UT)
A.
B.
C.
Healthy Utah
Molina Health
Select Access
Created 1/1/10
HI4
MEDICAID HMOs - VERMONT (VT)
None Available
Created 1/1/10
HI4
MEDICAID HMOs - VIRGINIA (VA)
A.
B.
C.
D.
E.
F.
G.
H.
Amerigroup
Anthem HealthKeepers
Anthem HealthKeepers Plus by Peninsula Health Care
Anthem HealthKeepers Plus by Priority Health Care
CareNet
Optima Family Care
Virginia Medallion
Virginia Premier Health Plan
Created 1/1/10
HI4
MEDICAID HMOs - WASHINGTON (WA)
A.
B.
C.
D.
E.
F.
G.
Asuris Northwest Health
Columbia United Providers
Community Health Plan of Washington
Group Health Corp.
Kaiser
Molina
Regence Blue Shield
Created 1/1/10
HI4
MEDICAID HMOs - WISCONSIN (WI)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
Abri Health Plan
Children Come First
Children's Community Health Plan
Community Care Organization
Community Health Partnership
Community Living Alliance
Compcare
Dean Health Plan
Elder Care Options
Group Health Cooperative
Gunderson Lutheran
Health Tradition Health Plan
i-Care
Managed Health Services
MercyCare Insurance Company
Created 1/1/10
HI4
MEDICAID HMOs - WISCONSIN (WI)
(continued)
P.
Q.
R.
S.
T.
U.
Network Health Plan
Physicians Plus Insurance Corp.
Security Health Plan
UnitedHealthcare of Wisconsin
Unity Health Insurance
Wraparound Milwaukee
Created 1/1/10
HI4
MEDICAID HMOs - WEST VIRGINIA (WV)
A.
B.
C.
Carelink Health Plans
The Health Plan of the Upper Ohio Valley
Unicare Health Plans
Created 1/1/10
HI4
MEDICAID HMOs - WYOMING (WY)
None Available
Created 7/31/10
HIT1
(front)
TRICARE Plan Names
A. TRICARE for Life
B. TRICARE Plus
C. TRICARE Prime
D. TRICARE Extra
E. TRICARE Standard
F. TRICARE Pharmacy / TRICARE Senior
Pharmacy
G. TRICARE Dental Program
H. TRICARE Retiree Dental Program
I. TRICARE Reserve Select (TRS)
J. TRICARE US Family Health Plan
Created 7/31/10
HIT1
(back)
Beneficiary Information Card
for TRICARE For Life
FRONT OF CARD
TRICARE For Life
To Provider: File claims in the usual manner to Medicare.
To Patient : Services that are a benefit of both Medicare and
TRICARE :No deductible or cost share is required.
Medicare only benefit :Medicare deductible and
cost share required.
TRICARE only benefit:TRICARE deductible and
cost share required.
For benefit questions call 1-888-DoD-LIFE
(1-888-363-5433)
www.tricare.osd.mil
For more information call 1-800-977-6753
www.hnfs.net
BACK OF CARD
TRICARE Senior Pharmacy
Military Treatment Facility: No Co-pay
National Mail Order Pharmacy: $3 generic;$9 brand name
(90 day supply)
TRICARE Network Pharmacy: $3 generic;$9 brand name
(30 day supply)
TRICARE Non-network Pharmacy: $9 or 20%of cost (30 day supply)
$150/person or $300/family
annual deductible applies.
For pharmacy questions call 1-877-DoD-MEDS
(Co-pays subject to change)
5007334 (9/01 T85)
(1-877-363-6337)
Created 3/1/09
HIT2
PLACES TO OBTAIN MEDICINES IN TRICARE PLAN
TRICARE Mail Order Pharmacy (TMOP)
TRICARE Retail Pharmacy Network pharmacy (TRRx)
Military Treatment Facility pharmacy (MTF)
Non-network retail pharmacy
Created 04/28/03
IA1
Social Security or Railroad Retirement
Supplemental Security Income (SSI)
Social Security Disability Insurance (SSDI)
Disability
Pensions
Job, Business, Professional Practice, Farm
Public Assistance Programs
Assistance from Relatives or Friends
Withdrawal from Retirement or Savings
Dividends
Lump-sum Payments
Other Regular Payments
Rental Properties
Other Sources
Created 05/02/02
IA1a
Annual Household Income
A. Less than $5,000
G. $30,000 – 34,999
B. $5,000 – 9,999
H. $35,000 – 39,999
C. $10,000 – 14,999
I. $40,000 – 44,999
D. $15,000 – 19,999
J. $45,000 – 49,999
E. $20,000 – 24,999
K. $50,000 +
F. $25,000 – 29,999
Created 05/02/02
IA1a – cont’d
Monthly Household Income
A. Less than $417
G. $2,500 – 2,916
B. $417 – 833
H. $2,917 – 3,333
C. $834 – 1,249
I. $3,334 – 3,749
D. $1,250 – 1,666
J. $3,750 – 4,166
E. $1,667 – 2,083
K. $4,167 +
F. $2,084 – 2,499
Created 05/02/02
IA2
Retirement Savings Accounts
Other Bank Accounts
Stocks, Mutual Funds, Bonds
Life Insurance Policies
Other Property
Vehicles
Other Assets
Created 05/01/06
IA3
Total Asset Value
A. Less than $5,000
B. $5,000 - 9,999
C. $10,000 - 19,999
D. $20,000 – 39,999
Created 05/01/06
IA4
Total Asset Value
E. $40,000 - 74,999
F. $75,000 - 149,999
G. $150,000 – 299,999
H. $300,000 +
Created 01/04/01
IU
Long Term Care Places
Skilled Nursing Homes
Intermediate Care Facilities
Board and Care Homes
Nursing Home Units in Hospitals
Facilities for the Mentally Retarded
Psychiatric Facilities
Group Homes
Created 3/1/09
KN1
Very Easy
Somewhat Easy
Somewhat Difficult
Very Difficult
Created 3/1/09
KN2
Just About Everything You Need To Know
Most Of What You Need To Know
Some Of What You Need To Know
A Little Of What You Need To Know
Almost None Of What You Need To Know
Created 3/1/09
KN4
What Kind of Information
How much you would have to pay for medical services
Information about Medicare Prescription Drug Coverage
Medicare’s new benefits or changes
What services Medicare does or doesn’t cover
The benefits of Medicare Advantage plans
Medigap or Supplemental insurance
Medicaid
Choosing or finding a doctor or other health care provider
Staying healthy
Quality of care from health care providers
Choosing a nursing home
Created 3/1/09
KN6
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Created 1/1/10
KN7
Created 3/1/09
KN9
Preferred Source of Information
Friends or family
Medical Professional (Doctor, Nurse, Clinic, etc.)
Pharmacist
Medicare or CMS
Social Security
State Medicaid Agency
Another Government Agency
Insurance Company, Including Medigap,
Medicare Advantage, Medicare Prescription
Drug Plan Companies
Current or Former Employer or Union
AARP or Senior Organizations
Media (Newspapers, TV, Radio, Magazine)
Created 1/1/10
KN13
Very Interested
Somewhat Interested
Not Very Interested
Not At All Interested
Created 1/1/10
KN14
Strongly Agree
Agree
Disagree
Strongly Disagree
Created 01/04/01
MP1
Health Practitioners Who Are Not
Medical Doctors
Acupuncturist
Audiologist
Optometrist
Chiropractor
Podiatrist (Foot Doctor)
Homeopath
Naturopath
Any Other Kind of Health Provider Who is
Not a Medical Doctor
Created 04/28/03
MP2
Mental Health Professionals
Psychiatrist
Psychologist
Clinical Social Worker
Licensed Professional Counselor
Created 01/04/01
MP3
Therapists
Physical Therapist
Speech Therapist
(Intravenous) I.V. Therapist
Massage Therapist
Occupational Therapist
Respiratory Therapist
Created 12/31/08
MP4
Other Medical Persons
Nurse
Nurse Practitioner
Paramedic (not including ambulance services)
Physician's Assistant
Created 01/04/01
MP5
Other Types of Medical Places
Health Clinic
Neighborhood Health Center
Rural Health Clinic
Infirmary
Mental Health Clinic
Urgent Care Center
Any Other Place
Created 07/25/02
OM1
Orthopedic Items
Crutches
Canes
Wheelchairs
Walkers
Corrective Shoes Or Inserts
Braces or Supports
Stockings
Created 07/25/02
OM1
Orthopedic Items
Crutches
Canes
Wheelchairs
Walkers
Corrective Shoes Or Inserts
Braces or Supports
Stockings
Created 01/04/01
OM2
Diabetic Equipment or Supplies
Syringes
Test Paper
Test Strips
Blood Monitoring Kits
Created 04/29/04
OM3
Prostheses
Artificial Leg or Arm
Mastectomy Prosthesis
Artificial or Glass Eye
Created 08/1/06
OM4
Other Medical Equipment and Supplies
Portable Commode or Raised Toilet Seat
Portable Tub Seat
Special Chair or Cushion
Hospital Bed
Ostomy Supplies
Incontinence Supplies Such as Depends, Serenity or Other
Brands of Disposable Undergarments, Pads, or Briefs
Bandages, Dressings, Tape Supplies
Pulmonary Equipment (Nebulizer, CPAP, etc.)
Blood Pressure Equipment
Created 01/04/01
OM5
Alterations Inside or Outside Home or Car
Ramps
Handrails (Other Than Tub Handrails)
Elevator or Incline Chair
Tub Seats
Tub Handrails
Any Car Alteration
Created 04/28/05
PA1
1. Very Confident
2. Confident
3. Somewhat Confident
4. Not At All Confident
Created 04/28/05
PA2
1. Very Likely
2. Likely
3. Unlikely
4. Very Unlikely
Created 04/28/05
PA4
1. Always
2. Usually
3. Sometimes
4. Never
Created 4/30/09
PD1
Very Easy
Somewhat Easy
Somewhat Difficult
Very Difficult
Created 4/30/09
PD2
Just About Everything You Need To Know
Most Of What You Need To Know
Some Of What You Need To Know
A Little Of What You Need To Know
Almost None Of What You Need To Know
Created 9/31/09
PM1
Often
Sometimes
Never
Created 4/30/09
RX1
Extremely Confident
Very Confident
Moderately Confident
Slightly Confident
Not Confident
Created 4/30/09
RX2
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Created 7/31/09
SC1
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Created 7/31/09
SC2
Didn't Think The Problem Was Serious
Thought It Would Cost Too Much
Trouble Finding or Getting To The Doctor
Time, Schedule, or Personal Conflicts
Thought Doctor Couldn’t Do Much About The Problem
Was Afraid of Finding Out What Was Wrong
Doctor Would Not Accept My Insurance
Created 7/31/09
SC3
Thought It Would Cost Too Much
Didn’t Think Medicine Would Help The Condition
Was Afraid of Medicine Reactions or Contraindications
Don’t Like To Take Medicine
Didn’t Think Medicine Was Necessary
The Medicine Was Not Covered By Insurance or Not On
The Plan’s Formulary
Trouble Obtaining Medicine
Obtained or Used Samples
Used Another Medicine As A Substitution
Created 7/31/09
SC4
Often
Sometimes
Never
Created 08/06/04
ST1
MEDICARE STATEMENT EXAMPLES
EXAMPLE 4
EXAMPLE 5
Created 08/06/04
ST1
MEDICARE STATEMENT EXAMPLES
EXAMPLE 6
EXAMPLE 7
HOME HEALTH CARE
Created 08/06/04
ST1
MEDICARE STATEMENT EXAMPLES
EXAMPLE 8
Created 06/17/08
ST2
TRICARE STATEMENT EXAMPLES
Example 1: Palmetto Government Benefits Administrators
If information
appears here the
“Provider Accepted
Assignment”.
Total
Charge
Medicare
Payment
Medicare
Approved
Amount
Created 12/30/05
ST2
TRICARE STATEMENT EXAMPLES
(continued)
Example 2: TRICARE Southwest
Medicare
Approved
Amount
Medicare
Payment
Total
Charge
Example 3: WPS TRICARE Administration
Total
Charge
Medicare
Approved
Amount
Medicare
Payment
Created 7/31/09
US1
Less Than 1 Year
1 Year To Less Than 3 Years
3 Years To Less Than 5 Years
5 Years To Less Than 10 Years
10 Years Or More
Created 7/31/09
US2
Strongly Agree
Agree
Disagree
Strongly Disagree
Created 07/31/10
2011
S
JANUARY
T W T
M
F
S
FEBRUARY
M T W T F
S
1
S
1
2
3
4
5
2
3
4
5
6
7
8
6
7
8
9
10
11
12
9
10
11
12
13
14
15
13
14
15
16
17
18
19
16
17
18
19
20
21
22
20
21
22
23
24
25
26
23
24
25
26
27
28
29
27
28
30
31
S
MARCH
T W T
M
F
S
S
1
2
3
4
5
APRIL
T W T
M
F
S
1
2
6
7
8
9
10
11
12
3
4
5
6
7
8
9
13
14
15
16
17
18
19
10
11
12
13
14
15
16
20
21
22
23
24
25
26
17
18
19
20
21
22
23
27
28
29
30
31
24
25
26
27
28
29
30
MAY
S
M
T
W
JUNE
T
F
S
S
M
T
1
2
3
4
5
6
7
8
9
10
11
12
13
14
5
6
15
16
17
18
19
20
21
12
22
23
24
25
26
27
28
29
30
31
W
T
F
S
1
2
3
4
7
8
9
10
11
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Created 07/31/10
2011
JULY
S
M
T
W
AUGUST
T
F
S
S
1
2
M
T
W
T
F
S
1
2
3
4
5
6
3
4
5
6
7
8
9
7
8
9
10
11
12
13
10
11
12
13
14
15
16
14
15
16
17
18
19
20
17
18
19
20
21
22
23
21
22
23
24
25
26
27
24
25
26
27
28
29
30
28
29
30
31
31
SEPTEMBER
M T W T F
S
S
S
1
2
3
OCTOBER
T W T
M
F
S
1
4
5
6
7
8
9
10
2
3
4
5
6
7
8
11
12
13
14
15
16
17
9
10
11
12
13
14
15
18
19
20
21
22
23
24
16
17
18
19
20
21
22
25
26
27
28
29
30
23
24
25
26
27
28
29
30
31
NOVEMBER
M T W T F
S
S
DECEMBER
M T W T F
S
1
2
3
4
5
S
1
2
3
6
7
8
9
10
11
12
4
5
6
7
8
9
10
13
14
15
16
17
18
19
11
12
13
14
15
16
17
20
21
22
23
24
25
26
18
19
20
21
22
23
24
27
28
29
30
25
26
27
28
29
30
31
Created 07/31/10
MEDICARE CURRENT BENEFICIARY SURVEY
NATIONAL STUDY - COMMUNITY COMPONENT
PRONUNCIATION GUIDE
The pronunciation of certain words within the questionnaire has been provided for your reference.
The words are listed in alphabetical order below.
Alzheimer's disease
(ahlts hy-merz dis-ease)
angina pectoris
(an-gy na pec toe ris)
antigen
(an-ti-jen)
aortic stenosis
(a-or-tik ste-no-sis)
arteriosclerosis
(ar-tee ri-oh-sclee-roe sis)
arthritis
(ar-thry tis)
asthma
(az mah)
atrial fibrillation
(a-tree-al fi-bri-la-shun)
benign prostatic hypertrophy (BPH)
(bi-nyn pro-sta-tik hy-per-tro-fee)
cardiopulmonary
(car dee-oh-pul moh-nar-y)
cataract
(kat ah-rakt)
cerebrovascular
(cer e-bro-vas cue-lahr)
colonoscopy
(ko-la-nas-ko-pee)
colorectal
(ko-la-rek-tal)
coronary
(core oh-nary)
dementia
(dee-men shia)
diabetes
(di ah-bee teez)
emphysema
(em-phy-see ma)
hemoglobin
(he-ma-glo-bin)
hemorrhage
(hem or-rage)
hypertension
(hi per-ten shun)
hysterectomy
(hys-ter-ec toe-me)
macular degeneration
(mak-yoo-lahr di-jen-er-a-shun)
malignancy
(ma-lig nan-cee)
mammogram
(mam o-gram)
myocardial infarction
(my-oh-kar dee-ahl in-fark-shun)
neuropathy
(noo-rop-uh-thee)
ophthalmologist
(off-thal-mol-o-jest)
osteoarthritis
(ahs tee-oh-ar-thry-tis)
osteoporosis
(ahs tee-oh-poe-roe-sis)
paralysis
(pa-ral y-sis)
Parkinson's disease
(par kin-sons dis-ease)
pneumonia
(new-moh nee-ah)
psychiatric
(sye-kee-at ric)
pulmonary
(pul moh-nar-y)
rheumatoid
(roo mah-toid)
sigmoidoscopy
(sig-moi-das-ka-pee)
Created 12/30/05
REFERENCE CARD FOR MEDICAL PROVIDER (LEFT-HAND COLUMN)
1.
2.
3.
29.
4.
5.
6.
7.
8.
9.
30.
10.
11.
28.
31.
32.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
91.
DENTIST/DENTAL PROVIDER
MEDICAL DOCTOR
AUDIOLOGIST
ACUPUNCTURIST
CHIROPRACTOR
CLINICAL SOCIAL WORKER
DIETITIAN/NUTRITIONST
HEARING THERAPIST
HOME HEALTH/HEALTH AIDE
HOMEMAKER
HOMEOPATH
HOSPICE WORKER
I.V. THERAPIST
LICENSED PRACTICAL NURSE (LPN)
MASSAGE THERAPIST
NATUROPATH
NURSE (RN)
NURSE PRACTITIONER
NURSE’S AIDE
OCCUPATIONAL THERAPIST (OT)
OPTOMETRIST
OSTEOPATH
PARAMEDIC
PHYSICAL THERAPIST (PT)
PHYSICIAN’S ASSISTANT
PODIATRIST (FOOT DOCTOR)
PSYCHOLOGIST
RESPIRATORY THERAPIST
SOCIAL/CASE WORKER
SPEECH THERAPIST
THERAPIST (MENTAL HEALTH)
X-RAY TECHNICIAN
OTHER MEDICAL PROVIDER SPECIALTY (NON-MD) SPECIFY
Created 07/28/01
EXAMPLES OF TYPES OF MEDICAL DOCTORS (RIGHT-HAND COLUMN)
ALLERGIST
ANESTHESIOLOGIST
CARDIOLOGIST
DERMATOLOGIST
ENDOCRINOLOGIST
GASTROENTEROLOGIST
GERIATRIC DOCTOR
GYNECOLOGIST
HEMATOLOGIST
INTERNAL MD/INTERNIST
NEPHROLOGIST
NEUROLOGIST
ONCOLOGIST
OPHTHALMOLOGIST
ORTHOPEDIST
PATHOLOGIST
PROCTOLOGIST
PULMONOLOGIST
PSYCHIATRIST
RADIOLOGIST
RHEUMATOLOGIST
SURGEON:
CARDIOVASCULAR
COLON/RECTAL
EYE
GENERAL
HAND
NEUROLOGICAL
ORTHOPEDIC
PLASTIC
THORACIC
VASCULAR
UROLOGIST
Created 08/4/05
Glossary of Prescribed Medicine Abbreviations
Medicine Form
Amp. = Ampules (elongated glass container of liquid medication)
Cap. = Capsules (gel caps, time release caps, solid caplets)
Elix. = Elixir (liquid)
hypo. = hypodermically (injection)
I.D. = intradermal (injection in skin)
I.M. = intramuscular (injection in muscle)
inf. = infusion (I.V. infusion)
Inhalant = medication administered per nose and/or mouth via mist
I.V. = intravenously (in vein)
patche = skin cover for medication or for test
per os/P.O. = by mouth
P.R. = per rectum
Pulv = powder
S.L. = Sublingual (under the tongue)
s.q./subq/S.C. = subcutaneous (under the skin)
syr = syrup
Tab = Tablet
tr = tincture
ung = ointment
vial = container (small) of sealed liquid medication usually for injections
When or How Often a Medicine is Administered
a.c. = before meals
ad. lib = as desired
b.d. = twice a day
b.i.d. = twice a day
b.i.n. = twice a night
H. = hour
h.s. = at bedtime
non rep. = don't repeat
noxt. = at night
p.c. = after food (after meals)
p.r.n. = as needed (as desired)
q.h. = every hour
q = every
q 2h = every 2 hours
q.d. = every day
q.i.d = four times a day
q.o.d. = every other day
rep. = let it be repeated
stat. = immediately
t.i.d. = three times a day
Created 08/4/05
Dosage or Strength of a Medicine
cc. = cubic centimeter (injections and liquid medications are measured in cc.)
dr. = drams 27 gr = 1 dram 8 drams = 1 oz.
fl. oz. = fluid ounce
gm or g = gram
gr = grain
gtt = drops
Kg = Kilogram
M2 = square meter
mEq = milliequivalent (weight of substance in 1 milliliter)
mg = milligram 1000 mg = 1 gm
mcg = microgram
ml = milliliter 1000 ml = 1 Liter
mm = millimeter 1000 mm = 1 meter
L. = Liter 1.0567 quarters = 1 Liter
Miscellaneous
a or aa = of each
AP = apical pulse
aq. = water
ASAP = as soon as possible
C = centigrade
c = with
CO2 = carbon dioxide
comp = compound
dil = dilute
et = and
F = Fahrenheit
Fx = fracture
G = gauge
GI = gastrointestinal
I.O. = intake and output
lauage = to wash out cavities (wounds)
Na = sodium
NG tube = nasal gastric tube for feeding [sizes in French (i.e., French 18]
NS/NA C1 = normal saline (Sodium Chloride Solution)
O2 = oxygen
o.d. = right eye
o.s. = left eye
o.u. = both eyes
pads = sterile or non-sterile coverings
s = without
S.O.B. = short of breath
sp. gr. = specific gravity
ss = half
T& = one tablet
T = temperature
T.O. = telephone order
& & = two tablets
TT
Created 07/28/01
STATE ABBREVIATIONS
Alabama
AL
Montana
MT
Alaska
AK
Nebraska
NE
Arizona
AZ
Nevada
NV
Arkansas
AR
New Hampshire
NH
California
CA
New Jersey
NJ
Colorado
CO
New Mexico
NM
Connecticut
CT
New York
NY
Delaware
DE
North Carolina
NC
District of Columbia
DC
North Dakota
ND
Florida
FL
Ohio
OH
Georgia
GA
Oklahoma
OK
Hawaii
HI
Oregon
OR
Idaho
ID
Pennsylvania
PA
Illinois
IL
Puerto Rico
PR
Indiana
IN
Rhode Island
RI
Iowa
IA
South Carolina
SC
Kansas
KS
South Dakota
SD
Kentucky
KY
Tennessee
TN
Louisiana
LA
Texas
TX
Maine
ME
Utah
UT
Maryland
MD
Vermont
VT
Massachusetts
MA
Virginia
VA
Michigan
MI
Washington
WA
Minnesota
MN
West Virginia
WV
Mississippi
MS
Wisconsin
WI
Missouri
MO
Wyoming
WY
Created 07/28/01
MEDICARE CURRENT BENEFICIARY SURVEY
NATIONAL STUDY - COMMUNITY COMPONENT
STATEMENT TERMS GLOSSARY
Approved amount -- The amount allowed by Medicare for a particular covered service, which is often less than the
provider charges or bills. Medicare calculates approved amounts in a variety of ways; the system for calculations
for physician's services is in the process of being revised considerably over the next few years.
Assignment -- "Accepting assignment" means accepting the Medicare approved amount as full payment for a
service.
Beneficiary -- In MCBS, someone covered by Medicare.
Benefit period -- A period of time over which medical costs are aggregated to determine whether deductibles have
been met. The benefit period for many Medicare services is the calendar year.
Claim -- A bill submitted to Medicare or to another health insurance plan.
Coinsurance -- OR, copayments. The beneficiary's share of the approved amount for medical services, after any
deductibles have been met. In Medicare Part B, the coinsurance rate is 20 percent. This rate is sometimes referred
to as "80-20." In Part A, the coinsurance rate varies by type of service and how much of the service (e.g., how many
days in the hospital) is used. "Copayment" is also the term used to refer to the beneficiary's payment amount for a
service provided by a managed care or HMO plan.
Covered services -- Medical services for which Medicare will pay all or part of approved charges.
Deductible -- The amount of approved medical expense that must be incurred before Medicare begins to pay. There
are separate deductibles for Part A and Part B Medicare-covered services and these can change from year to year.
Doc-in-a-box -- This is also a term that may vary across regions. This is a form of walk-in or clinic care, usually
found in or near a mall or strip shopping area. It generally provides primary care, including some emergency care,
and attracts individuals who do not rely on a single physician or other source of care.
Dread disease plan -- A kind of insurance that covers the cost of medical care only for certain diseases, such as
cancer or stroke.
Extra billing -- The amount a provider bills a beneficiary beyond the Medicare approved amount for a service (see
Assignment).
Extra cash plan -- Also called a "hospital indemnity plan," a kind of insurance that pays a covered person a fixed
amount (say, $100) for each day spent in a hospital.
Group coverage -- Health insurance provided through an employer, union, or other group, that offers the same plan
to a number of people associated with the group at the same cost per person.
Health insurance plan -- A package of benefits for paying for medical care; the "plan" is defined by what services
are covered, the conditions for paying and amounts of payment for covered services, and the cost of premium
covered persons must pay. The details of a particular plan are usually described formally in a "policy."
Health Maintenance Organization (HMO) -- There are several names for Health Maintenance Organizations.
These include: Coordinated care plans, managed care plans and prepaid plans. In addition, competitive medical
plans (CMPs), and Health Care Prepayment Plans (HCPPs) are included as prepaid health care. These names may
vary by region of the country, some include a Preferred Provider Organization (PPO).
Long-term Care Facility -- A long term care facility is a facility with 3 or more beds; providing either personal care
or continuous supervision of residents; is a place or unit certified as a Skilled Nursing Facility (SNF) by Medicare or
Medicaid; or is a place or unit certified as a Nursing Facility (NF) by Medicaid.
Long-term Care Insurance -- A form of private health insurance that covers stays in a nursing home, and may
cover other health care such as skilled nursing care received at home.
Medicare payment -- The amount Medicare pays on a claim.
Noncovered services -- Medical services for which Medicare will not pay any amount. Dental care is a noncovered
service and most prescribed medicines are not covered by Medicare.
Out-of-pocket expenditures -- Out-of-pocket expenditures are a part of the charge(s) that a beneficiary or his/her
family have paid/will pay for medical care. This should not include any amount that the SP expects to receive
reimbursement for or any amounts that the beneficiary has already received reimbursements for or money from
Medicare or a private health insurance plan.
Part A -- The hospital insurance portion of Medicare that covers inpatient care, some nursing home care, and some
home health care.
Part B -- The medical insurance portion of Medicare that covers physician services, diagnostic laboratory tests,
some medical equipment and supplies, and so on.
Premium -- The amount the beneficiary (or someone else) pays for Medicare coverage. Most other insurance plans
have premiums as well, which may be paid in full or in part by the main insured person.
Private health insurance -- Health insurance provided by a commercial insurance company such as Blue
Cross/Blue Shield.
Provider -- The person or other entity providing a medical service or equipment, e.g., the doctor, therapist, or
hospital.
Public health insurance -- A Federal, state, or local government program that pays for all or part of a person's
health care. Medicaid is an example of a public health insurance plan.
Reference Date -- A date "bounding" the time a question covers. For the MCBS, the Reference Date is usually the
date of the previous interview.
Reference Periods -- A period of time covered by a question. The MCBS Current Round Reference Period is
generally from the date of the previous interview up to the date of the current interview. The MCBS Survey
Reference Period generally includes the period of time from the interview 3 rounds back from the current interview
to the date of the current interview (e.g., the Round 10 survey reference period begins on the Round 7 interview date
and ends on the Round 10 interview date).
Source of payment -- An inclusive term that includes all parties, including insurance and public plans (Medicare)
and private payments (family or self out-of-pocket expenses) that pay for medical care. This term includes all
sources of payment regardless of the time frame of the payments (e.g., many Medigap plans do not pay until after
Medicare has paid the bill). These private payments can take up to a year to be paid.
Created 6/17/08
Safe Break-off Points in the MCBS Continuing Interview
While it is possible to break off an interview at most places in the instrument, it is strongly recommended
that you break off at the beginning of a section or one of the other screens listed below.
Component
Abbrev.
SECTION
Address Verification
Household
Supplemental Section
AV
ENS
HA
ADDRESS VERIFICATION
ENUMERATION
HOUSING CHARACTERISTICS
Health Ins
Health Ins
HIS
HI
HEALTH INSURANCE SUMMARY
HEALTH INSURANCE
Insurance Plans
DM
DISCOUNT/SAVINGS MEMBERSHIP
Utilization
Utilization
Utilization
Utilization
Utilization
Utilization
Utilization
Utilization
Supplemental Section
DU
ER
IP
OP
IU
HHS
HH
MP
AC
DENTAL UTILIZATION
EMERGENCY ROOM UTILIZATION
INPATIENT UTILIZATION
OUTPATIENT UTILIZATION
INSTITUTIONAL UTILIZATION
HOME HEALTH SUMMARY
HOME HEALTH UTILIZATION
MEDICAL PROVIDER UTILIZATION
ACCESS TO CARE SUPPLEMENT
Utilization
Utilization
Utilization
COST Series
OM
PMS
PM
ST
OTHER MEDICAL EXPENSES
PRESCRIBED MEDICINES
PRESCRIBED MEDICINES
STATEMENT CHARGE SERIES
COST Series
COST Series
COST Series
Supplemental Section
PS
NS
CPS
HF
POST-STATEMENT CHARGE
NO STATEMENT CHARGE SERIES
CHARGE PAYMENT SUMMARY
HEALTH STATUS AND FUNCTIONING
SUPPLEMENT
Supplemental Section
SC
Supplemental Section
Supplemental Section
Supplemental Section
Supplemental Section
US
DI
IA
RX
Closing
Closing
CL
EX
Safe
Break-off Points
AV1
ENSINTRO
HAINTRO
HAINTRO2A
HISINTRO
HIMCINTR
HIMC1A, HIMC1
DM1INT
DM2INTRO
DUINTRO
ER1
IPS1, IP1A, IP1
OP1
IU1
HHS1, HHS2A
HH1
MP1
ACINTRO
AC6A, AC9
AC20, AC33
OM1
PMSINTRA
PMINTROA
ST1, ST2, ST4
ST81, ST82
NONE
NONE
NONE
HFA1
HFKINTRO
HFLINTRO
HFN1
SC1
SATISFACTION WITH CARE
SUPPLEMENT
USUAL SOURCE OF CARE SUPPLEMENT
US1
DEMOGRAPHICS AND INCOME
DIINTROA
INCOME AND ASSETS SUPPLEMENT
IAINT8, IAINTRO
DRUG COVERAGE SUPPLEMENT
RX1, RXINTRO
RX19
CLOSING
NONE
CLOSING FOR EXIT INTERVIEW
NONE
Created 04/30/09
MEDICARE CURRENT BENEFICIARY SURVEY
NATIONAL STUDY - COMMUNITY COMPONENT
SUPPLEMENT GLOSSARY
FOR INCOME AND ASSETS
Dividend income -- Includes dividends received, credited, or reinvested from ownership of stock or
mutual funds.
Farm self employment income -- Net money income (gross receipts minus business expenses) received
from the operation of an unincorporated farm by a person on his or her own account, as an owner, renter,
or sharecropper.
Income from estates and trusts -- Includes any regular payments from an estate or trust fund.
Interest income -- Includes interest received or credited to checking and savings accounts, money
market funds, certificates of deposit (CD's), IRAs, KEOGHS and government bonds.
Non-farm self employment income -- Net money income (gross receipts minus business expenses)
received from an unincorporated business, professional practice, or partnership in which the person was
engaged.
Outstanding Debt -- Amount of money or balance that a person or couple owes. This is usually
calculated by using the purchasing price and the balance that remains. Outstanding debt includes the
balance owed on the items specifically mentioned in the question text.
Public assistance income other than SSI -- Includes income from Aid to Families with Dependent
Children (AFDC), food stamps or from other government programs such as general or emergency
assistance.
Rental income -- Includes income from the rental of land, buildings, or real estate, or income from
roomers and boarders.
Royalties income -- Includes profit or loss from any royalties.
Social Security/Railroad Retirement Income -- Includes any Social Security and Railroad Retirement
payments to retired persons, to dependents of deceased insured workers, and to disabled workers.
Supplemental Security Income (SSI) -- A program of income support for low-income aged, blind, or
disabled persons established by Title XVI of the Social Security Act.
Wages or salary -- Total money earnings received for work performed as an employee at any time
during the year previous to the interview. It includes wages, salary, commissions, pay from Armed
Forces, tips, piece rate payments, and cash bonuses eared.
Whole life or universal life insurance -- Life insurance policies which accrue cash equity.
| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 2010-11-09 |