CMS-P0015A English Showcards HI-Eng

7/30/2011

HIMC (FRONT)

MEDICARE OPTIONS

• “Original” Medicare, or
• “Medicare Advantage” (MA) plan

OTHER PUBLIC PLAN
OPTIONS

• Medicaid
• Public plan other than Medicaid
• TRICARE/TRICARE for Life

MEDICARE
PRESCRIPTION DRUG
PLAN OPTIONS

• “Stand-alone” plan (PDP) with Original
Medicare, or
• Medicare Advantage Prescription Drug
Plan (MA-PD)

PRIVATE
SUPPLEMENTAL
INSURANCE OPTIONS

• Purchase directly from an insurance
company
• Purchase through an employer, union, or
other group, such as AARP

HIMC (BACK)

Original Medicare

Medicare Advantage (HMOs, PPOs, PFFS)

• You have your choice of doctors and hospitals.
• Generally, you or your supplemental coverage
pay deductibles and coinsurance.
• If you want drug coverage, you must join a
stand-alone Medicare prescription drug plan –
a separate policy just for drugs.
• You can buy a Medigap plan, which can help
pay expenses not covered by Medicare.

• May either require you to see medical
providers in their network or let you choose
and pay more of the costs.
• You usually pay a copay or coinsurance for
covered services.
• Many plans include drug coverage. Th
is will
give you all of your coverage in one plan.
• A Medigap plan is generally not needed or
available.
TRICARE/TRICARE For Life
• Health care plan for active-duty service
members, retirees, and their families.
• TRICARE generally pays the fees left outstanding
after Medicare has made their payment.
• Not required to join a Medicare prescription
drug plan. If you join a Medicare Advantage Plan
with prescription drug coverage, TRICARE won’t
pay for medicines.

Medicaid
• Public health care plan that helps make
Medicare affordable for beneficiaries with low
incomes and modest assets.
• Medicare beneficiaries who are also enrolled
in Medicaid are referred to as “dual eligibles.”
• May be automatically enrolled in a Medicare
prescription drug plan and be eligible for a
low-income subsidy or “extra help.”
Public plans other than Medicaid

• Include state, county, or city-based programs such as a pharmacy program, where the local
government provides discounts for the cost of prescribed medicines.
• insurance comes from a public source other than Medicare or Medicaid.

Created 7/30/11

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. HealthSpring (HealthSpring of Alabama)
D. Humana Gold Choice/HumanaChoicePPO
(Humana Insurance Company)
E. VIVA Medicare Plus (VIVA Health)
F. Windsor Medicare Extra (Windsor Health
Plan, Inc.)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Alaska (AK)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. AARP MedicareComplete (United Healthcare)
B. Advantra Freedom (Coventry Health Care)
C. AR BlueCross - Medi-Pak Advantage (Arkansas Blue Cross)
D. Care Improvement PPO (XL Health Corporation)
E. Humana Gold Choice/HumanaChoicePPO (Humana
Insurance Company)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Alaska (AK)

(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
F. Medi-Pak Advantage St. Vinvent (ARKANSAS BLUE CROSS
AND BLUE SHIELD)
G. Mercy Medicare ADVANTAGE (Mercy Health System)
H. SecureHorizons MedicareDirect (United Healthcare)
I. Sterling Basic/Connect/Options/Partners (Sterling Life
Insurance Company)
J. Today’s Options (Universal American)
K. Windsor Medicare Extra (Windsor Health Group, Inc.)

Created 7/30/11

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. ANY, ANY, ANY Plan/e-ANY, ANY, ANY Plan
(Universal Health Care)
D. CareMore (CareMore Health Plan)
E. CIGNA Medicare Access (CIGNA Health Care)
F. Humana Gold/HumanaChoicePPO (Humana Insurance
Company)
G. MediSun/Sun Health (Banner Health)
H. SCAN Health Plan Arizona (SCAN - Senior Care Action
Network)
I. SecureHorizons Medicare Direct (United Healthcare)
J. Today’s Options (Universal American)
K. Universal (Universal Health Care)

Created 7/30/11

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. Advantra Freedom (Coventry Health Care)
C. AR BlueCross - Medi-Pak Advantage (Arkansas Blue
Cross)
D. Care Improvement PPO (XL Health Corporation)
E. Humana Gold Choice/HumanaChoicePPO (Humana
Insurance Company)
F. Medi-Pak Advantage St. Vinvent (ARKANSAS BLUE
CROSS AND BLUE SHIELD)
G. Mercy Medicare ADVANTAGE (Mercy Health System)
H. SecureHorizons MedicareDirect (United Healthcare)
I. Sterling Basic/Connect/Options/Partners (Sterling Life
Insurance Company)
J. Today’s Options (Universal American)
K. Windsor Medicare Extra (Windsor Health Group, Inc.)

Created 7/30/11

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. Arta Gold (Arta Medicare Health Plan)
C. Blue Cross Senior Secure (Anthem Blue Cross)
D. Blue Shield 65 Plus (Blue Shield of California)
E. Care1st Medicare Advantage Plan/Dual Plus (Care 1st)
F. CareMore (CareMore Health Plan)
G. CCHP Senior Program (Chinese Community Health

Plan)

H. Central Health Medicare Plan (Central Health)
I. Citizens Choice Healthplan (Citizens Choice

Healthplan)

J. Easy Choice (Easy Choice Health Plans)
K. Freedom Blue (Anthem Blue Cross)
L. GEMCare Medicare Plus (Golden Empire)

Created 7/30/11

HIMC1

Medicare Advantage Plans - California (CA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
M. Golden State Medicare Health Plan (Golden State

Medicare Health Plan - HMO)

N. Humana Gold Plus (Humana)
O. Inter Valley Health Plan (Inter Valley Health Plan)
P. MD Care Advantage (MD Care Inc.)
Q. Molina Medicare Options (Molina Healthcare of

California)

R. My Choice (SCAN Health Plan)
S. SCAN Health Plan (SCAN - Senior Care Action

Network)

T. SecureHorizons MedicareDirect (United Healthcare)
U. Senior Advantage (Kaiser Permanente)
V. StartSmart (CareMore Health Plan)
W. Today’s Options (Universal American)

Created 7/30/11

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. Colorado Access Advantage (Colorado Access)
C. Denver Health Medicare (Denver Health Medical
Plan)
D. Erickson Advantage Champion/
Guardian/Signature (Erickson Advantage)
E. HumanaGold/HumanaChoiocePPO (Humana
Insurance Company)
F. Senior Advantage (Kaiser Permanente)
G. SmartValue/SureValue (Anthem Blue Cross and
Blue Shield)
H. Sterling Basic/Connect/Options/Partners (Sterling
Life Insurance Company)
I. Today’s Options (Universal American)

Created 7/30/11

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. ConnectiCare
(Health Plan of Greater New York)
C. MediBlue HMO
(Anthem Blue Cross and Blue Shield)
D. UnitedHealthcare MedicareComplete
Essential/MedicareComplete Plan (United
Healthcare)
E. WellCare (WellCare Health Plans, Inc.)

Created 7/30/11

HIMC1

Medicare Advantage Plans - District of Columbia (DC)

(Medicare Managed Care, such as Medicare HMO,

Medicare PPO, or Medicare PFFS Plan)

A. ANY, ANY, ANY Plan/e-ANY, ANY, ANY Plan
(Universal Health Care)
B. Bravo (Bravo Health)
C. Universal (Universal Health Care)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Delaware (DE)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)

A. Bravo (Bravo Health)

Created 7/30/11

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. Amerivantage (AMERIGROUP Community Care)
C. ANY, ANY, ANY Plan/e-ANY, ANY, ANY Plan
(Universal Health Care)
D. AvMed Medicare Preferred (SantaFe HealthCare)
E. BlueMedicare (Health Options, Inc./Blue Cross and
Blue Shield of Florida)
F. Capital Health Plan (Capital Health Plan)
G. Care Centers/CareComplete/Direct/Free/Needs/One
(CarePlus Health Plans)
H. Citrus Care/Saver (Citrus Health Care, Inc.)
I. Coventry Summit/Coventry Vista (Coventry)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Florida

(FL)

(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
J. e-Medicare Masterpiece Direct/Premier Direct
(Universal Health Care, Inc.)
K. FHCP Medvantage (Florida Health Care Plan, Inc.)
L. Freedom (Freedom Health, Inc.)
M. Health First (Health First Medicare Plans)
N. HealthSpring HealthyAdvantage/HealthyLiving
(HealthSpring of Florida)
O. HumanaChoice/Humana Gold (Humana Medical Plan,
Inc.)
P. JacksonHealth for Life/Secure/Success (JMH Health
Plan)
Q. Leon Cares (Leon Medical Centers Health Plans)
R. Medica HealthCare Plans MedicareMax (Medica
HealthCare Plans)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Florida

(FL)

(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
S. Medicare Masterpiece (Universal Health Care, Inc.)
T. MediMax (HealthSun Health Plans, Inc)
U. Molina Medicare Options (Molina Healthcare of Florida)
V. Optimum (Optimum Healthcare, Inc.)Preferred Care
Partners (Preferred Care Partners, Inc.)
W. PUP (Physicians United Plan)
X. Sterling Basic/Connect/Options/Partners (Sterling Life
Insurance Company)
Y. SunPlus Advantage Plan (HealthSun Health Plans, Inc.)
Z. Today’s Options (Universal American)

AA. Universal (Universal Health Care)

BB. WellCare (WellCare Health Plans, Inc.)

Created 7/30/11

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/Elite (Coventry
Health Plan)
C. ANY, ANY, ANY Plan/e-ANY, ANY, ANY Plan
(Universal Health Care)
D. Blue Value (Blue Cross Blue Shield Healthcare
Plan of Georgia)
E. Care Improvement Plus (Care Improvement Plus)
F. Humana Gold Choice/HumanaChoicePPO
(Humana Insurance Company)
G. Kaiser Permanente Senior Advantage (Kaiser
Foundation Health Plan, Inc.)
H. Secure Horizons Medicare Direct (United
Healthcare)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Georgia (GA)

(Medicare Managed Care, such as Medicare HMO,

Medicare PPO, or Medicare PFFS Plan)

(continued)

I. Silver Advantage (Coventry Health Care, INC)
J. SmartValue (Blue Cross Blue Shield of Georgia)
K. Sterling Basic/Connect/Options/Partners (Sterling

Life Insurance Company)

L. Today’s Options (Universal American)
M. UnitedHealthcare Personal Care Plus

(UnitedHealthcare)

N. Universal (Universal Health Care)
O. WellCare (Wellcare Health Plans, Inc.)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Hawaii (HI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)

A. AARP MedicareComplete (United
Healthcare)
B. Akamai Advantage (Akamai Advantage by
HMSA)
C. AlohaCare Advantage/Advantage Plus
(AlohaCare)
D. Humana Gold Choice/HumanaChoicePPO
(Humana Insurance Company)
E. Ohana Liberty/Reserve/Value (WellCare)

F. SecureHorizons MedicareDirect (United
Healthcare)
G. Senior Advantage (Kaiser Permanente)

Created 7/30/11

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 (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. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
G. Today’s Options (Universal American)

Created 7/30/11

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 Freedom (Coventry Health Care)
C. Erickson Advantage
Champion/Guardian/Signature (Erickson
Advantage)
D. Essence Advantage (Essence Healthcare)
E. GoldAdvantage (Group Health Plan)
F. Health Alliance Medicare (Health Alliance
Medical Plans)
G. HealthSpring Healthy Advantage/Healthy
Living (Healthspring, Inc.)
H. Humana Gold/HumanaChoicePPO (Humana
Insurance Company)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Illinois (IL)

(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)

I. PersonalCare Advantra Gold/Silver
(PersonalCare Advantra)
J. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
K. Today’s Options (Universal American)
L. WellCare (WellCare Health Plans, Inc.)

Created 7/30/11

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 Enhanced/Preferred
(ADVANTAGE Health Solutions, Inc.)
C. Blue Medicare Access/Anthem Senior
Advantage/Medicare Preferred/SmartValue
(Anthem Blue Cross and Blue Shield)
D. Clarian Medicare (Clarian Health Plans, Inc.)

E. Humana Gold Choice/HumanaChoicePPO
(Humana Insurance Company)
F. Platinum Select Rx (Welborn Health Plans)
G. Secure Horizons Medicare Direct (United
Healthcare)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Indiana (IN)

(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)

H. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
I. Today’s Options (Universal American)
J. WellCare (WellCare Health Plans, Inc.)
K. Wishard Complete Care (ADVANTAGE Health
Solutions, Inc.)

Created 7/30/11

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. Humana Gold Choice/HumanaChoicePPO
(Humana Insurance Company)
D. MedicareBlue PPO (Wellmark Blue Cross
and Blue Shield)
E. SecureHorizons MedicareDirect (United
Healthcare)
F. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
G. Today’s Options (Universal American)

Created 7/30/11

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. Erickson Advantage
Champion/Guardian/Signature (Erickson
Advantage)
D. Humana Gold/HumanaChoicePPO
MyCare (Humana Insurance Company)
E. SecureHorizons MedicareDirect (United
Healthcare)
F. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
G. Today’s Options (Universal American)

Created 7/30/11

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. HumanaChoice/Humana Gold (Humana
Insurance Company)
D. SecureHorizons MedicareDirect (United
Healthcare)
E. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
F. Today’s Options (Universal American)

Created 7/30/11

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/e-ANY, ANY, ANY Plan
(Universal Health Care)
C. Choices/HealthCare Select (Peoples Health)
D. Humana Gold/HumanChoicePPO/MyCare

(Humana Health Benefit Plan of LA, Inc.)

E. SecureHorizons MedicareDirect MEDICARE
COMPLETE (United Healthcare)
F. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
G. Today’s Options (Universal American)
H. Universal (Universal Health Care)
I. WellCare (WellCare Health Plans, Inc.)

Created 7/30/11

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. Martin’s Point Generations Advantage (Martin’s Point
Health Care)
C. SecureHorizons Medicare Direct (United Healthcare)

D. Today’s Options (Universal American)

Created 7/30/11

HIMC1

Medicare Advantage Plans ­
Maryland (MD)

(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)

A. ANY, ANY, ANY Plan/e-ANY, ANY, ANY
Plan (Universal Health Care)
B. Bravo (Bravo Health)
C. Erickson Advantage
Champion/Guardian/Signature (Erickson
Advantage)
D. Today’s Options (Universal American)
E. Universal (Universal Health Care)

Created 7/30/11

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. Erickson Advantage
Champion/Guardian/Signature
(Erickson Advantage)
D. Fallon Senior Plan (Fallon Community
Health Plan)
E. HNE Medicare (Health New England, Inc.)

F. Today’s Options (Universal American)
G. Tufts Medicare Preferred

(Tufts Health Plan)

Created 7/30/11

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)
B. BCN Advantage (Blue Care Network)
C. Erickson Advantage Champion/Guardian/Signature
(Erickson Advantage)
D. HealthPlus Senior (HealthPlus of Michigan)
E. Humana Gold Choice/HumanaChoicePPO (Humana
Insurance Company)
F. Medicare Plus Blue (Blue Cross Blue Shield of
Michigan)
G. Molina Medicare Options (Molina Healthcare)
H. Paramount Elite (ProMedica Health System)
I. PriorityMedicare (PriorityHealth)
J. SecureHorizons MedicareDirect (United Healthcare)
K. Today’s Options (Universal American)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Minnesota (MN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)

A. Humana Gold Choice (Humana Insurance Company)

B. MedicareBlue PPO/VantageBlue (Blue Cross and
Blue Shield of Minnesota)
C. Sterling Basic/Connect/Options/Partners (Sterling
Life Insurance Company)
D. UCare (UCare Minnesota)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Mississippi (MS)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. ANY, ANY, ANY Plan/e-ANY, ANY, ANY Plan (Universal
Health Care)
B. HealthSpring (HealthSpring, Inc.)
C. Humana Gold/HumanaChoicePPO (Humana Insurance
Company)
D. SecureHorizons MedicareDirect (United Healthcare)
E. Sterling Basic/Connect/Options/Partners (Sterling Life
Insurance Company)
F. Today’s Options (Universal American)
G. Windsor Medicare Extra (Windsor Health Group Inc.)

Created 7/30/11

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. Essence Advantage (Essence Healthcare)
F. Gold Advantage/Advantra (Group Health Plan, Inc.)
G. Humana Gold/HumanaChoicePPO/MyCare (Humana
Insurance Company)
H. Mercy MedicareADVANTAGE (Mercy Health Plans)
I. SecureHorizons MedicareDirect (United Healthcare)
J. SmartValue (Blue Cross Blue Shield of Missouri)
K. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
L. Today’s Options (Universal American)
M. WellCare (WellCare Health Plans, Inc.)

Created 7/30/11

HIMC1

Medicare Advantage Plans ­
Montana (MT)

(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)

A. Humana Gold/HumanaChoicePPO (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. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
F. Today’s Options (Universal American)

Created 7/30/11

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/Advantra Freedom (Coventry Health Care)
C. Ambassador/Patriot/Presidential (AMERICA’S 1ST
CHOICE INSURANCE COMPANY OF NC, INC.)
D. ANY, ANY, ANY Plan/e-ANY, ANY, ANY Plan
(Universal Health Care)
E. Blue Medicare HMO/PPO (PARTNERS National Health
Plans, a BCBSNC Company)
F. Humana Gold Choice/HumanaChoicePPO (Humana
Insurance Company)
G. SecureHorizons MedicareDirect (United Healthcare)
H. SecurityChoice (Unicare Life & Health Ins. Company)
I. Sterling Basic/Connect/Options/Partners (Sterling Life
Insurance Company)
J. Today’s Options (Universal American)
K. Universal (Universal Health Care)

Created 7/30/11

HIMC1

Medicare Advantage Plans - North Dakota (ND)

(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)

A. Humana Gold Choice (Humana Insurance Company)
B. Medica Advantage/Prime (Medica Health Plans)
C. MedicareBlue (Blue Cross Blue Shield of North Dakota)
D. SecureHorizons Medicare Direct (United Healthcare)
E. Sterling Basic/Connect/Options/Partners (Sterling Life
Insurance Company)
F. Today’s Options (Universal American)

Created 7/30/11

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. Humana Gold Choice (Humana Insurance
Company)
D. MedicareBlue PPO (Blue Cross and Blue
Shield of Nebraska)
E. SecureHorizons MedicareDirect (United
Healthcare)
F. SecurityChoice (Unicare Life and Health
Ins. Company)
G. Today’s Options (Universal American)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Nevada (NV)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
A. Anthem Medicare Preferred Premier (Anthem Blue
Cross and Blue Shield)
B. ANY, ANY, ANY Plan/e-ANY, ANY, ANY Plan
(Universal Health Care)
C. CareMore (CareMore Health Plan)
D. Humana Gold Choice (Humana Insurance Company)
E. Medicare Masterpiece (Universal Health Care, Inc.)
F. SecureHorizons MedicareDirect (United Healthcare)
G. Senior Care Plus (Hometown Health Plan, Inc.)
H. Senior Dimensions/Sierra VillageHealth (Health Plan of
Nevada, Inc.)
I. Sierra Nevada Spectrum/Sierra Spectrum/Sierra
Optima (Sierra Health & Life Ins., Inc.)
J. StartSmart (CareMore Health Plan)
K. Today’s Options (Universal American)
L. Universal (Universal Health Care)

Created 7/30/11

HIMC1

Medicare Advantage Plans - New Hampshire (NH)

(Medicare Managed Care, such as Medicare HMO,

Medicare PPO, or Medicare PFFS Plan)

A. Humana Gold Choice (Humana Insurance Company)

B. SecureHorizons MedicareDirect (United Healthcare)

C. SmartValue (Anthem Blue Cross and Blue Shield)
D. Sterling Basic/Connect/Options/Partners (Sterling

Life Insurance Company)

E. Today’s Options (Universal American)

Created 7/30/11

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 (Aetna)
C. AmeriHealth 65 (AmeriHealth)
D. Amerivantage (AMERIGROUP Community
Care)
E. Bravo (Bravo Health)
F. Erickson Advantage
Champion/Guardian/Signature (Erickson
Advantage)
G. HealthFirst NJ (HealthFirst NJ)
H. Horizon Medicare Blue (Horizon Blue Cross
Blue Shield of New Jersey, Inc.)
I. Wellcare (WellCare Health Plans, Inc.)

Created 7/30/11

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. Humana Gold Choice/HumanaChoicePPO
(Humana Insurance Company)
D. Lovelace Senior Plan (Lovelace Health Plan)
E. Molina Medicare Options (Molina Healthcare of
New Mexico, Inc.)
F. Presbyterian MediCare PPO/Presbyterian
Senior Care Plan (Presbyterian Medi-Care
Health Plan)
G. San Juan Medicare Plus-Enhanced/Standard
(Lovelace Senior Plan)

Created 7/30/11

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. Access Medicare Platinum (Access Medicare)

C. Aetna (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 (BlueCross BlueShiels of WNY &
BlueShield of NENY)
G. CCM Direct (Comprehensive Care
Management)
H. CDPHP (Capital District Physician’s Health
Plan)
I. Elderplan (Elderplan, Inc.)

Created 7/30/11

HIMC1

Medicare Advantage Plans – New York (NY)

(Medicare Managed Care, such as Medicare HMO,

Medicare PPO, or Medicare PFFS Plan)

(continued)

J. EmblemHealth Dual Eligible/PPO/VIP

(EmblemHealth Medicare PPO/HMO)

K. Empire MediBlue

Essential/Freedom/Plus/Select/Value (Empire

BlueCross BlueShield)

L. Essence Advantage/Advantage Plus (Essence

Healthcare)

M. Fidelis Medicare Advantage (New York State

Catholic Hlth. Plan Inc.)

N. Health Plus Elite (Health Plus Elite)
O. HealthFirst (Healthfirst Medicare Plan)
P. HIP VIP (EmblemHealth)
Q. Humana Gold Choice (Humana Insurance

Company of New York)

R. Independent Health (Independent Health)

Created 7/30/11

HIMC1

Medicare Advantage Plans – New York (NY)

(Medicare Managed Care, such as Medicare HMO,

Medicare PPO, or Medicare PFFS Plan)

(continued)

S. Liberty Health Advantage (Liberty Health

System)

T. MetroPlus (MetroPlus Health Plan)
U. MVP Gold (MVP Health Plan, Inc.)
V. Preferred Care Gold (MVP Health Care)
W. SecureHorizons MedicareDirect (United

Healthcare)

X. Today's Options (Universal American)
Y. Touchstone Health Medicare (Touchstone

Health)

Z. Univera Medicare (Excellus Health Plan, Inc.)
AA.

VNS CHOICE Medicare (VNS CHOICE)

BB.

WellCare (WellCare Health Plans, Inc.)

Created 7/30/11

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. Advantra/Advantra Freedom (Coventry Health
Care)
C. Aetna (Aetna)
D. Anthem Senior Advantage/Medicare
Preferred/Blue Medicare Access (Anthem Blue
Cross and Blue Shield)
E. ANY, ANY, ANY Plan/e-ANY, ANY, ANY Plan
(Universal Health Care)
F. Basic-Select (PrimeTime Health Plan)
G. HumanaChoicePPO/Humana Gold (Humana
Insurance Company)
H. MediGold (Mount Carmel Health)
I. Molina Medicare Options (Molina Healthcare
of Ohio)

Created 7/30/11

HIMC1

Medicare Advantage Plans – Ohio (OH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)

J. Paramount Elite (Pro Media Health System)
K. PrimeTime Health Plan (PrimeTime Health
Plan)
L. SecureChoice/SecureFreedom (Union
Security Insurance Company)
M. SummaCare Secure (Summa Health System)

N. Today’s Options (Universal American)
O. Universal (Universal Health Care)
P. UPMC For Life (UPMC Health Plan)
Q. WellCare (WellCare Health Plans, Inc.)

Created 7/30/11

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. Generations Healthcare (Martins Point Health
Care)
C. Humana Gold Choice/HumanaChoicePPO
(Humana Insurance Company)
D. SecureHorizons Medicare Direct (United
Healthcare)
E. Senior Health Plan (CommunityCare Senior
Health Plan)
F. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
G. Today’s Options (Universal American)

Created 7/30/11

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 Health Plans)
C. CareOregon Advantage (CareOregon, Inc.)
D. CareSource (CareSource)
E. Clear One Explorer/Essentials/Practical
Premier (PacificSource)
F. Humana Gold Choice (Humana Insurance
Company)
G. Marion Polk Community Health Plan
Advantage/Physicians Choice (Marion Polk
Community Health Plan Advantage)
H. ODS Advantage PPO (ODS Health Plan, Inc.)

I. PremierCare (FamilyCare Health Plans, Inc.)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Oregon (OR)

(Medicare Managed Care, such as Medicare HMO,

Medicare PPO, or Medicare PFFS Plan)

(continued)

J. Providence Medicare (Providence Health
Plan)
K. Regence MedAdvantage (Regence BlueCross
BlueShield of Oregon)
L. Samaritan Advantage (Samaritan Advantage
Health Plan)
M. Senior Advantage (Kaiser Permanente)
N. Trillium Advantage (Trillium Community Health
Plan)

Created 7/30/11

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/Advantra Freedom (Coventry Health
Care)
C. Aetna (Aetna)
D. ANY, ANY, ANY Plan/e-ANY, ANY, ANY Plan
(Universal Health Care)
E. Bravo (Bravo Health)
F. Erickson Advantage
Champion/Guardian/Signature (Erickson
Advantage)
G. FreedomBlue (Highmark Inc.)
H. Geisinger Gold (Geisinger Gold)
I.

Humana Gold Choice/HumanaChoicePPO
(Humana Insurance Company)

Created 7/30/11

HIMC1

Medicare Advantage Plans –

Pennsylvania (PA)

(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
J. Keystone 65/Personal Choice 65 (Independence
Blue Cross)
K. SecureHorizons MedicareComplete/
MedicareDirect (United Healthcare)
L. SecurityBlue (Keystone Health Plan West, Inc.)
M. SeniorBlue (Keystone Health Plan Central,
Inc./Capital Advantage Insurance Company)
N. Today's Options (Universal American)
O. UnitedHealthcare Dual Complete/Medicare
Complete Essential/MedicareComplete
(UnitedHealthcare Community Plan)
P. Universal (Universal Health Care)
Q. UPMC for Life (UPMC Health Plan)

Created 7/30/11

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. Dorado/Elite Dorado (Preferred Medicare Choice,
Inc.)
C. First Care+Plus/First+Plus (First Medical Health
Plan, Inc.)
D. Humana Gold/HumanaChoicePPO (Humana
Health Plans/Humana Insurance of Puerto Rico,
Inc.)
E. MAPFRE Medicare Excel (MAPFRE LIFE
INSURANCE COMPANY)
F. MCS Classicare (MCS Life Insurance Company)
G. Medicare y Mucho Más (Medicare y Mucho Más)
H. PMC Max/Premier Preferred (Preferred Medicare
Choice, Inc.)
I. Triple-S Medicare (Triple-S, Inc.)

Created 7/30/11

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)

Created 7/30/11

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/e-ANY, ANY, ANY Plan
(Universal Health Care)
D. Care Improvement Plus (Care Improvement Plus)
E. Guardian Tribute (Guardian Healthcare, Inc.)
F. Humana Gold Choice/HumanaChoicePPO
(Humana Insurance Company)
G. Medicare Blue (Blue Cross Blue Shield of South
Carolina)
H. Today’s Options (Universal American)
I. Universal (Universal Health Care)
J. Windsor Medicare Extra (Windsor Health Group)

Created 7/30/11

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. Humana Gold Choice (Humana Insurance
Company)
C. Medica Prime (Medica Insurance
Company)
D. MedicareBlue PPO (Wellmark Blue Cross
Blue Shield of South Dakota)
E. SecureHorizons MedicareDirect (United
Healthcare)
F. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
G. Today’s Options (Universal American)

Created 7/30/11

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. Amerivantage (AMERIGROUP Community
Care)
C. BlueAdvantage (BlueCross BlueShield of
Tennessee)
D. Healthspring (Healthspring of Tennesee)
E. HumanaChoicePPO/Humana Gold Choice
(Humana Insurance Company)
F. SecureHorizons MedicareDirect
G. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
H. Today’s Options (Universal American)
I. Windsor Medicare Extra (Windsor Health
Group, Inc.)

Created 7/30/11

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. Amerivantage (AMERIGROUP Community Care)
D. ANY, ANY, ANY Plan/e-ANY, ANY, ANY Plan
(Universal Health Care)
E. Bravo (Bravo Health)
F. Care Improvement (Care Improvement)
G. Care N’Care (Care N’Care Health Plan)
H. e-Medicare Masterpiece Direct (Universal HMO of
Texas, Inc.)
I. Erickson Advantage Champion/Guardian/Signature
(Erickson Advantage)
J. FirstCare Advantage (FirstCare Health Plans)
K. HumanaChoicePPO/Humana Gold (Humana Insurance
Company)
L. KelseyCare Advantage (KelseyCare-Seybold)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Texas (TX)

(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)
M. Medicare Masterpiece (Universal Health Care, Inc.)
N. Molina Medicare Options/Options Plus (Molina
Healthcare of Texas, Inc.)
O. Physicians Health Choice (PHYSICIANS HEALTH
CHOICE)
P. SecureHorizons MedicareDirect (United Healthcare)
Q. Sterling Basic/Connect/Options/Partners (Sterling Life
Insurance Company)
R. Texan Plus (Texas First Health Plans SelectCare of
Texas, LLC)
S. Texas Healthspring/TXHS HealthyAdvantage/Valley
Advantage (Texas Healthspring)
T. Today’s Options (Universal American)
U. Universal (Universal Health Care)
V. WellCare (WellCare Health Plans, Inc.)

Created 7/30/11

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/e-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. Sierra Spectrum/Sierra Optima (Sierra Health
& Life Ins., Inc.)
H. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
I. Universal (Universal Health Care)

Created 7/30/11

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. Humana Gold Choice (Humana Insurance Company)

C. SecureHorizons MedicareDirect (United Healthcare)

D. Today’s Options (Universal American)

Created 7/30/11

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. Anthem Medicare Preferred/SmartValue (Anthem Blue Cross
and Blue Shield)
C. ANY, ANY, ANY Plan/e-ANY, ANY, ANY Plan (Universal
Health Care)
D. Carilion Clinic Medicare Health Plan (Carilion Clinic Medicare
Health Plan)
E. Erickson Advantage Champion/Guardian/Signature (Erickson
Advantage)
F. Humana Gold/HumanaChoicePPO
(Humana Insurance Company)
G. Optima Medicare (Optima Health)
H. Piedmont Select Medicare Option One/Two
(Piedmont Medicare Advantage)
I.

SecureHorizons MedicareDirect (United Healthcare)

J. SecurityChoice (Unicare Life and Health Ins. Company)
K. Sterling Basic/Connect/Options/Partners (Sterling Life
Insurance Company)
L. Today’s Options (Universal American)
M. Universal (Universal Health Care)

Created 7/30/11

HIMC1

Medicare Advantage Plans ­
Washington (WA)

(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)

A. Asuris TruAdvantage (Asuris Northwest
Health)
B. ChoicePartners Medicare (Molina

Healthcare of Washington, Inc.)

C. Community HealthFirst (Community
HealthFirst Medicare Advantage Plan)
D. Essence Advantage (Essence HealthCare)

E. Group Health Clear Care (Group Health
Cooperative)
F. Humana Gold Choice (Humana Insurance
Company)
G. Kaiser Permanente Senior Advantage
(Kaiser Foundation Health Plan, Inc.)

Created 7/30/11

HIMC1

Medicare Advantage Plans ­
Washington (WA)

(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
(continued)

H. Molina Medicare Options (Molina

Healthcare of Washington, Inc.)

I. Partners (Puget Sound Health Partners)

J. Providence Medicare (Providence Health
Plan)
K. Regence MedAdvantage (Regence
BlueCross BlueShield/Regence
BlueShield)
L. Sterling Basic/Connect/Options/Partners
(Sterling Life Insurance Company)
M. Today’s Options (Universal American)

Created 7/30/11

HIMC1

Medicare Advantage Plans ­
West Virginia (WV)

(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)

A. FreedomBlue (Highmark Health Insurance
Company)
B. Health Plan
SecureCare/SecureChoice/Freedom (The
Health Plan)
C. Humana Gold Choice/HumanaChoicePPO
(Humana Insurance Company)
D. SecurityChoice (Unicare Life & Health Ins.
Company)
E. UPMC For Life (UPMC Health Plan)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Wisconsin (WI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)

A. Advocare (Security Health Plan of Wisconsin, Inc.)

B. Anthem Medicare/Senior
(Anthem Blue Cross and Blue Shield)
C. Gundersen Lutheran Senior
(Gundersen Lutheran Health Plan, Inc.)
D. HumanaChoicePPO/Humana Gold Choice
(Humana Insurance Company)
E. Network/Network Platinum
(NHIC-Network Health Insurance Corp.)

Created 7/30/11

HIMC1

Medicare Advantage Plans - Wisconsin (WI)

(Medicare Managed Care, such as Medicare HMO,

Medicare PPO, or Medicare PFFS Plan)

(continued)

F. SecureHorizons MedicareDirect (United Healthcare)

G. SmartValue/SecurityChoice/Medicare Preferred
(Blue Cross Blue Shield of Wisconsin)
H. Today’s Health (Today’s Health)
I. UCare for Seniors (UCare)

Created 7/30/11

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)

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 1/3/11

HI3

Sample Medicaid Card - Alabama (AL)

Created 1/3/11

HI3

Sample Medicaid Card - Alaska (AK)

Created 1/3/11

HI3

Sample Medicaid Card - Arizona (AZ)

Created 1/3/11

HI3

Sample Medicaid Card - Arkansas (AR)

Created 1/3/11

HI3

Sample Medicaid Card - California (CA)

Created 1/3/11

HI3

Sample Medicaid Card - Colorado (CO)
Card issued before June 1, 2010:

Created 1/3/11

HI3

Sample Medicaid Card - Colorado (CO)

(continued)

Card issued after June 1, 2010:

Created 1/3/11

HI3

Sample Medicaid Card - Connecticut (CT)

Created 1/3/11

HI3

Sample Medicaid Card - District of Columbia (DC)

Created 1/3/11

HI3

Sample Medicaid Card - Delaware (DE)

Created 1/3/13

HI3

Sample Medicaid Card - Alabama (AL)

Created 1/3/13

HI3

Sample Medicaid Card - Alaska (AK)

Created 1/3/13

HI3

Sample Medicaid Card - Arizona (AZ)

Created 1/3/13

HI3

Sample Medicaid Card - Arkansas (AR)

Created 1/3/13

HI3

Sample Medicaid Card - California (CA)

Created 1/3/13

HI3

Sample Medicaid Card - Colorado (CO)

Created 1/3/13

HI3

Sample Medicaid Card - Connecticut (CT)

Created 1/3/13

HI3

Sample Medicaid Card - District of Columbia (DC)

Created 1/3/13

HI3

Sample Medicaid Card - Delaware (DE)

Created 1/3/13

HI3

Sample Medicaid Card - Florida (FL)

Created 1/3/13

HI3

Sample Medicaid Card - Georgia (GA)

Created 1/3/13

HI3

Sample Medicaid Card - Hawaii (HI)

Created 1/3/13

HI3

Sample Medicaid Card - Idaho (ID)

Created 1/3/13

HI3

Sample Medicaid Card - Illinois (IL)

Created 1/3/13

HI3

Sample Medicaid Card - Indiana (IN)

Created 1/3/13

HI3

Sample Medicaid Card - Iowa (IA)

Created 1/3/13

HI3

Sample Medicaid Card - Kansas (KS)

Created 1/3/13

HI3

Sample Medicaid Card - Kentucky (KY)

Created 1/3/13

HI3

Sample Medicaid Card - Louisiana (LA)

Created 1/3/13

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
207-287-3081. 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 1/3/13

HI3

Sample Medicaid Card - Maryland (MD)

Created 1/3/13

HI3

Sample Medicaid Card - Massachusetts (MA)

Created 1/3/13

HI3

Sample Medicaid Card - Michigan (MI)

Created 1/3/13

HI3

Sample Medicaid Card - Minnesota (MN)

Created 1/3/13

HI3

Sample Medicaid Card - Mississippi (MS)

Created 1/3/13

HI3

Sample Medicaid Card - Missouri (MO)

Created 1/3/13

HI3

Sample Medicaid Card - Montana (MT)

Created 1/3/13

HI3

Sample Medicaid Card - North Carolina (NC)

Created 1/3/13

HI3

Sample Medicaid Card - North Dakota (ND)

Created 1/3/13

HI3

Sample Medicaid Card - Nebraska (NE)

Created 1/3/13

HI3

Sample Medicaid Card - Nevada (NV)

Created 1/3/13

HI3

Sample Medicaid Card - New Hampshire (NH)

Created 1/3/13

HI3

Sample Medicaid Card - New Jersey (NJ)

Created 1/3/13

HI3

Sample Medicaid Card - New Mexico (NM)

Created 1/3/13

HI3

Sample Medicaid Card - New York (NY)

Created 1/3/13

HI3

Sample Medicaid Card - Ohio (OH)

Created 1/3/13

HI3

Sample Medicaid Card - Oklahoma (OK)

Created 1/3/13

HI3

Sample Medicaid Card - Oregon (OR)

Created 1/3/13

HI3

Sample Medicaid Card - Pennsylvania (PA)

Created 1/3/13

HI3

Sample Medicaid Card – Puerto Rico (PR)

[Card image varies by Medicaid plan name.]

Created 1/3/13

HI3

Sample Medicaid Card - Rhode Island (RI)

Created 1/3/13

HI3

Sample Medicaid Card - South Carolina (SC)

Created 1/3/13

HI3

Sample Medicaid Card - South Dakota (SD)

Created 1/3/13

HI3

Sample Medicaid Card - Tennessee (TN)

[Card image varies by Medicaid plan name.]

Created 1/3/13

HI3

Sample Medicaid Card - Texas (TX)

Created 1/3/13

HI3

Sample Medicaid Card - Utah (UT)

Created 1/3/13

HI3

Sample Medicaid Card - Vermont (VT)

Created 1/3/13

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 1/3/13

HI3

Sample Medicaid Card - Washington (WA)

Created 1/3/13

HI3

Sample Medicaid Card - West Virginia (WV)

Created 1/3/13

HI3

Sample Medicaid Card - Wisconsin (WI)

Created 1/3/13

HI3

Sample Medicaid Card - Wyoming (WY)

Created 1/3/11

HI4

MEDICAID HMOs - ALABAMA (AL)
None Available

Created 1/3/11

HI4

MEDICAID HMOs - ALASKA (AK)
None Available

Created 1/3/11

HI4

MEDICAID HMOs - ARIZONA (AZ)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.

Arizona Physicians IPA (APIPA)
Bridgeway Acute Plan
Care First Arizona
Cochise Health Systems
Evercare Select
Health Choice Arizona
Maricopa Health Plan
Mercy Care Plan
Phoenix Health Plan
Pima Health Plan
University Family Care

Created 1/3/11

HI4

MEDICAID HMOs - ARKANSAS (AR)
None Available

Created 1/3/11

HI4

MEDICAID HMOs - CALIFORNIA (CA)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.

AHF Healthcare Centers
Alameda Alliance for Health
AltaMed
Anthem Blue Cross Partnership Plan
CalOptima
Care First Partner Plan
CenCal Health
Central California Alliance for Health
Coalition for Elders Independence (PACE)
Community Health Group Partnership Plan
Contra Costa Health Plan
Family Mosaic
Health Net Community Solutions
Health Plan of San Joaquin
Health Plan of San Mateo
Inland Empire Health Plan
Kaiser Permanente

Created 1/3/11

HI4

MEDICAID HMOs - CALIFORNIA (CA)

(continued)

R.
S.
T.
U.
V.
W.
X.
Y.
Z.
AA.

Kaiser PHP
Kern Family Health Care
L.A. Care Health Plan
Molina Healthcare of California Partner Plan
On Lok Senior Health Services (PACE)
Partnership Health Plan of California
San Francisco Health Plan
Santa Clara Family Health Plan
Senior Care Action Network (SCAN) Health Plan
Sutter Senior Care

Created 1/3/11

HI4

MEDICAID HMOs - COLORADO (CO)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.

Behavioral Healthcare Incorporated
Colorado Access - CRICC
Colorado Access Health Plan
Colorado Health Network
Denver Health Medicaid Choice Plan
Foothills Behavioral Health
Kaiser - CRICC
Northeast Behavioral Health
Primary Care Physicians Program
Rocky Mountain Health Plan

Created 1/3/11

HI4

MEDICAID HMOs - CONNECTICUT (CT)
A.
B.
C.

Aetna Better Care Program
Americhoice - United Health Care
Community Healthcare Network

Created 1/3/11

HI4

MEDICAID HMOs - DISTRICT OF COLUMBIA (DC)

A.
B.
C.

DC Chartered Health Plan
Health Services for Children with Special Needs
Unison

Created 1/3/11

HI4

MEDICAID HMOs - DELAWARE (DE)
A.
B.
C.

Americhoice - United Health Care
Delaware Physicians Care Inc. - Aetna
State Primary Care

Created 1/3/11

HI4

MEDICAID HMOs - FLORIDA (FL)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.

Amerigroup Community Care
Better Health
Buena Vista
Children's Medical Services
Citrus Health Care
First Coast Advantage
Freedom Health
HealthEase of Florida
Humana Medical Plan
Integral Health Plan
Jackson Memorial Health Plan
Molina Healthcare of Florida
Personal Health Plan
Positive Healthcare Florida
Preferred Medical Plan
Prestige Health Choice
Simply Healthcare Plans

Created 1/3/11

HI4

MEDICAID HMOs - FLORIDA (FL)
(continued)

R.
S.
T.
U.
V.
W.

South Florida Community Care Network
Staywell Health Plan of Florida
Sunshine State Health Plan
United HealthCare of Florida
Universal Health Care
Vista

Created 1/3/11

HI4

MEDICAID HMOs - GEORGIA (GA)
A.
B.
C.

AmeriGroup Community Care
Peach State Health Plan
WellCare

Created 1/3/11

HI4

MEDICAID HMOs - HAWAII (HI)
A.
B.
C.
D.
E.

AlohaCare
Evercare
Hawaii Medical Service Association (HMSA)
Kaiser
Ohana Health Plan

Created 1/3/11

HI4

MEDICAID HMOs - IDAHO (ID)
A.
B.

Healthy Connections
Medicare-Medicaid Coordinated Plan (Prepaid Ambulatory
Health Plan - PAHP)

Created 1/3/11

HI4

MEDICAID HMOs - ILLINOIS (IL)
A.
B.
C.

Family Health Network
Harmony Health Plan
Meridian Health Plan

Created 1/3/11

HI4

MEDICAID HMOs - INDIANA (IN)
A.
B.
C.

Anthem
Managed Health Services (MHS)
MDwise

Created 1/3/11

HI4

MEDICAID HMOs - IOWA (IA)
None Available

Created 1/3/11

HI4

MEDICAID HMOs - KANSAS (KS)
A.
B.
C.
D.
E.

Cenpatico Behavioral Health
Children's Mercy Family Health Partners
Kansas Health Solutions
Unicare Health Plan of Kansas
Value Options

Created 1/3/11

HI4

MEDICAID HMOs - KENTUCKY (KY)
A.
B.

Kentucky Medicaid Health Care Partnership Program
Passport Health Plan

Created 1/3/11

HI4

MEDICAID HMOs - LOUISIANA (LA)
A.

CommunityCARE

Created 1/3/11

HI4

MEDICAID HMOs - MAINE (ME)
None Available

Created 1/3/11

HI4

MEDICAID HMOs - MASSACHUSETTS (MA)

A.
B.
C.
D.
E.
F.
G.

Boston Medical Center HealthNet Plan (BMCHP)
Fallon Community Health Plan (FCHP)
Health New England
Neighborhood Health Plan
Network Health Plan (NH)
PACE
Senior Care Options

Created 1/3/11

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 1/3/11

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 1/3/11

HI4

MEDICAID HMOs - MINNESOTA (MN)
A.
B.
C.
D.
E.
F.
G.
H.

Blue Plus
HealthPartners
Itasca Medical Care
Medica
Metropolitan Health Plan
PrimeWest Health Systems
South Country Health Alliance
Ucare Minnesota

Created 1/3/11

HI4

MEDICAID HMOs - MISSISSIPPI (MS)
None Available

Created 1/3/11

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 1/3/11

HI4

MEDICAID HMOs - MONTANA (MT)
None Available

Created 1/3/11

HI4

MEDICAID HMOs - NEBRASKA (NE)
A.
B.

Magellan Behavioral Health
Share Advantage

Created 1/3/11

HI4

MEDICAID HMOs - NEW HAMPSHIRE (NH)
None Available

Created 1/3/11

HI4

MEDICAID HMOs - NEW JERSEY (NJ)
A.
B.
C.
D.

AmeriChoice of New Jersey, Inc.
Amerigroup New Jersey, Inc.
Healthfirst Health Plan of New Jersey, Inc.
Horizon New Jersey Health

Created 1/3/11

HI4

MEDICAID HMOs - NEW MEXICO (NM)
A.
B.
C.
D.
E.
F.
G.

Amerigroup of New Mexico
Blue Cross/Blue Shield of New Mexico
Evercare New Mexico
Lovelace Community Health
Molina Healthcare of New Mexico
OptumHealth New Mexico
Presbyterian Health Plan

Created 1/3/11

HI4

MEDICAID HMOs - NEVADA (NV)
A.
B.

Amerigroup
Health Plan of Nevada

Created 1/3/11

HI4

MEDICAID HMOs - NEW YORK (NY)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.

Affinity Health Plan
AmeriGroup New York Inc.
Amida Care SNP
Capital District Physicians Health Plan Inc.
Excellis Health Plan Inc.
GHI HMO Select Inc.
Health First PHSP Inc.
Health Insurance Plan of Greater 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

Created 1/3/11

HI4

MEDICAID HMOs - NEW YORK (NY)
(continued)

R.
S.
T.
U.
V.
W.
X.
Y.

New York State Catholic Health Plan Inc.
PCMP II-Gold Choice
SCHC Total Care Inc. (Syracuse Area)
Southern Tier Pediatrics
Southern Tier Priority Health Care
United Health Care of New York Inc.
Univera Community Health Inc.
Well Care of New York Inc.

Created 1/3/11

HI4

MEDICAID HMOs - NORTH CAROLINA (NC)
None Available

Created 1/3/11

HI4

MEDICAID HMOs - NORTH DAKOTA (ND)

A.

Program of All Inclusive Care for the Elderly (PACE)

Created 1/3/11

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 1/3/11

HI4

MEDICAID HMOs - OKLAHOMA (OK)
A.

SoonerCare Choice

Created 1/3/11

HI4

MEDICAID HMOs - OREGON (OR)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.

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.
Oregon Health Management Services (OHMS)
Providence Health Assurance

Created 1/3/11

HI4

MEDICAID HMOs - OREGON (OR)
(continued)

O.

Tuality Health Alliance

Created 1/3/11

HI4

MEDICAID HMOs - PENNSYLVANIA (PA)
A.
B.
C.
D.
E.
F.
G.
H.

Aetna Better Health
AmeriHealth Mercy Health Plan
Conventry Cares
Gateway Health Plan
Health Partners
Keystone Health Plan
United Healthcare
University of Pennsylvania Managed Care (UPMC) Health
Plan

Created 1/3/11

HI4

MEDICAID HMOs - PUERTO RICO (PR)
A.
B.

Humana Health Plans of Puerto Rico
MCS Health Management Options

Created 1/3/11

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 1/3/11

HI4

MEDICAID HMOs - SOUTH CAROLINA (SC)

A.
B.
C.
D.
E.

Absolute Total Care
Blue Choice Health Plan of South Carolina
First Choice by Select Health of South Carolina
South Carolina Solutions (PCCM)
Unison Health Plan

Created 1/3/11

HI4

MEDICAID HMOs - SOUTH DAKOTA (SD)
None Available

Created 1/3/11

HI4

MEDICAID HMOs - TENNESSEE (TN)
A.
B.
C.
D.

AmeriChoice
AmeriGroup
BlueCare
TennCare Select

Created 1/3/11

HI4

MEDICAID HMOs - TEXAS (TX)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.

Aetna Medicaid
AmeriGroup Community Care
Community First Health Plans
Community Health Choice
Cook Children's Health Plan
Driscoll Children's Health Plan
El Paso First Premier Plan
Evercare of Texas
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 1/3/11

HI4

MEDICAID HMOs - UTAH (UT)
A.
B.
C.

Healthy U
Molina Health Care of Utah
Select Access

Created 1/3/11

HI4

MEDICAID HMOs - VERMONT (VT)
None Available

Created 1/3/11

HI4

MEDICAID HMOs - VIRGINIA (VA)
A.
B.
C.
D.
E.
F.

Amerigroup
Anthem HealthKeepers Plus
CareNet
Optima Family Care
Virginia Medallion
Virginia Premier Health Plan

Created 1/3/11

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 1/3/11

HI4

MEDICAID HMOs - WISCONSIN (WI)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.

Abri Health Plan
Care WI First
Children Come First
Children's Community Health Plan
Community Care Incorporated
Community Health Partnership
Compcare
Dean Health Plan
Group Health Cooperative
Gunderson Lutheran
Health Tradition Health Plan
i-Care
Managed Health Services
MercyCare Insurance Company
Network Health Plan
Physicians Plus Insurance Corp.
Security Health Plan

Created 1/3/11

HI4

MEDICAID HMOs - WISCONSIN (WI)
(continued)

R.
S.
T.

UnitedHealthcare of Wisconsin
Unity Health Insurance
Wraparound Milwaukee

Created 1/3/11

HI4

MEDICAID HMOs - WEST VIRGINIA (WV)
A.
B.
C.

Carelink Health Plans
The Health Plan of the Upper Ohio Valley
Unicare Health Plans

Created 1/3/11

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