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Medicare Current Beneficiary Survey
Version Information
Component: Community
Language: English
Introduction
This guide contains a comprehensive, up-to-date list of MCBS Showcards and
Reference Cards. Over time, we may make changes to your Showcards and
Reference Cards by updating the content, adding new cards, or eliminating existing
cards.
You can use this guide to ensure that you are using the most up-to-date set of cards.
To check if you are using the most recent versions, look at the date of the “Current
Version” in the table on the following pages and compare it with the date on the
bottom of your Showcards and Reference cards. If you’re missing updated versions
of Showcards or Reference cards, notify your Field Manager, who will arrange to
have them sent to you.
The Showcards are arranged in alphabetical order according to questionnaire
section name. However, some Field Interviewers prefer to arrange the Showcard
sections by the order in which the sections will appear during the interview.
MCBS Showcards
Quex Sections
ACQ
AVQ
CLQ
CPS
CPQ
DIQ
DVH
END
ENS
ERQ
HAQ
HFQ
Showcards
AC1
AC2
(None)
(None)
(None)
CP1
CP2
CP3
DI1
DI2
DI3
DI4
DI5
DI6
DVH1
DVH2
DVH3
(None)
ENS1
(None)
HA1
HA2
HA3
HF1
HF2
HF3
HF4
HF5
HF6
HF7
HF8
Current Version
January 10, 2018
January 10, 2018
(None)
(None)
(None)
May 2019
May 2019
May 2019
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
August 1, 2015
January 2019
January 2019
January 2019
(None)
July 24, 2017
(None)
July 28, 2014
July 28, 2014
July 28, 2014
August 1, 2015
August 1, 2015
August 1, 2015
August 3, 2016
August 3, 2016
August 3, 2016
August 3, 2016
August 3, 2016
MCBS Showcards
Quex Sections
HHQ
HIQ
IAQ
Showcards
HF9
HF10
HF11
HF12
HF13
HH1
HH2
HH3
HH4
HH5
HI1
HI2
HI3
HI4
HI5
HI6
HIT1
HIT2
IA1
IA2
IA3
IA4
IA5
IA6
IA7
IA8
IA9
IA10
IA11
IA12
IA13
Current Version
August 3, 2016
August 3, 2016
July 2019
July 2019
July 2019
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
February 17, 2015 & July 24, 2017
November 7, 2017
November 7, 2017
November 7, 2017
November 7, 2017
November 7, 2017
July 28, 2014
July 28, 2014
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
MCBS Showcards
Quex Sections
INQ
INQ
IPQ
IUQ
IRQ
KNQ
Showcards
IA14
IA15
IA16
IA17
IA18
IA19
IA20
IA21
IA22
IA23
IA24
IA25
IA26
IA27
IA28
IA29
IA30
IA31
IA32
IA33
IA34
IA35
IA36
(None)
(None)
IU1
(None)
KN1
KN2
KN3
KN4
Current Version
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
May 3, 2017
May 3, 2017
May 4, 2016
May 4, 2016
(None)
(None)
January 10, 2018
(None)
July 28, 2014
July 28, 2014
January 13, 2016
January 11, 2017
MCBS Showcards
Quex Sections
MBQ
MPQ
NAQ
NSQ
OMQ
OPQ
PMQ
PMS, PSQ, PVQ
RXQ
SCQ
STQ
Showcards
Current Version
KN5
KN6
KN7
KN8
KN9
(None)
MP1
MP2
MP3
MP4
MP5
MP6
January 11, 2017
January 11, 2017
January 11, 2017
January 10, 2018
January 11, 2017
NA1
(None)
OM1
OM2
OM3
OM4
OM5
(None)
PM1
(None)
RX1
RX2
RX3
RX4
RX5
SC1
SC2
SC3
(None)
August 3, 2016
(None)
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
(None)
July 24, 2017
(None)
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
May 2, 2018
July 28, 2014
July 24, 2017
July 24, 2017
(None)
(None)
January 2019
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
July 24, 2017
MCBS Showcards
Quex Sections
USQ
Showcards
US1
US2
US3
US4
US5
US6
US7
Current Version
January 10, 2018
January 10, 2018
January 10, 2018
January 10, 2018
January 10, 2018
January 10, 2018
January 10, 2018
AC1
• Allergy/immunology (allergies, asthma)
• Anesthesiology
• Cardiology (heart)
• Dermatology (skin)
• Endocrinology/metabolism (diabetes, thyroid)
• Family practice
• Gastroenterology
• General practice
• General surgery
• Geriatrics (elderly)
• Gynecology – obstetrics
• Hematology (blood)
• Hospital residence
• Internal medicine (internist)
• Nephrology (kidneys)
• Neurology
(continued)
Updated January 10, 2018
AC1
• Nuclear medicine
• Oncology (tumors, cancer)
• Ophthalmology (eyes)
• Orthopedics
• Osteopathy (DO)
• Otorhinolaryngology (ear, nose, throat)
• Pain Management Specialist
• Pathology
• Physical med/rehab
• Physician’s Assistant
• Plastic surgery
• Podiatrist
• Proctology
• Psychiatry/psychiatrist
• Pulmonary (lungs)
(continued)
Updated January 10, 2018
AC1
• Radiology
• Rheumatology (arthritis)
• Thoracic surgery (chest)
• Urology
• Vascular Surgeon/Specialist
Updated January 10, 2018
AC2
• Allergy/Immunology
• Cardiology (Heart)
• Dermatology (Skin)
• Endocrinology/Metabolism (Diabetes, Thyroid)
• Gastroenterology
• General Surgery
• Geriatrics (Elderly)
• Gynecology - Obstetrics
• Hematology (Blood)
• Internal Medicine (Internist)
• Nephrology (Kidneys)
• Neurology
• Oncology (Tumors, Cancer)
• Ophthalmology (Eyes)
• Orthopedics
(continued)
Updated January 10, 2018
AC2
• Osteopathy (DO)
• Otorhinolaryngology (Ear, Nose, Throat)
• Pathology
• Phys Med/Rehab
• Plastic Surgery
• Proctology
• Psychiatry/Psychiatrist
• Pulmonary (Lungs)
• Rheumatology (Arthritis)
• Urology
• Audiologist
• Chiropractor
• Dentist
• Optometrist
• Physical Therapist
• Psychologist
Updated January 10, 2018
CP1
● Never
● Some days
● Most days
● Every day
Updated May 2019
CP2
● A little
● A lot
● Somewhere in between a little
and a lot
Updated May 2019
CP3
● Not at all
● A little
● A lot
● Somewhere in between a little
and a lot
Updated May 2019
DI1
• Mexican, Mexican American, Chicano(a)
• Puerto Rican
• Cuban
Updated July 28, 2014
DI2
• American Indian or Alaska Native
• Asian
• Black or African American
• Native Hawaiian or other Pacific Islander
• White
Updated July 28, 2014
DI3
• Asian Indian
• Chinese
• Filipino
• Japanese
• Korean
• Vietnamese
Updated July 28, 2014
DI4
• Native Hawaiian
• Guamanian or Chamorro
• Samoan
Updated July 28, 2014
DI5
• 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
Updated July 28, 2014
DI6
Monthly Breakdown
Annual Income
A. Less than $5,000
A. Less than $417
B. $5,000 – less than $10,000
B. $417 – less than $834
C. $10,000 – less than $15,000
C. $834 – less than $1,250
D. $15,000 – less than $20,000
D. $1,250 – less than $1,667
E. $20,000 – less than $25,000
E. $1,667 – less than $2,084
F. $25,000 – less than $30,000
F. $2,084 – less than $2,500
G. $30,000 – less than $40,000
G. $2,500 – less than $3,334
H. $40,000 – less than $50,000
H. $3,334 – less than $4,167
I.
$50,000 – less than $66,000
I.
$4,167 – less than $5,500
J.
$66,000 – less than $109,000
J.
$5,500 – less than $9,084
K. $109,000 or more
K. $9,084 or more
Updated August 1, 2015
DVH1
● General exam, checkup or consultation
● Cleaning, prophylaxis, or polishing
● X-rays, radiographs, or bitewings
● Fluoride treatment
● Sealant (plastic coatings on back teeth)
● Fillings
● Inlays
● Crowns or caps
● Root canal
● Periodontal scaling, root planing, or gum
surgery
● Periodontal recall visit (periodic or
regular)
(Continued)
Updated January 2019
DVH1
● Extraction, tooth pulled
● Implants
● Abscess or infection treatment
● Other oral surgery
● Fixed bridges
● Dentures or removable partial dentures
● Relining or repair of bridges or dentures
● Orthodontia, braces, or retainers
● Bond, whiten, or bleach
● Treatment for TMD or TMJ
Updated January 2019
DVH2
● Eye Or Vision Exam
● Contact Lens Fitting
● Contact Lens Purchase
● Eye Glass Frame Fitting Or Adjustment
● Eye Glass Purchase
● Refractive Surgery (Corrective Vision
Surgery)
● Cataract Surgery
● Glaucoma Surgery
● Corneal Surgery
● Vitreo-Retinal Surgery
● Oculoplastic Surgery
● Eye Muscle Surgery
● Eye Removal
Updated January 2019
DVH3
● Hearing Aid Fitting/Evaluation
● Hearing Aid Purchase
● Hearing Exam
● Ear Wax Removal
● Ear Ventilation Tubes
● Tympanoplasty (Reconstruction of ear
drum)
● Cochlear Implant Surgery
● Hearing Rehabilitative Services
Updated January 2019
ENS1
• 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)
• Peace time (all other times)
Updated July 24, 2017
HA1
• One-family, detached
• Two-family or duplex
• Apartment or condominium building
• Mobile home, trailer
• Rowhouse, townhouse
• “mother-in-law” apartment
Updated July 28, 2014
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
Updated July 28, 2014
HA3
• Prepared meals
• Housekeeping, maid, or cleaning services
• Laundry services
• Help with medications
• Transportation
• Recreational services
Updated July 28, 2014
HF1
• Much better now than one year ago
• Somewhat better now than one year ago
• About the same
• Somewhat worse now than one year ago
• Much worse now than one year ago
Updated August 1, 2015
HF2
• It will get much better
• It will get somewhat better
• It will not change
• It will get somewhat worse
• It will get much worse
Updated August 1, 2015
HF3
• No difficulty at all
• A little difficulty
• Some difficulty
• A lot of difficulty
• Not able to do it
Updated August 1, 2015
HF4
• Bladder
• Blood
• Bone
• Brain
• Breast
• Cervix
• Colon (bowel)
• Esophagus
• Gall Bladder
• Kidney
• Larynx (windpipe)
• Leukocytes (Leukemia)
• Liver
(continued)
Updated August 3, 2016
HF4
• Lung
• Lymph Nodes (Lymphoma)
• Mouth/Tongue/Lip
• Ovary
• Pancreas
• Prostate
• Rectum
• Soft Tissue/Fat
• Stomach
• Testis
• Throat
• Thyroid
• Uterus
Updated August 3, 2016
HF5
• Type 1
• Type 2
• Borderline
• Pre-Diabetes
• Gestational (Pregnancy-related)
Updated August 3, 2016
HF6
• All of the time
• Most of the time
• Some of the time
• A little of the time
• None of the time
Updated August 3, 2016
HF7
• 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
about managing Diabetes
Updated August 3, 2016
HF8
HF9
HF8
• Not at all
• Several days
• More than half the days
• Nearly every day
Updated August 3, 2016
HF9
HF10
HF9
HF8
• Not at all difficult
• Somewhat difficult
• Very difficult
• Extremely difficult
Updated August 3, 2016
HF10
• 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
Updated August 3, 2016
HF11
Updated July 2019
HF12
Updated July 2019
HF13
Updated July 2019
HH1
Home Help by Health or Medical
Professionals
• Nurse (visiting nurse, private duty nurse,
etc.)
• Doctor
• Social worker
• Therapist
• Hospice worker
Updated July 28, 2014
HH2
Medical or Nursing Treatment
• Applying sterile bandages or dressings
• Giving medications
• Taking blood pressure
• Giving shots or injections
Updated July 28, 2014
HH3
Help With Daily Needs
• Using the telephone
• Doing housework
• Preparing meals
Updated July 28, 2014
HH4
• Bathing
• Showering
• Dressing
• Eating
• Walking
• Using the toilet
Updated July 28, 2014
HH5
Personal Care or Help with Daily Needs
from Persons Who Do Not Live with You
• Home health aides
• Homemakers
• Friends
• Neighbors
• Relatives
Updated July 28, 2014
HI1
Health Insurance Coverage Options
“Original” Medicare
“Medicare Advantage” (MA) plan
o with Prescription Drug Plan (MA-PD) or
without
Medicaid
TRICARE/TRICARE for Life
Public Programs (other than Medicaid)
Medicare Part D Prescription Drug Plan (PDP)
Private/Supplemental Insurance Plan
o Purchased directly from an insurance
company, or
o Obtained through an employer, union, or
other group, such as AARP
Updated February 17, 2015
HI1
ORIGINAL MEDICARE
MEDICARE ADVANTAGE
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 standalone 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.
If you want drug coverage, you must join a plan that
includes drug coverage. This will give you all of
your coverage in one plan.
A Medigap plan is not available.
MEDICAID
TRICARE/TRICARE FOR LIFE
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.”
Will be automatically enrolled in a Medicare
prescription drug plan and be eligible for a lowincome subsidy or “extra help.”
Covers active-duty service members, retirees, and
their families.
TRICARE generally pays the fees left outstanding
after Medicare has made their payment.
Updated July 24, 2017
(continued)
HI1
PRIVATE HEALTH INSURANCE
MEDICARE PART D PRESCRIPTION DRUG PLAN
Includes supplemental or Medigap plans, plans that
are provided by a former or current employer, and
Separate policies that cover only prescribed
other plans purchased directly through a private
medicines.
company, union, association, or other group.
Beneficiaries pay a monthly premium and copay or
Cover the cost of hospital or doctor visits, prescribed
coinsurance for their required prescriptions.
medicines, or dental care.
Standalone plans are only available to beneficiaries
Common type: Medicare Supplement Insurance
who are covered by Original Medicare; otherwise
(Medigap), which is available to recipients of
drug coverage is available as part of Medicare
Original Medicare and helps pay some of the health
Advantage plans.
care costs that Original Medicare doesn't cover, like
copayments, coinsurance and deductibles.
PUBLIC PROGRAMS (OTHER THAN MEDICAID)
Include state, county, or city-based programs such as a pharmacy program, where the local government
provides at least partial coverage for the cost of prescribed medicines.
Insurance comes from a public source other than Medicare or Medicaid.
Updated July 24, 2017
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Alabama (AL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Humana Gold Plus (Arcadian Health Plan, Inc.)
2
Humana Gold Choice (Humana Insurance
Company)
3
AARP MedicareComplete Plan
(UnitedHealthcare)
4
Aetna Medicare Value Plan (Aetna Medicare)
5
Cigna-HealthSpring (Cigna-HealthSpring)
6
HumanaChoice (Humana Insurance Company)
7
Blue Advantage (Blue Advantage (PPO))
8
Bright Advantage (Bright Health)
9
Aetna Medicare (Aetna Medicare)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Alabama (AL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10
VIVA Medicare (VIVA Medicare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Alabama (AL)
1
Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Alabama (AL)
1
Maternity Program
2
Mercy Life of Alabama
3
Multiple primary care providers
4
Multiple primary care providers
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Alabama (AL)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Blue Cross Select [Tier] (Blue Cross and Blue Shield
of Alabama)
2 Blue Protect (Blue Cross and Blue Shield of Alabama)
3 Blue Saver [Tier] (Blue Cross and Blue Shield of
Alabama)
4 Blue Value [Tier] (Blue Cross and Blue Shield of
Alabama)
5 Blue [Tier] (Blue Cross and Blue Shield of Alabama)
6 [Tier] (Bright Health Insurance Company)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Alabama (AL)
1 Alabama AIDS Drug Assistance Program
2 Alabama Senior Rx (Partner for Medication Access)
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Arkansas (AR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
AR Blue Cross - Medi-Pak Advantage
(ARKANSAS BLUE CROSS AND BLUE SHIELD)
2
Care Improvement Plus Medicare Advantage
(UnitedHealthcare)
3
Cigna-HealthSpring Preferred AR
(Cigna-HealthSpring)
4
Humana Gold Choice (Humana Insurance
Company)
5
AARP MedicareComplete Plan
(UnitedHealthcare)
6
Advantra Total Care (Coventry Health Care)
7
Advantra Freedom (Coventry Health Care)
8
HumanaChoice (Humana Insurance Company)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Arkansas (AR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9
Horizons (Superior Select Health Plans)
10 Medi-Pak Advantage (Health Advantage)
11 Humana (Arcadian Health Plan, Inc.)
12 Classic Plus (QualChoice Advantage)
13 Allwell Medicare (Allwell)
14 WellCare (WellCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Arkansas (AR)
1
Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Arkansas (AR)
1 Arkansas Medicaid Non-Emergency Transportation
2 Multiple primary care providers
3 PACE
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Arkansas (AR)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Ambetter Balanced Care (Celtic Insurance
Company)
2
Ambetter Essential Care (Celtic Insurance
Company)
3
Ambetter Secure Care Free PCP Visits (Celtic
Insurance Company)
4
[Tier] (QCA Health Plan, Inc.)
5
[Tier] (QualChoice Life & Health Insurance
Company, Inc.)
6
[Tier] (USAble Mutual Insurance Company)
7
[Tier] AW (USAble Mutual Insurance Company)
8
[Tier] AWM (USAble Mutual Insurance Company)
9
[Tier] Classic (QCA Health Plan, Inc.)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Arkansas (AR)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
10 [Tier] Classic Saver (QCA Health Plan, Inc.)
11 [Tier] M (USAble Mutual Insurance Company)
12 [Tier] Saver (QualChoice Life & Health Insurance
Company, Inc.)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Arkansas (AR)
1 AIDS Drug Assistance Program
2 Arkansas Health Care Access Foundation
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Arizona (AZ)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Blue Medicare Advantage (Blue Cross Blue
Shield of Arizona Advantage)
2
UnitedHealthcare MedicareDirect
(UnitedHealthcare)
3
CareMore (CareMore Health Plan of Arizona,
Inc.)
4
Humana Gold Choice (Humana Insurance
Company)
5
Humana Gold Plus (Humana Health Plan, Inc.)
6
AARP MedicareComplete (UnitedHealthcare)
7
HumanaChoice (Humana Insurance Company)
8
Cigna-HealthSpring Preferred (Cigna)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Arizona (AZ)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9
Bright Advantage (Bright Health)
10
Aetna Medicare (Aetna Medicare)
11
Allwell Medicare (Allwell)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Arizona (AZ)
1 Arizona Health Care Cost Containment System
(AHCCCS)
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Arizona (AZ)
1
Bridgeway Health Solutions MLTSS
2
Care 1st
3
Comprehensive Medical and Dental Program
4
Division of Developmental Disabilities MLTSS
5
Health Choice Arizona
6
Health Net Access
7
Maricopa Health Plan
8
Mercy Care MLTSS
9
Mercy Care Plan
10
Mercy Maricopa Integrated Care
11
Phoenix Health Plan
12
United Healthcare MLTSS
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
Arizona (AZ)
13
UnitedHealthcare Plan
14
University Family Care
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Arizona (AZ)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Ambetter Balanced Care (Health Net of Arizona, Inc.)
2 Ambetter Essential Care (Health Net of Arizona, Inc.)
3 Ambetter Secure Care (Health Net of Arizona, Inc.)
4 EverydayHealth Neighborhood Network (Blue Cross
and Blue Shield of Arizona, Inc.)
5 Portfolio Neighborhood Network (Blue Cross and Blue
Shield of Arizona, Inc.)
6 SimpleHealth Neighborhood Network (Blue Cross and
Blue Shield of Arizona, Inc.)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Arizona (AZ)
1 Arizona CoppeRX
2 Arizona AIDS Drug Assistance Program (ADAP)
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
California (CA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Ibt Voluntary Employee Benefits Trust
2
Health Net Seniority Plus Sapphire Premier
(HEALTH NET COMMUNITY SOLUTIONS)
3
Anthem MediBlue Access (Anthem Blue Cross
Life and Health Insurance Co.)
4
Sharp SecureHorizons Plan by UnitedHealthcare
(UnitedHealthcare)
5
Stanford Health Care Advantage (Stanford
Health Care Advantage)
6
Traditional-LA (Imperial Health Plan of California,
Inc.)
7
Traditional-SF (Imperial Health Plan of
California, Inc.)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
California (CA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
AARP MedicareComplete SecureHorizons
(UnitedHealthcare)
9
Traditional (Imperial Health Plan of California,
Inc.)
10
Care1st AdvantageOptimum Plan (Care1st
Health Plan)
11
CCHP Senior Program (Chinese Community
Health Plan)
12
Inter Valley Health Plan (Inter Valley Health Plan)
13
UnitedHealthcare MedicareDirect
(UnitedHealthcare)
14
Alignment Health Plan (Alignment Health Plan)
(continued)
Created on 11/07/2017
3
HI2
MEDICARE ADVANTAGE PLANS
California (CA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
15
Coordinated Choice Plan (Care1st Health Plan)
16
Central Health (Central Health Medicare Plan)
17
Aetna Medicare Choice Plan (Aetna Medicare)
18
Sharp Direct Advantage (Sharp Health Plan)
19
Golden State Medicare Gold (Golden State)
20
Blue Shield (Blue Shield of California)
21
Brand New Day Classic (Brand New Day)
22
Easy Choice (Easy Choice Health Plan)
(continued)
Created on 11/07/2017
4
HI2
MEDICARE ADVANTAGE PLANS
California (CA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
23 Health Net (Health Net of California)
24 Kaiser Permanente (Kaiser Permanente)
25 Humana (Arcadian Health Plan, Inc.)
26 Aspire Health (Aspire Health Plan)
27 Aetna Medicare (Aetna Medicare)
28 Anthem (Anthem Blue Cross)
29 Scripps (SCAN Health Plan)
30 SCAN (SCAN Health Plan)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
California (CA)
1
Medi-Cal
Created on 11/07/2017
1
HI4
MEDICAID HMOs
California (CA)
1
Access Dental Plan-LA (Plan 409)
2
Access Dental Plan-Sacramento ( Plan 421)
3
Alameda Alliance for Health
4
Alta Med Health Senior Buenacare/Los Angeles
5
Anthem Blue Cross/Alameda
6
Anthem Blue Cross/Alpine
7
Anthem Blue Cross/Amador
8
Anthem Blue Cross/Butte
9
Anthem Blue Cross/Calaveras
10
Anthem Blue Cross/Colusa
11
Anthem Blue Cross/Contra Costa
12
Anthem Blue Cross/El Dorado
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
California (CA)
13
Anthem Blue Cross/Fresno
14
Anthem Blue Cross/Glenn
15
Anthem Blue Cross/Inyo
16
Anthem Blue Cross/Kings
17
Anthem Blue Cross/Madera
18
Anthem Blue Cross/Mariposa
19
Anthem Blue Cross/Mono
20
Anthem Blue Cross/Nevada
21
Anthem Blue Cross/Placer
22
Anthem Blue Cross/Plumas
23
Anthem Blue Cross/Sacramento
24
Anthem Blue Cross/San Benito
25
Anthem Blue Cross/San Francisco
(continued)
Created on 11/07/2017
3
HI4
MEDICAID HMOs
California (CA)
26
Anthem Blue Cross/Santa Clara
27
Anthem Blue Cross/Sierra
28
Anthem Blue Cross/Sutter
29
Anthem Blue Cross/Tehama
30
Anthem Blue Cross/Tulare
31
Anthem Blue Cross/Tuolumne
32
Anthem Blue Cross/Yuba
33
Brandman Centers for Senior Care/Los Angeles
34
CalOPTIMA PACE/Orange
35
CalOPTIMA/Orange
36
CalViva Health Fresno
37
CalViva Health Kings
(continued)
Created on 11/07/2017
4
HI4
MEDICAID HMOs
California (CA)
38
CalViva Health Madera
39
California Health & Wellness/Alpine
40
California Health & Wellness/Amador
41
California Health & Wellness/Butte
42
California Health & Wellness/Calaveras
43
California Health & Wellness/Colusa
44
California Health & Wellness/El Dorado
45
California Health & Wellness/Glenn
46
California Health & Wellness/Imperial
47
California Health & Wellness/Inyo
48
California Health & Wellness/Mariposa
49
California Health & Wellness/Mono
50
California Health & Wellness/Nevada
(continued)
Created on 11/07/2017
5
HI4
MEDICAID HMOs
California (CA)
51
California Health & Wellness/Placer
52
California Health & Wellness/Plumas
53
California Health & Wellness/Sierra
54
California Health & Wellness/Sutter
55
California Health & Wellness/Tehama
56
California Health & Wellness/Tuolumne
57
California Health & Wellness/Yuba
58
Care 1st Healthplan/San Diego
59
CenCal/San Luis Obispo
60
CenCal/Santa Barbara
61
Center for Elders Independence/Alameda
62
Center for Elders Independence/Contra Costa
(continued)
Created on 11/07/2017
6
HI4
MEDICAID HMOs
California (CA)
63
Central California Alliance for Health/Merced
64
Central California Alliance for Health/Monterey
65
Central California Alliance for Health/Santa Cruz
66
Community Health Group/San Diego
67
Contra Costa Health Plan
68
Family Mosaic Project/San Francisco
69
Gold Coast Health Plan/Ventura
70
Health Net / LA
71
Health Net of CA-Dental-LA ( Plan 405)
72
Health Net of CA-Dental-Sacramento (Plan 427)
73
Health Net/Kern
(continued)
Created on 11/07/2017
7
HI4
MEDICAID HMOs
California (CA)
74
Health Net/Sacramento
75
Health Net/San Diego
76
Health Net/San Joaquin
77
Health Net/Stanislaus
78
Health Net/Tulare
79
Health Plan of San Joaquin/San Joaquin
80
Health Plan of San Joaquin/Stanislaus
81
Health Plan of San Mateo
82
Health Plan of San Mateo CCS Demo/San Mateo
83
Inland Empire Health Plan/Riverside
84
Inland Empire Health Plan/San Bernardino
85
Innovage/Riverside
(continued)
Created on 11/07/2017
8
HI4
MEDICAID HMOs
California (CA)
86
Innovage/San Bernardino
87
Kaiser/Amador
88
Kaiser/El Dorado
89
Kaiser/Placer
90
Kaiser/Sacramento
91
Kaiser/San Diego
92
Kern Health Systems
93
LA Care
94
Liberty Dental Plan of CA-LA (Plan 416)
95
Liberty Dental Plan of CA/Sacramento (Plan 425)
96
Molina Health Care/Imperial
97
Molina Health Care/Sacramento
(continued)
Created on 11/07/2017
9
HI4
MEDICAID HMOs
California (CA)
98
Molina Health Care/San Diego
99
Molina Healthcare/Riverside
100
Molina Healthcare/San Bernardino
101
ONLOK LifeWays/Alameda
102
ONLOK LifeWays/San Francisco
103
ONLOK Lifeways/Santa Clara
104
Partnership Health Plan of CA/Del Norte
105
Partnership Health Plan of CA/Humboldt
106
Partnership Health Plan of CA/Lake
107
Partnership Health Plan of CA/Lassen
108
Partnership Health Plan of CA/Marin
109
Partnership Health Plan of CA/Mendocino
110
Partnership Health Plan of CA/Modoc
(continued)
Created on 11/07/2017
10
HI4
MEDICAID HMOs
California (CA)
111
Partnership Health Plan of CA/Napa
112
Partnership Health Plan of CA/Shasta
113
Partnership Health Plan of CA/Siskiyou
114
Partnership Health Plan of CA/Solano
115
Partnership Health Plan of CA/Sonoma
116
Partnership Health Plan of CA/Trinity
117
Partnership Health Plan of CA/Yolo
118
Positive Healthcare/Los Angeles
119
SCAN Health Plan/Los Angeles (plan code 200)
120
SCAN Health Plan/Los Angeles (plan code 201)
121
SCAN Health Plan/Riverside (plan code 204)
(continued)
Created on 11/07/2017
11
HI4
MEDICAID HMOs
California (CA)
122 SCAN Health Plan/Riverside (plan code 205)
123 SCAN Health Plan/San Bernardino (plan code 206)
124 SCAN Health Plan/San Bernardino (plan code 207)
125 San Francisco Health Plan
126 Santa Clara Family Health Plan
127 St. Paul's PACE/San Diego
128 Sutter SeniorCare/Sacramento
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
California (CA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Only state-operated exchanges serve California
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
California (CA)
1
AIDS Drug Assistance Program
2
Operation Access (OA)
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Colorado (CO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Friday Health Plans of Colorado (Friday Health
Plans of Colorado)
2
Denver Health Medicare Select (Denver Health
Medical Plan, Inc.)
3
Anthem MediBlue Access (Anthem Blue Cross
and Blue Shield)
4
Anthem MediBlue Plus (Anthem Blue Cross and
Blue Shield)
5
AARP MedicareComplete SecureHorizons
(UnitedHealthcare)
6
Kaiser Permanente Senior Advantage (Kaiser
Permanente)
7
Humana Gold Choice (Humana Insurance
Company)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Colorado (CO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
Rocky Mountain (Rocky Mountain Health Plans)
9
Aetna Medicare Prime Plan (Aetna Medicare)
10 HumanaChoice (Humana Insurance Company)
11 Erickson Advantage (UnitedHealthcare)
12 Humana (Humana Health Plan, Inc.)
13 Bright Advantage (Bright Health)
14 Aetna Medicare (Aetna Medicare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Colorado (CO)
1
Health First Colorado
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Colorado (CO)
1
Access Behavioral Care - Denver
2
Access Behavioral Care - Northeast
3
Accountable Care Collaborative: Rocky Mountain
Health Plan Prime (ACC: RMHP Prime)
4
Behavioral Healthcare Inc.
5
Colorado Health Partnerships
6
Denver Health Medicaid Choice
7
Foothills Behavioral Health Partners
8
Multiple primary care providers
9
RCCO 1: Rocky Mountain Health Plans
10
RCCO 1: Rocky Mountain Health Plans
11
RCCO 2: Colorado Access
12
RCCO 2: Colorado Access
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
Colorado (CO)
13
RCCO 3: Colorado Access
14
RCCO 3: Colorado Access
15
RCCO 4: Integrated Community Health Partners
16
RCCO 4: Integrated Community Health Partners
17
RCCO 5: Colorado Access
18
RCCO 5: Colorado Access
19
RCCO 6: Colorado Community Health Alliance
20
RCCO 6: Colorado Community Health Alliance
21
RCCO 7: Community Care
22
RCCO 7: Community Care of Central Colorado
(continued)
Created on 11/07/2017
3
HI4
MEDICAID HMOs
Colorado (CO)
23 Rocky Mountain Health Care Services PACE
24 Rocky Mountain Health Plan
25 Total Longterm Care - Pueblo DBA InnovAge
Greater Colorado PACE
26 Total Longterm Care DBA InnovAge Greater
Colorado PACE
27 Volunteers of America
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Colorado (CO)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Only state-operated exchanges serve Colorado
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Colorado (CO)
1 Colorado AIDS Drug Assistance Program
2 Bridging the Gap Colorado
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Connecticut (CT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1 UnitedHealthcare MedicareComplete
(UnitedHealthcare)
2 Anthem MediBlue (Anthem Blue Cross and Blue
Shield)
3 AARP MedicareComplete Choice (UnitedHealthcare)
4 ConnectiCare (ConnectiCare, Inc.)
5 Aetna Medicare (Aetna Medicare)
6 WellCare (WellCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Connecticut (CT)
1
Connecticut Medicaid
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Connecticut (CT)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Only state-operated exchanges serve Connecticut
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Connecticut (CT)
1 CT AIDS Drug Assistance Program (CADAP)
2 CT Pharmaceutical Assistance Contract to the Elderly
and Disabled
3 AmeriCares Free Clinics
4 State-Administered General Assistance (SAGA)
Medical Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
District of Columbia (DC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1 Kaiser Permanente Medicare Advantage (Kaiser
Permanente)
2 MedStar Medicare Choice (MedStar Family Choice,
Inc)
3 Kaiser Permanente Medicare Plus (Kaiser
Permanente)
4 Aetna Medicare Standard Plan (Aetna Medicare)
5 Aetna Medicare Premier Plan (Aetna Medicare)
6 Cigna-HealthSpring (Cigna-HealthSpring)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
District of Columbia (DC)
1
DC Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
District of Columbia (DC)
1 AmeriHealth District of Columbia
2 AmeriHealth District of Columbia
3 Health Services for Children with Special Needs
4 Medical Transportation Management Inc.
5 Medstar Family Choice
6 Medstar Family Choice
7 Trusted Health Plan
8 Trusted Health Plan
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
District of Columbia (DC)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Only state-operated exchanges serve Washington,
D.C.
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
District of Columbia (DC)
1
DC AIDS Drug Assistance Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Florida (FL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Leon Medical Centers Health Plans - Leon Cares
(HealthSpring of Florida, Inc.)
2
UnitedHealthcare The Villages
MedicareComplete (UnitedHealthcare)
3
Florida Hospital SunSaver Plan (Health First
Health Plans, Inc.)
4
Medica HealthCare Plans MedicareMax
(UnitedHealthcare)
5
Cigna-HealthSpring (HealthSpring of Florida,
Inc.)
6
AARP MedicareComplete Choice
(UnitedHealthcare)
7
Health First (Health First Health Plans, Inc.)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Florida (FL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
Aetna Medicare Premier Plan (Aetna Medicare)
9
Psers Hop (Employer Pdp) (Psers Hop Program)
10
Simply More (Simply Healthcare Plans, Inc.)
11
Capital Health Plan (Capital Health Plan)
12
Coventry Medicare (Coventry Health Care)
13
HealthSun (HealthSun Health Plans, Inc.)
14
AARP MedicareComplete (UnitedHealthcare)
15
CareExtra (CarePlus Health Plans, Inc.)
16
HumanaChoice (Humana Insurance Company)
(continued)
Created on 11/07/2017
3
HI2
MEDICARE ADVANTAGE PLANS
Florida (FL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
17
AvMed Medicare Choice (AvMed Medicare)
18
CareFree (CarePlus Health Plans, Inc.)
19
CareOne (CarePlus Health Plans, Inc.)
20
Aetna Medicare (Coventry Health Care)
21
Preferred Choice (UnitedHealthcare)
22
BlueMedicare Choice (Florida Blue)
23
FHCP's (Florida Health Care Plans)
24
Humana (Humana Medical Plan, Inc.)
25
Optimum (Optimum HealthCare, Inc.)
26
BlueMedicare (Florida Blue HMO)
27
Freedom (Freedom Health, Inc.)
(continued)
Created on 11/07/2017
4
HI2
MEDICARE ADVANTAGE PLANS
Florida (FL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
28
WellCare (WellCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Florida (FL)
1
Florida Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Florida (FL)
1
AHF / Positive Healthcare
2
AIDS Healthcare Foundation
3
American Eldercare
4
American Eldercare, Inc.
5
Amerigroup
6
Amerigroup Florida, Inc.
7
Amerigroup Florida, Inc.
8
Better Health
9
Better Health, LLC
10
Buena Vista
11
CareFlorida
12
Chapters Health Nursing Home Diversion Plan
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
Florida (FL)
13
Children's Medical Services
14
Children's Medical Services Network
15
Clear Health Alliance
16
Community Based Care Partnership
17
Community Living
18
Coventry Health Care
19
Coventry Healthcare of Florida, Inc.
20
DentaQuest
21
First Coast Advantage, LLC
22
First Coast Advantage, LLC.
23
Florida Health Partners, Inc.
24
Florida Healthcare Plus
25
Florida MHS, Inc. DBA MAGELLAN
(continued)
Created on 11/07/2017
3
HI4
MEDICAID HMOs
Florida (FL)
26
Florida PACE Center
27
Florida True Health
28
Freedom
29
Healthease
30
Healthy Palm Beaches
31
Hope Choices
32
Hope Select Care
33
Humana
34
Humana Medical Plan
35
Humana Medical Plan, Inc.
36
Integral Quality Care
37
Lakeview Center, Inc.
(continued)
Created on 11/07/2017
4
HI4
MEDICAID HMOs
Florida (FL)
38
Little Havana Activities and Nutrition Centers of
Miami
39
Magellan Behavioral Health of Florida
40
Magellan Complete Care, LLC
41
Managed Care of North America
42
Medica
43
Molina Healthcare
44
Molina Healthcare of Florida
45
Molina Healthcare of Florida, Inc.
46
Multiple primary care providers
47
N FL Behavioral Health Par
48
Neighborly Care Network
49
Palm Beach PACE
(continued)
Created on 11/07/2017
5
HI4
MEDICAID HMOs
Florida (FL)
50
Positive
51
Preferred Medical Plan
52
Preferred Medical Plan
53
Prestige
54
Prestige Health Choice
55
Project Independence at Home
56
Public Health Trust of Dade County
57
Simply DBA Clear Health Alliance
58
Simply Healthcare Plan
59
Simply Healthcare Plans, Inc.
60
South Florida Community Care Network
61
South Florida Community Care Network
62
Staywell
(continued)
Created on 11/07/2017
6
HI4
MEDICAID HMOs
Florida (FL)
63
Staywell Health Plan of Florida
64
Suncoast Neighborly Care, Inc.
65
Sunshine
66
Sunshine Health Plan Child Welfare
67
Sunshine Health Plan, Inc.
68
Sunshine State Health Plan, Inc.
69
United Healthcare Plan
70
United Healthcare of Florida
71
United Healthcare of Florida, Inc.
72
United Home Care Service
73
Universal Healthcare Plan
74
Urban Jacksonville
75
Vista Healthplan of South Florida
(continued)
Created on 11/07/2017
7
HI4
MEDICAID HMOs
Florida (FL)
76 Worldnet Services
77 Yourcare Brevard/Brevard Alzheimer's Foundation
Inc.
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Florida (FL)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Ambetter Balanced Care (Celtic Insurance
Company)
2
Ambetter Essential Care (Celtic Insurance
Company)
3
Ambetter Secure Care Free PCP Visits (Celtic
Insurance Company)
4
BlueCare [Tier] (Health Options, Inc.)
5
BlueOptions [Tier] (Blue Cross and Blue Shield of
Florida)
6
BlueSelect [Tier] (Blue Cross and Blue Shield of
Florida)
7
Florida Hospital GYM ACCESS [Tier] (Health
First Commercial Plans, Inc.)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Florida (FL)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
8
Florida Hospital [Tier] (Health First Commercial
Plans, Inc.)
9
Gym Access IND Essential Plus [Tier] (Florida
Health Care Plan, Inc.)
(continued)
Created on 11/07/2017
3
HI5
HEALTHCARE MARKETPLACE PLANS
Florida (FL)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
10
Gym Access IND [Tier] (Florida Health Care
Plan, Inc.)
11
Gym Access IND [Tier] BC (Florida Health Care
Plan, Inc.)
12
Health First GYM ACCESS [Tier] (Health First
Commercial Plans, Inc.)
13
Health First [Tier] (Health First Commercial
Plans, Inc.)
14
IND Essential Plus [Tier] (Florida Health Care
Plan, Inc.)
15
IND [Tier] (Florida Health Care Plan, Inc.)
16
IND [Tier] BC (Florida Health Care Plan, Inc.)
17
IND [Tier] Standardized (Florida Health Care
Plan, Inc.)
(continued)
Created on 11/07/2017
4
HI5
HEALTHCARE MARKETPLACE PLANS
Florida (FL)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
18 Molina Marketplace Options [Tier] (Molina
Healthcare of Florida, Inc)
19 Molina Marketplace [Tier] (Molina Healthcare of
Florida, Inc)
20 myBlue [Tier] (Health Options, Inc.)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Florida (FL)
1 AIDS Drug Assistance Program
2 Florida Discount Drug Card
3 Florida Health Care Access Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Georgia (GA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
BCBSHP MediBlue (Blue Cross Blue Shield
Healthcare Plan of Georgia)
2
Humana Gold Plus (Humana Employers Health
Plan of Georgia, Inc.)
3
Care Improvement Plus Medicare Advantage
(UnitedHealthcare)
4
BCBSGa MediBlue Access (Anthem Blue Cross
and Blue Shield)
5
Kaiser Permanente Senior Advantage (Kaiser
Permanente)
6
Cigna-HealthSpring Preferred NGA
(Cigna-HealthSpring)
7
AARP MedicareComplete Plus Plan
(UnitedHealthcare)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Georgia (GA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
UnitedHealthcare MedicareDirect
(UnitedHealthcare)
9
Cigna-HealthSpring Preferred
(Cigna-HealthSpring)
10
Humana Gold Choice (Humana Insurance
Company)
11
AARP MedicareComplete Plan
(UnitedHealthcare)
12
Aetna Medicare Select Plan (Aetna Medicare)
13
Advantra Preferred (Coventry Health Care)
14
Advantra Platinum (Coventry Health Care)
15
HumanaChoice (Humana Insurance Company)
(continued)
Created on 11/07/2017
3
HI2
MEDICARE ADVANTAGE PLANS
Georgia (GA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
16 Clover Health GA Green (CLOVER HEALTH)
17 Aetna Medicare (Aetna Medicare)
18 Allwell Medicare (Allwell)
19 EON CHOICE (Eon Health)
20 EON SELECT (Eon Health)
21 WellCare (WellCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Georgia (GA)
1
Georgia Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Georgia (GA)
1
Amerigroup Community Care
2
Amerigroup Community Care
3
Amerigroup Community Care
4
Peach State Health Plan
5
Peach State Health Plan
6
WellCare
7
WellCare
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Georgia (GA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Ambetter Balanced Care (Ambetter of Peach
State Inc.)
2
Ambetter Essential Care (Ambetter of Peach
State Inc.)
3
Ambetter Secure Care Free PCP Visits
(Ambetter of Peach State Inc.)
4
BCBSHP [Tier] Pathway Guided Access (Blue
Cross Blue Shield Healthcare Plan of Georgia,
Inc.)
5
BCBSHP [Tier] Pathway X (Blue Cross Blue
Shield Healthcare Plan of Georgia, Inc.)
6
BCBSHP [Tier] Pathway X Guided Access (Blue
Cross Blue Shield Healthcare Plan of Georgia,
Inc.)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Georgia (GA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
7
BCBSHP [Tier] Pathway X Guided Access for
(Blue Cross Blue Shield Healthcare Plan of
Georgia, Inc.)
8
BCBSHP [Tier] Pathway X for (Blue Cross Blue
Shield Healthcare Plan of Georgia, Inc.)
(continued)
Created on 11/07/2017
3
HI5
HEALTHCARE MARKETPLACE PLANS
Georgia (GA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
9
KP GA Signature [Tier] (Kaiser Foundation Health
Plan of Georgia)
10 KP GA Signature [Tier] Std (Kaiser Foundation
Health Plan of Georgia)
11 KP GA [Tier] (Kaiser Foundation Health Plan of
Georgia)
12 KP GA [Tier] Std (Kaiser Foundation Health Plan of
Georgia)
13 SoloCare [Tier] (Alliant Health Plans)
14 SoloCare [Tier] HDHP (Alliant Health Plans)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Georgia (GA)
1
AIDS Drug Assisstance Program
2
Donated Drug Repository Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Iowa (IA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
HealthPartners UnityPoint Health (HealthPartners
UnityPoint Health)
2
Health Alliance Medicare Guide HMO (Health
Alliance Medicare)
3
Medical Associates (Medical Associates Health
Plan, Inc.)
4
AARP MedicareComplete Choice
(UnitedHealthcare)
5
Humana Gold Choice (Humana Insurance
Company)
6
Gundersen Senior Preferred (Senior Preferred)
7
AARP MedicareComplete Plan
(UnitedHealthcare)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Iowa (IA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
AARP MedicareComplete (UnitedHealthcare)
9
HumanaChoice (Humana Insurance Company)
10 Coventry (Coventry Health Care)
11 Humana (CHA HMO, Inc.)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Iowa (IA)
1
Iowa Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Iowa (IA)
1
Magellan Behavioral Health of Iowa
2
Meridian Health Plan of Iowa
3
Multiple primary care providers
4
PACE
5
TMS
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Iowa (IA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Inspire by Medica [Tier] (Medica Insurance Company)
2 Inspire by Medica [Tier] Plus (Medica Insurance
Company)
3 Medica CHI Health [Tier] (Medica Insurance
Company)
4 Medica CHI Health [Tier] Plus (Medica Insurance
Company)
5 Medica Insure [Tier] (Medica Insurance Company)
6 Medica Insure [Tier] Plus (Medica Insurance
Company)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Iowa (IA)
1
AIDS Drug Assistance Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Illinois (IL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Blue Cross Medicare Advantage Choice (Blue
Cross and Blue Shield of IL, NM, OK)
2
Blue Cross Medicare Advantage (Blue Cross
Blue Shield of IL, MT, NM)
3
HealthPartners UnityPoint Health (HealthPartners
UnityPoint Health)
4
Medical Associates (Medical Associates Health
Plan, Inc.)
5
Community (Community Care Alliance of Illinois,
NFP)
6
AARP MedicareComplete Choice Plan
(UnitedHealthcare)
7
UnitedHealthcare MedicareComplete
(UnitedHealthcare)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Illinois (IL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
Health Alliance Medicare (Health Alliance
Medicare)
9
AARP MedicareComplete Choice
(UnitedHealthcare)
10
Humana Gold Choice (Humana Insurance
Company)
11
Humana Gold Plus (Humana Health Plan, Inc.)
12
Aetna Medicare Value Plan (Aetna Medicare)
13
Coventry Total Care (Coventry Health Care)
14
Spartan Plan IL (Sunrise Advantage Plan)
15
AARP MedicareComplete (UnitedHealthcare)
(continued)
Created on 11/07/2017
3
HI2
MEDICARE ADVANTAGE PLANS
Illinois (IL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
16 Cigna-HealthSpring (Cigna-HealthSpring)
17 HumanaChoice (Humana Insurance Company)
18 Advantra Option (Coventry Health Care)
19 Essence Advantage (Essence Healthcare)
20 Gold Advantage (Coventry Health Care)
21 MeridianCare Essential (MeridianCare)
22 Aetna Medicare (Aetna Medicare)
23 Advantra (Coventry Health Care)
24 MeridianCare (MeridianCare)
25 WellCare (WellCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Illinois (IL)
1
Illinois Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Illinois (IL)
1
Advocate Accountable Care
2
Aetna Better Health
3
Aetna Better Health
4
Be Well Partners in Health
5
Better Health Network, LLC
6
Blue Cross Blue Shield of Illinois
7
Blue Cross Blue Shield of Illinois
8
Community Care Alliance of Illinois
9
Community Care Partners, LLC
10
CountyCare
11
CountyCare
12
Family Health Network
13
Family Health Network
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
Illinois (IL)
14
Harmony Health Plan
15
Harmony Health Plan
16
Health Alliance Connect
17
Health Alliance Connect
18
HealthCura, Inc.
19
HealthSpring of Tennessee
20
Healthcare Consortium of Illinois DBA EntireCare
Coordination
21
Humana Health Plan
22
IlliniCare Health Plan
23
IlliniCare Health Plan
24
Illinois Health Connect
25
Illinois Partnership for Health, Inc.
(continued)
Created on 11/07/2017
3
HI4
MEDICAID HMOs
Illinois (IL)
26
La Rabida Children's Hospital
27
Loyola Physician Partners, LLC
28
Lurie Children's Hospital of Chicago
29
Meridian Health Plan
30
Meridian Health Plan
31
Meridian Health Plan
32
Molina Healthcare of Illinois
33
Molina Healthcare of Illinois
34
My Health Care Coordination
35
MyCare Chicago
36
NextLevel Health Partners
37
Precedence CCE
38
SmartPlan Choice
(continued)
Created on 11/07/2017
4
HI4
MEDICAID HMOs
Illinois (IL)
39
Together4Health CCE
40
UI Health Plus
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Illinois (IL)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Ambetter Balanced Care IlliniCare Health
Network (Celtic Insurance Company)
2
Ambetter Balanced Care Standardized IlliniCare
Health Network (Celtic Insurance Company)
3
Ambetter Secure Care Free PCP Visits IlliniCare
Health Network (Celtic Insurance Company)
4
Blue Choice Preferred Security (Blue Cross Blue
Shield of Illinois)
5
Blue Choice Preferred [Tier] (Blue Cross Blue
Shield of Illinois)
6
Blue Choice Preferred [Tier] Two PCP Visits
(Blue Cross Blue Shield of Illinois)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Illinois (IL)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
7
Blue FocusCare [Tier] (Blue Cross Blue Shield of
Illinois)
8
Blue Precision [Tier] (Blue Cross Blue Shield of
Illinois)
(continued)
Created on 11/07/2017
3
HI5
HEALTHCARE MARKETPLACE PLANS
Illinois (IL)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
9
BlueCare Direct [Tier] Advocate (Blue Cross Blue
Shield of Illinois)
10 Cigna Connect (Cigna HealthCare of Illinois, Inc.)
11 Elite [Tier] (Health Alliance Medical Plans, Inc.)
12 Methodist [Tier] (Health Alliance Medical Plans, Inc.)
13 OSF [Tier] (Health Alliance Medical Plans, Inc.)
14 Riverside [Tier] (Health Alliance Medical Plans, Inc.)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Illinois (IL)
1 Access to Care
2 DuPage Physician's Medical Assistance Program
(DPMAP)
3 Illinois Cares Rx Basic and Plus
4 AIDS Drug Assistance Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Indiana (IN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
IU Health Plans Medicare (Indiana University
Health Plans - Medicare)
2
Anthem MediBlue Access Basic (Anthem Blue
Cross and Blue Shield)
3
Reid Health Alliance Medicare HMO (Health
Alliance Medicare)
4
Anthem MediBlue Access (Anthem Blue Cross
and Blue Shield)
5
Anthem MediBlue Plus (Anthem Blue Cross and
Blue Shield)
6
Health Alliance Medicare (Health Alliance
Medicare)
7
Humana Gold Plus (Arcadian Health Plan, Inc.)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Indiana (IN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
Humana Gold Choice (Humana Insurance
Company)
9
AARP MedicareComplete (UnitedHealthcare)
10 HumanaChoice (Humana Insurance Company)
11 MeridianCare Essential (MeridianCare)
12 Aetna Medicare (Aetna Medicare)
13 Allwell Medicare (Allwell)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Indiana (IN)
1
Indiana Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Indiana (IN)
1
Advantage Health Solutions
2
Anthem
3
Anthem
4
MDWise
5
MDWise
6
MDWise
7
Managed Health Services
8
Managed Health Services
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Indiana (IN)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Ambetter Balanced Care (Celtic Insurance
Company)
2
Ambetter Essential Care (Celtic Insurance
Company)
3
Ambetter Secure Care Free PCP Visits (Celtic
Insurance Company)
4
CareSource Federal Simple Choice [Tier]
(CareSource Indiana, Inc.)
5
CareSource Federal Simple Choice [Tier] Dental
and (CareSource Indiana, Inc.)
6
CareSource Hoosier Choice [Tier] (CareSource
Indiana, Inc.)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Indiana (IN)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
7
CareSource Hoosier Choice [Tier] Dental and
(CareSource Indiana, Inc.)
8
CareSource Low Premium [Tier] (CareSource
Indiana, Inc.)
(continued)
Created on 11/07/2017
3
HI5
HEALTHCARE MARKETPLACE PLANS
Indiana (IN)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
9
CareSource Low Premium [Tier] Dental and
(CareSource Indiana, Inc.)
10 CareSource [Tier] (CareSource Indiana, Inc.)
11 CareSource [Tier] Dental and (CareSource Indiana,
Inc.)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Indiana (IN)
1 Indiana Prescription Drug Program, Hoosier RX
2 AIDS Drug Assistance Program
3 Indiana Drug Card
4 Healthy Indiana Plan (HIP)
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Kansas (KS)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Blue Medicare Advantage Access (BCBS of
Kansas City, Blue K)
2
Blue Medicare Advantage (Blue Cross and Blue
Shield of Kansas City (Blue K)
3
UnitedHealthcare MedicareDirect
(UnitedHealthcare)
4
Humana Gold Choice (Humana Insurance
Company)
5
AARP MedicareComplete Plan
(UnitedHealthcare)
6
Advantra Advantage (Coventry Health Care)
7
Cigna-HealthSpring (Cigna-HealthSpring)
8
Advantra Freedom (Coventry Health Care)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Kansas (KS)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9
HumanaChoice (Humana Insurance Company)
10 Erickson Advantage (UnitedHealthcare)
11 Humana (Humana Health Plan, Inc.)
12 Coventry (Coventry Health Care)
13 Allwell Medicare (Allwell)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Kansas (KS)
1
KanCare program
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Kansas (KS)
1 Amerigroup Kansas, Inc.
2 PACE-Midland
3 PACE-Via Christi
4 Sunflower State Health Plan
5 United HealthCare Community Plan of Kansas
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Kansas (KS)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Ambetter Balanced Care (Sunflower State Health
Plan, Inc)
2
Ambetter Essential Care (Sunflower State Health
Plan, Inc)
3
Ambetter Secure Care Free PCP Visits
(Sunflower State Health Plan, Inc)
4
BlueCare Simple [Tier] HDHP (Blue Cross and
Blue Shield of Kansas, Inc.)
5
BlueCare [Tier] (Blue Cross and Blue Shield of
Kansas, Inc.)
6
Medica Connect [Tier] (Medica Insurance
Company)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Kansas (KS)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
7
Medica Connect [Tier] H S (Medica Insurance
Company)
8
Medica Connect [Tier] H SPlus (Medica
Insurance Company)
(continued)
Created on 11/07/2017
3
HI5
HEALTHCARE MARKETPLACE PLANS
Kansas (KS)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
9
Medica Connect [Tier] Plus (Medica Insurance
Company)
10 Select by Medica [Tier] (Medica Insurance
Company)
11 Select by Medica [Tier] H S (Medica Insurance
Company)
12 Select by Medica [Tier] H SPlus (Medica Insurance
Company)
13 Select by Medica [Tier] Plus (Medica Insurance
Company)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Kansas (KS)
1 Kansas AIDS Drug Assistance Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Kentucky (KY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Gateway Health Medicare Assured (Gateway
Health Medicare Assured)
2
Anthem MediBlue Access Basic (Anthem Blue
Cross and Blue Shield)
3
Anthem MediBlue Access (Anthem Blue Cross
and Blue Shield)
4
Anthem MediBlue Plus (Anthem Blue Cross and
Blue Shield)
5
UnitedHealthcare MedicareDirect
(UnitedHealthcare)
6
Humana Community HMO (Humana Medical
Plan, Inc.)
7
Humana Gold Plus (Arcadian Health Plan, Inc.)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Kentucky (KY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
Humana Gold Choice (Humana Insurance
Company)
9
AARP MedicareComplete Plan (UnitedHealthcare)
10 Humana Value Plus (Humana Insurance Company)
11 Aetna Medicare Value Plan (Aetna Medicare)
12 HumanaChoice (Humana Insurance Company)
13 Aetna Medicare (Aetna Medicare)
14 Classic Plus (RiverLink Health)
15 WellCare (WellCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Kentucky (KY)
1
Kentucky Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Kentucky (KY)
1
Anthem Medicaid of Kentucky
2
Coventry Cares
3
Humana Care Source
4
Pass Port Health Plan
5
Well Care of Kentucky
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Kentucky (KY)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Anthem [Tier] Pathway X (Anthem Health Plans
of KY(Anthem BCBS))
2
Anthem [Tier] Pathway X Transition (Anthem
Health Plans of KY(Anthem BCBS))
3
Anthem [Tier] Pathway X for (Anthem Health
Plans of KY(Anthem BCBS))
4
CareSource Federal Simple Choice [Tier]
(CareSource Kentucky Co.)
5
CareSource Federal Simple Choice [Tier] Dental
and (CareSource Kentucky Co.)
6
CareSource Low Premium [Tier] (CareSource
Kentucky Co.)
7
CareSource Low Premium [Tier] Dental and
(CareSource Kentucky Co.)
8
CareSource [Tier] (CareSource Kentucky Co.)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Kentucky (KY)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
9 CareSource [Tier] Dental and (CareSource Kentucky
Co.)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Kentucky (KY)
1 Kentucky AIDS Drug Assistance Program
2 Kentucky Prescription Assistance Program
3 Department of Aging and Independent Living (DAIL)
Disability Assistance
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Louisiana (LA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
AAA4 Vantage TRADITIONAL PLUS (Vantage
Health Plan, Inc.)
2
Humana (Humana Health Benefit Plan of
Louisiana, Inc.)
3
AAA0 Vantage STANDARD (Vantage Health
Plan, Inc.)
4
AAA1 Vantage PREMIUM (Vantage Health Plan,
Inc.)
5
AAA8 Vantage BASIC (Vantage Health Plan,
Inc.)
6
AARP MedicareComplete Plan
(UnitedHealthcare)
7
Aetna Medicare Freedom Plan (Aetna Medicare)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Louisiana (LA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
AAA9 Vantage (Vantage Health Plan, Inc.)
9
HumanaChoice (Humana Insurance Company)
10 Peoples Health Choices (Peoples Health)
11 WellCare Value (WellCare Health Plan)
12 Advantra (Coventry Health Care)
13 Blue Advantage (HMO Louisiana)
14 Allwell Medicare (Allwell)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Louisiana (LA)
1
Healthy Louisiana
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Louisiana (LA)
1
AmeriHealth Caritas Louisiana
2
Amerigroup Louisiana
3
Community Health Solutions
4
LBHP
5
Louisiana Healthcare Connections
6
MCNA
7
PACE - Baton Rouge
8
PACE - Greater New Orleans
9
PACE - Lafayette
10
UnitedHealthcare Community Plan
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Louisiana (LA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Blue (HMO Louisiana, Inc.)
2
Blue Connect L (HMO Louisiana, Inc.)
3
Blue Connect N (HMO Louisiana, Inc.)
4
Blue Connect S (HMO Louisiana, Inc.)
5
Blue Max (Louisiana Health Service & Indemnity
Company)
6
Blue Saver (Louisiana Health
Service & Indemnity Company)
7
Community Blue (HMO Louisiana, Inc.)
8
Signature Blue (HMO Louisiana, Inc.)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Louisiana (LA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
9
Vantage Individual Essential [Tier] (Vantage
Health Plan, Inc.)
10
Vantage Individual Freedom [Tier] (Vantage
Health Plan, Inc.)
(continued)
Created on 11/07/2017
3
HI5
HEALTHCARE MARKETPLACE PLANS
Louisiana (LA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
11 Vantage Individual Savings [Tier] (Vantage Health
Plan, Inc.)
12 Vantage Plus Individual Essential [Tier] (Vantage
Health Plan, Inc.)
13 Vantage Plus Individual Freedom [Tier] (Vantage
Health Plan, Inc.)
14 Vantage Plus Individual Savings [Tier] (Vantage
Health Plan, Inc.)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Louisiana (LA)
1
Louisiana Health Access Program
2
Lousiana SenioRx
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Massachusetts (MA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Health New England Medicare (Health New
England Medicare Advantage Plans)
2
Medicare HMO Blue (Blue Cross Blue Shield of
Massachusetts)
3
Medicare PPO Blue (Blue Cross Blue Shield of
Massachusetts)
4
Harvard Pilgrim Stride (Harvard Pilgrim Health
Care, Inc.)
5
Tufts Medicare Preferred HMO (Tufts Health
Plan)
6
AARP MedicareComplete Choice
(UnitedHealthcare)
7
AARP MedicareComplete Plan
(UnitedHealthcare)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Massachusetts (MA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
Aetna Medicare Freedom Plan (Aetna Medicare)
9
Aetna Medicare Value Plan (Aetna Medicare)
10 Erickson Advantage (UnitedHealthcare)
11 Fallon Senior Plan (Fallon Health)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Massachusetts (MA)
1
MassHealth
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Massachusetts (MA)
1
Boston Medial Center Healthnet Plan
2
Celticare
3
Commonwealth Care Alliance
4
Elder Service Plan East Boston Neighborhood
Health Plan
5
Elder Service Plan at Fallon
6
Elder Service Plan of the Cambridge Hospital
7
Element Care, Inc.
8
Fallon Community Health Plan
9
Fallon Community Health Plan
10
Harbor Community Health Center
11
Health New England
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
Massachusetts (MA)
12 Massachusetts Behavioral Health Partnership
13 Mercy Life, Inc.
14 Neighborhood Health Plan
15 Network Health
16 Primary Care Clinician
17 Senior Whole Health
18 Serenity Care PACE Program
19 Tufts Health Plan
20 UPHAMS's Elder Service Plan
21 United HealthCare
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Massachusetts (MA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Only state-operated exchanges serve Massachusetts
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Massachusetts (MA)
1 Massachusetts Prescription Advantage Plan
2 HIV Drug Assistance Program
3 Health Safety Net
4 Commonwealth Care
5 CenterCare
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Maryland (MD)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
University of Maryland Health Advantage
Complete
2
Kaiser Permanente Medicare Advantage (Kaiser
Permanente)
3
Johns Hopkins Advantage MD (Johns Hopkins
HealthCare)
4
MedStar Medicare Choice (MedStar Family
Choice, Inc)
5
Kaiser Permanente Medicare Plus (Kaiser
Permanente)
6
Aetna Medicare Connect Plus (Aetna Medicare)
7
Cigna-HealthSpring (Cigna-HealthSpring)
8
HumanaChoice (Humana Insurance Company)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Maryland (MD)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9 Erickson Advantage (UnitedHealthcare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Maryland (MD)
1
Maryland Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Maryland (MD)
1
Amerigroup Community Plan
2
Hopkins Elder Plus
3
Jai Medical Systems
4
Kaiser Permanente
5
Maryland Physicians Care
6
MedStar Family Choice
7
Priority Partners
8
Riverside Health of Maryland
9
UnitedHealthCare
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Maryland (MD)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Only state-operated exchanges serve Maryland
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Maryland (MD)
1 Senior Prescription Drug Assistance Program
2 Maryland Kidney Disease Program
3 Maryland AIDS Drug Assistance Program
4 Primary Adult Care Program (PAC)
5 Maryland Health Insurance Plan (MHIP)
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Michigan (MI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Blue Cross Medicare Private Fee for Service
(Blue Cross Blue Shield of Michigan)
2
Medicare Plus Blue PPO (Blue Cross Blue Shield
of Michigan)
3
Upper Peninsula Health Plan (Upper Peninsula
Health Plan)
4
Humana Gold Plus (Humana Medical Plan of
Michigan, Inc.)
5
HAP Senior Plus Option (HAP Senior Plus
(PPO))
6
Humana Gold Choice (Humana Insurance
Company)
7
Humana Value Plus (Humana Insurance
Company)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Michigan (MI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
PriorityMedicare (Priority Health Medicare)
9
HumanaChoice (Humana Insurance Company)
10 Erickson Advantage (UnitedHealthcare)
11 BCN Advantage (Blue Care Network)
12 HAP Senior Plus (HAP Senior Plus)
13 Paramount Elite (Paramount Elite)
14 Aetna Medicare (Aetna Medicare)
15 MeridianCare (MeridianCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Michigan (MI)
1 Michigan Department of Health and Human Service
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Michigan (MI)
1
Blue Cross Complete
2
Blue Cross Complete of Michigan
3
CMH Partnership of Southeast MI
4
Care Resources
5
CentraCare
6
CoventryCares of Michigan
7
CoventryCares of Michigan
8
Detroit Wayne Mental Health Authority
9
HAP Midwest Health Plan
10
HAP Midwest Health Plan
11
Harbor Health Plan
12
Harbor Health Plan
13
HealthPlus Partners Inc.
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
Michigan (MI)
14
HealthPlus Partners, Inc.
15
Healthy Kids Dental
16
Huron Valley PACE
17
Lakeshore Regional Entity
18
Life Circles
19
Macomb County CMH Services
20
McLaren Health Plan
21
McLaren Health Plan
22
Meridian Health Plan
23
Meridian Health Plan of Michigan, Inc.
24
Mid-State Health Network
25
Molina Healthcare of Michigan
26
Molina Healthcare of Michigan
(continued)
Created on 11/07/2017
3
HI4
MEDICAID HMOs
Michigan (MI)
27
NorthCare Network
28
Northern Michigan Regional Entity
29
Oakland County CMH Authority
30
PACE of Southeast MI
31
PACE of Southwest MI
32
PHP of Mid-Michigan FamilyCare
33
PHP of Mid-Michigan FamilyCare
34
Priority Health Choice, Inc.
35
Priority Health Choice, Inc.
36
Region 10 PIHP
37
Southwest Michigan Behaviorial Health
38
Total Health Care
39
Total Health Care
(continued)
Created on 11/07/2017
4
HI4
MEDICAID HMOs
Michigan (MI)
40
UnitedHealthcare Community Plan
41
UnitedHealthcare Community Plan, Inc.
42
Upper Peninsula Health Plan
43 Upper Peninsula Health Plan
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Michigan (MI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Blue Cross® Metro Detroit [Tier] (Blue Care
Network of Michigan)
2
Blue Cross® Metro Detroit [Tier] Extra (Blue Care
Network of Michigan)
3
Blue Cross® Metro Detroit [Tier] Saver (Blue
Care Network of Michigan)
4
Blue Cross® Preferred [Tier] (Blue Care Network
of Michigan)
5
Blue Cross® Preferred [Tier] Extra (Blue Care
Network of Michigan)
6
Blue Cross® Preferred [Tier] Saver (Blue Care
Network of Michigan)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Michigan (MI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
7
Blue Cross® Premier Value (Blue Cross Blue
Shield of Michigan Mutual Insurance Company)
8
Blue Cross® Premier [Tier] (Blue Cross Blue
Shield of Michigan Mutual Insurance Company)
(continued)
Created on 11/07/2017
3
HI5
HEALTHCARE MARKETPLACE PLANS
Michigan (MI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
9
Blue Cross® Premier [Tier] Extra (Blue Cross
Blue Shield of Michigan Mutual Insurance
Company)
10
Blue Cross® Premier [Tier] Saver (Blue Cross
Blue Shield of Michigan Mutual Insurance
Company)
11
Blue Cross® Select Value (Blue Care Network of
Michigan)
12
Blue Cross® Select [Tier] (Blue Care Network of
Michigan)
13
Blue Cross® Select [Tier] Extra (Blue Care
Network of Michigan)
14
Blue Cross® Select [Tier] Saver (Blue Care
Network of Michigan)
(continued)
Created on 11/07/2017
4
HI5
HEALTHCARE MARKETPLACE PLANS
Michigan (MI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
15
McLaren Young Adult[Tier] (McLaren Health Plan
Community)
16
McLaren [Tier] (McLaren Health Plan
Community)
(continued)
Created on 11/07/2017
5
HI5
HEALTHCARE MARKETPLACE PLANS
Michigan (MI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
17
McLaren [Tier] Standard (McLaren Health Plan
Community)
18
Meridian Healthy [Tier] (Meridian Health Plan of
Michigan, Inc.)
19
Meridian Savings [Tier] (Meridian Health Plan of
Michigan, Inc.)
20
Meridian Smart [Tier] (Meridian Health Plan of
Michigan, Inc.)
21
Meridian [Tier] (Meridian Health Plan of
Michigan, Inc.)
22
Molina Marketplace Options [Tier] (Molina
Healthcare of Michigan, Inc.)
23
Molina Marketplace [Tier] (Molina Healthcare of
Michigan, Inc.)
(continued)
Created on 11/07/2017
6
HI5
HEALTHCARE MARKETPLACE PLANS
Michigan (MI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
24
MyPriority [Tier] (Priority Health)
25
MyPriority [Tier] Beaumont Health Network
(Priority Health)
(continued)
Created on 11/07/2017
7
HI5
HEALTHCARE MARKETPLACE PLANS
Michigan (MI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
26
MyPriority [Tier] Bronson Healthcare Partners
(Priority Health)
27
MyPriority [Tier] Spectrum Health Partners
(Priority Health)
28
MyPriority [Tier] St John Providence Network
(Priority Health)
29
MyPriority [Tier] St Joseph Mercy Health System
Network (Priority Health)
30
Sparrow PHP Healthy (Physicians Health Plan)
31
Sparrow PHP [Tier] (Physicians Health Plan)
32
Sparrow PHP [Tier] Basic (Physicians Health
Plan)
33
Sparrow PHP [Tier] Basic Exclusive (Physicians
Health Plan)
(continued)
Created on 11/07/2017
8
HI5
HEALTHCARE MARKETPLACE PLANS
Michigan (MI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
34
Sparrow PHP [Tier] Exclusive (Physicians Health
Plan)
35
Sparrow PHP [Tier] HDHP Exclusive (Physicians
Health Plan)
36
Total Saver Complete (Total Health Care USA,
Inc.)
37
Total Saver Plus (Total Health Care USA, Inc.)
38
Total Standard (Total Health Care USA, Inc.)
39
Totally You (Total Health Care USA, Inc.)
40
Totally You Complete (Total Health Care USA,
Inc.)
41
Totally You Simple Choice (Total Health Care
USA, Inc.)
(continued)
Created on 11/07/2017
9
HI5
HEALTHCARE MARKETPLACE PLANS
Michigan (MI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
42 Totally You Value (Total Health Care USA, Inc.)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Michigan (MI)
1 Michigan Drug Assistance Program (MIDAP)
2 Elder Prescription Insurance Program (EPIC)
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Minnesota (MN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Blue Cross Medicare Advantage (Blue Cross
Blue Shield of Minnesota)
2
Platinum Blue (Blue Cross and Blue Shield of
Minnesota)
3
Medica Advantage Solution Edge (Medica Health
Plans)
4
Medica Prime Solution (Medica Insurance
Company)
5
Gundersen MN Senior Preferred (Senior
Preferred)
6
HealthPartners Journey Stride (HealthPartners)
7
Humana Gold Choice (Humana Insurance
Company)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Minnesota (MN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
HealthPartners Freedom (HealthPartners)
9
HumanaChoice (Humana Insurance Company)
10 EssentiaCare (EssentiaCare)
11 UCare for Seniors (UCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Minnesota (MN)
1
Minnesota Medical Assistance
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Minnesota (MN)
1
Blue Plus
2
Blue Plus
3
Blue Plus
4
Health Partners
5
Health Partners
6
Health Partners
7
Hennepin Health
8
Itasca Medical Care
9
Itasca Medical Care
10
Itasca Medical Care
11
Medica
12
Medica
13
Medica
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
Minnesota (MN)
14
Medica
15
Metropolitan Health
16
Metropolitan Health
17
Metropolitan Health
18
Passport to Health-Multiple Primary Care
Providers
19
Prime West Health
20
Prime West Health
21
Prime West Health
22
Prime West Health
23
South Country Health
24
South Country Health
25
South Country Health
(continued)
Created on 11/07/2017
3
HI4
MEDICAID HMOs
Minnesota (MN)
26
South Country Health
27
U Care
28
U Care
29
U Care
30
U Care
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Minnesota (MN)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Only state-operated exchanges serve Minnesota
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Minnesota (MN)
1 Minnesota AIDS Drug Assistance Program (ADAP)
2 MinnesotaCare
3 Minnesota's General Assistance Medical Care
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Missouri (MO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Missouri Department Of Transportation/Highway
Patrol Plan
2
Blue Medicare Advantage Access (BCBS of
Kansas City, Blue K)
3
Blue Medicare Advantage (Blue Cross and Blue
Shield of Kansas City (Blue K)
4
Care Improvement Plus Medicare Advantage
(UnitedHealthcare)
5
Anthem MediBlue Access (Anthem Blue Cross
and Blue Shield)
6
Anthem MediBlue Plus (Anthem Blue Cross and
Blue Shield)
7
AARP MedicareComplete Choice Plan
(UnitedHealthcare)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Missouri (MO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
UnitedHealthcare MedicareDirect
(UnitedHealthcare)
9
Humana Gold Choice (Humana Insurance
Company)
10
CoxHealth MedicarePlus (Essence Healthcare)
11
Humana Gold Plus (Humana Health Plan, Inc.)
12
AARP MedicareComplete (UnitedHealthcare)
13
Cigna-HealthSpring (Cigna-HealthSpring)
14
HumanaChoice (Humana Insurance Company)
15
Essence Advantage (Essence Healthcare)
16
Gold Advantage (Coventry Health Care)
(continued)
Created on 11/07/2017
3
HI2
MEDICARE ADVANTAGE PLANS
Missouri (MO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
17
Advantra (Coventry Health Care)
18
Coventry (Coventry Health Care)
19
Allwell Medicare (Allwell)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Missouri (MO)
1
MO HealthNet
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Missouri (MO)
1
Alexian Brothers Community Services
2
HealthCare USA Central
3
HealthCare USA Eastern
4
HealthCare USA Western
5
Home State Central
6
Home State Eastern
7
Home State Western
8
Logisticare Solutions
9
Missouri Care Central
10
Missouri Care Eastern
11
Missouri Care Western
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Missouri (MO)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Ambetter Balanced Care (Celtic Insurance Company)
2 Ambetter Essential Care (Celtic Insurance Company)
3 Ambetter Secure Care Free PCP Visits (Celtic
Insurance Company)
4 Anthem [Tier] Pathway X (Healthy Alliance Life
Co(Anthem BCBS))
5 Anthem [Tier] Pathway X for (Healthy Alliance Life
Co(Anthem BCBS))
6 Cigna Connect (Cigna Health and Life Insurance
Company)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Missouri (MO)
1 Missouri Rx Plan (MoRx)
2 Missouri AIDS Drug Assistance Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
North Carolina (NC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Blue Medicare PPO Enhanced (Blue Cross and
Blue Shield of North Carolina)
2
Gateway Health Medicare Assured (Gateway
Health Medicare Assured)
3
Blue Medicare HMO (Blue Cross and Blue Shield
of North Carolina)
4
Humana Gold Plus (Humana WI Health
Organization Insurance Corp)
5
FirstMedicare Direct PPO Plus (FirstMedicare
Direct)
6
Cigna-HealthSpring Preferred
(Cigna-HealthSpring)
7
HealthTeam Advantage Plan (HealthTeam
Advantage)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
North Carolina (NC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
AARP MedicareComplete Choice (UnitedHealthcare)
9
Humana Gold Choice (Humana Insurance
Company)
10 FirstMedicare Direct (FirstMedicare Direct)
11 AARP MedicareComplete (UnitedHealthcare)
12 HumanaChoice (Humana Insurance Company)
13 Erickson Advantage (UnitedHealthcare)
14 Aetna Medicare (Aetna Medicare)
15 WellCare Value (WellCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
North Carolina (NC)
1
Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
North Carolina (NC)
1
Alliance Behavioral Healthcare
2
CCNC/CA Carolina ACCESS
3
Cardinal Innovations Healthcare Solutions
4
Carolina Senior CARE
5
Center Point Human Services
6
Eastpointe
7
Elderhaus
8
Health Management
9
Life St. Joseph of the Pine
10
Multiple Primary Care Proivders
11
PACE
12
PACE @ HOME
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
North Carolina (NC)
13 PACE of the Southern Piedmont
14 PACE of the TRIAD
15 Partners Behavioral Health Management
16 Piedmont Health Senior Care
17 Sandhills Center
18 Senior Total Life Care
19 Smoky Mountain Center
20 Trillium Health Resources
21 VOANX Senior Community Care of North Carolina
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
North Carolina (NC)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Blue Advantage [Tier] broad network (Blue Cross and
Blue Shield of NC)
2 Blue Advantage broad network (Blue Cross and Blue
Shield of NC)
3 Blue Local local network Carolinas HealthCare
System (Blue Cross and Blue Shield of NC)
4 Blue Local local network Duke Health and WakeMed
(Blue Cross and Blue Shield of NC)
5 Blue Select tiered network (Blue Cross and Blue
Shield of NC)
6 Blue Value [Tier] limited network (Blue Cross and
Blue Shield of NC)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
North Carolina (NC)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
7 Blue Value limited network (Blue Cross and Blue
Shield of NC)
8 Cigna Connect (Cigna HealthCare of North Carolina,
Inc.)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
North Carolina (NC)
1 North Carolina AIDS Drug Assistance Program
2 Med-assist
3 Premium Assistance Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Nebraska (NE)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
The Uprehs Prime Medicare Plan (Union Pacific
Railroad Employes Health Systems)
2
Blue Cross Blue Shield Nebraska MA (Blue
Cross and Blue Shield of Nebraska)
3
UnitedHealthcare MedicareDirect
(UnitedHealthcare)
4
Humana Gold Plus (Arcadian Health Plan, Inc.)
5
Humana Gold Choice (Humana Insurance
Company)
6
Coventry Advantra (Coventry Health Care)
7
AARP MedicareComplete (UnitedHealthcare)
8
HumanaChoice (Humana Insurance Company)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Nebraska (NE)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9
Classic Plus (HeartlandPlains Health)
10
Coventry (Coventry Health Care)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Nebraska (NE)
1
Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Nebraska (NE)
1 Amerihealth Caritas (D.B.A. Arbor Health Plan)
2 Coventry Health Care of Nebraska (D.B.A. Aetna)
3 Immanuel Pathways
4 Magellan Health
5 United Health Care of Nebraska
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Nebraska (NE)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Medica CHI Health [Tier] (Medica Insurance
Company)
2 Medica CHI Health [Tier] Plus (Medica Insurance
Company)
3 Medica Insure [Tier] (Medica Insurance Company)
4 Medica Insure [Tier] Plus (Medica Insurance
Company)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Nebraska (NE)
1
AIDS Drug Assistance Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
New Jersey (NJ)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1 Horizon Medicare Blue (Horizon Blue Cross Blue
Shield of New Jersey)
2 Amerivantage Balance (Amerigroup Community
Care)
3 Aetna Medicare NJ Silver Plan (Aetna Medicare)
4 Psers Hop (Employer Pdp) (Psers Hop Program)
5 AARP MedicareComplete (UnitedHealthcare)
6 Erickson Advantage (UnitedHealthcare)
7 Clover Health NJ (CLOVER HEALTH)
8 Aetna Medicare (Aetna Medicare)
9 WellCare Value (WellCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
New Jersey (NJ)
1
New Jersey FamilyCare
Created on 11/07/2017
1
HI4
MEDICAID HMOs
New Jersey (NJ)
1
Amerigroup
2
Amerivantage Specialty +
3
Blue Cross Blue Shield of NM
4
Healthfirst NJ Maximum Plan
5
Horizon Medicare Blue Totalcare
6
Horizon NJ Health
7
Inspira LIFE
8
LIFE
9
LIFE at Lourdes
10
LogistiCare
11
Lutheran Senior LIFE Jersey City
12
Presbyterian Health Plan
13
UnitedHealthcare Community Plan
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
New Jersey (NJ)
14
WellCare Health Plans of NJ, Inc.
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
New Jersey (NJ)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Backup [Tier] (Oscar Garden State Insurance
Corporation)
2
Classic Secure (Oscar Garden State Insurance
Corporation)
3
Classic [Tier] (Oscar Garden State Insurance
Corporation)
4
Horizon Advantage Essentials (Horizon
Healthcare Services, Inc.)
5
Horizon Advantage [Tier] (Horizon Healthcare
Services, Inc.)
6
IHC Local Value Simple Saver (AmeriHealth Ins
Company of New Jersey)
7
IHC [Tier] AmeriHealth Advantage (AmeriHealth
Ins Company of New Jersey)
8
IHC [Tier] Local Value (AmeriHealth HMO, Inc.)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
New Jersey (NJ)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
9
IHC [Tier] Local Value (AmeriHealth Ins Company of
New Jersey)
10 IHC [Tier] Regional Preferred (AmeriHealth HMO,
Inc.)
11 IHC [Tier] Regional Preferred (AmeriHealth Ins
Company of New Jersey)
12 IHC [Tier] Regional Preferred Coins (AmeriHealth
Ins Company of New Jersey)
13 IHC [Tier] Tier Advantage (AmeriHealth Ins
Company of New Jersey)
14 OMNIA [Tier] (Horizon Healthcare Services, Inc.)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
New Jersey (NJ)
1 New Jersey Pharmaceutical Assistance for the Aged
and Disabled (PAAD)
2 New Jersey Senior Gold Prescription Discount
Program
3 AIDS Drug Distribution Program
4 Hospital Care Payment Assistance Program
5 NJ WorkAbility
6 New Jersey Hospital Care Payment Assistance
Program (Charity Care)
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
New Mexico (NM)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Blue Cross Medicare Advantage Choice Plus
(BCBS of IL, NM, OK)
2
Presbyterian MediCare PPO Plan (Presbyterian
Insurance Company, Inc.)
3
Blue Cross Medicare Advantage (Blue Cross
Blue Shield of IL, MT, NM)
4
CHRISTUS Health Plan Generations (CHRISTUS
Health Plan Generations)
5
Molina Medicare Options (Molina Healthcare of
New Mexico, Inc.)
6
Amerivantage Classic (Amerigroup Community
Care of New Mexico)
7
Presbyterian Senior Care Plan (Presbyterian
Health Plan)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
New Mexico (NM)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
AARP MedicareComplete Choice (UnitedHealthcare)
9
Humana Gold Choice (Humana Insurance
Company)
10 Humana Gold Plus (Humana Health Plan, Inc.)
11 AARP MedicareComplete (UnitedHealthcare)
12 HumanaChoice (Humana Insurance Company)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
New Mexico (NM)
1
Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
New Mexico (NM)
1 Innovage Greater New Mexico PACE dba Total
Community Care
2 Molina Healthcare of New Mexico Inc
3 UnitedHealthcare Community Plan
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
New Mexico (NM)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Blue Community Security (Blue Cross Blue
Shield of New Mexico)
2
Blue Community [Tier] (Blue Cross Blue Shield of
New Mexico)
3
Blue Community [Tier] Three PCP Visits (Blue
Cross Blue Shield of New Mexico)
4
Blue Community [Tier] Two PCP Visits (Blue
Cross Blue Shield of New Mexico)
5
Care Connect HDHP [Tier] (New Mexico Health
Connections)
6
Care Connect [Tier] (New Mexico Health
Connections)
7
Care Connect [Tier] Plus (New Mexico Health
Connections)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
New Mexico (NM)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
8
Molina Marketplace [Tier] (Molina Healthcare of
New Mexico, Inc.)
9
New Mexico [Tier] (CHRISTUS Health Plan)
(continued)
Created on 11/07/2017
3
HI5
HEALTHCARE MARKETPLACE PLANS
New Mexico (NM)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
10 New Mexico [Tier] HD (CHRISTUS Health Plan)
11 New Mexico [Tier] LD (CHRISTUS Health Plan)
12 New Mexico [Tier] S (CHRISTUS Health Plan)
13 New Mexico [Tier] SLD (CHRISTUS Health Plan)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
New Mexico (NM)
1 New Mexico Department of Health AIDS Drug
Assistance Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Nevada (NV)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Humana Gold Plus (Humana WI Health
Organization Insurance Corp)
2
AARP MedicareComplete Plan
(UnitedHealthcare)
3
Senior Care Plus: Freedom (Senior Care Plus)
4
Anthem (Anthem Blue Cross and Blue Shield)
5
Senior Care Plus: Value (Senior Care Plus)
6
HumanaChoice (Humana Insurance Company)
7
Senior Dimensions (UnitedHealthcare)
8
Prominence (Prominence Health Plan)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Nevada (NV)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9
Aetna Medicare (Aetna Medicare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Nevada (NV)
1
Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Nevada (NV)
1
Amerigroup Community Care
2
Axis Point Health
3
Health Plan of Nevada
4
Logisticare
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Nevada (NV)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Ambetter Balanced Care (SilverSummit Healthplan,
Inc.)
2 Ambetter Essential Care (SilverSummit Healthplan,
Inc.)
3 Ambetter Secure Care Free PCP Visits (SilverSummit
Healthplan, Inc.)
4 MyHPN [Tier] (Health Plan of Nevada, Inc.)
5 MyHPN [Tier] Transition (Health Plan of Nevada, Inc.)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Nevada (NV)
1
Ryan White Part B Program
2
Nevada Disability Rx
3
Nevada Senior Rx
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
New York (NY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
BlueCross BlueShield Forever Blue (BCBS of
WNY and BlueShield of NEN)
2
BlueShield Forever Blue (BlueCross BlueShield
of WNY and BlueShield of NEN)
3
BlueCross BlueShield (BlueCross BlueShield of
WNY and BlueShield of NEN)
4
Today's Options Advantage (Universal American,
A WellCare Company)
5
Today's Options Premier (Universal American, A
WellCare Company)
6
BlueShield (BlueCross BlueShield of WNY and
BlueShield of NEN)
7
Affinity Medicare Passport Essentials (Affinity
Health Plan)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
New York (NY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
UnitedHealthcare MedicareComplete Choice
(UnitedHealthcare)
9
Humana Gold Plus (Humana Health Company of
New York, Inc.)
10
VNSNY CHOICE Medicare Classic (VNSNY
CHOICE Medicare)
11
HumanaChoice (Humana Insurance Company of
New York)
12
Univera SeniorChoice (Excellus Health Plan, Inc)
13
EmblemHealth VIP (EmblemHealth Medicare
HMO)
14
GoldSecure with Part D (MVP HEALTH CARE)
15
WellSelect with Part D (MVP HEALTH CARE)
(continued)
Created on 11/07/2017
3
HI2
MEDICARE ADVANTAGE PLANS
New York (NY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
16
AARP MedicareComplete (UnitedHealthcare)
17
Healthfirst (Healthfirst Medicare Plan)
18
GoldValue with Part D (MVP HEALTH CARE)
19
BasiCare with Part D (MVP HEALTH CARE)
20
Gold PPO with Part D (MVP HEALTH CARE)
21
Medicare (Excellus Health Plan, Inc)
22
Elderplan Extra Help (Elderplan)
23
Independent (Independent Health)
24
Preferred Gold (MVP HEALTH CARE)
25
Aetna Medicare (Aetna Medicare)
26
Fidelis Medicare (Fidelis Care)
(continued)
Created on 11/07/2017
4
HI2
MEDICARE ADVANTAGE PLANS
New York (NY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
27
CDPHP (CDPHP Medicare Choices)
28
WellCare (WellCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
New York (NY)
1
New York Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
New York (NY)
1
Aetna Better Health
2
Affinity Health Plan
3
Affinity Health Plan
4
Affinity Health Plan
5
Affinity/Medicaid Advantage
6
AgeWell New York
7
AlphaCare/Managed Long Term Care
8
AmeriGroup
9
AmeriGroup
10
AmeriGroup
11
AmeriGroup Advantage Plus/Medicaid Advantage
Plus
12
AmeriGroup Community Connections
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
New York (NY)
13
AmidaCare Special Needs
14
AmidaCare Special Needs
15
ArchCare Community Life
16
ArchCare Senior Life
17
Capital District Physician's Health Plan
18
Capital District Physician's Health Plan
19
Capital District Physician's Health Plan
20
Catholic Health - Life
21
CenterLight
22
CenterLight Select
23
Centers Plan for Healthy Living/Managed Long
Term Care
24
Complete Senior Care
(continued)
Created on 11/07/2017
3
HI4
MEDICAID HMOs
New York (NY)
25
Eddy Senior Care
26
ElderPlan/Managed Long Term Care
27
ElderPlan/Medicaid Advantage
28
ElderPlan/Medicaid Advantage Plus
29
Elderserve
30
ErieNiagara/Managed Long Term Care
31
Excellus
32
Excellus
33
Excellus
34
Extended MLTC/Managed Long Term Care
35
Fidelis Care at Home
36
GuildNet
37
GuildNet/Medicaid Advantage Plus
(continued)
Created on 11/07/2017
4
HI4
MEDICAID HMOs
New York (NY)
38
HHH Choices
39
HHH Choices/Medicaid Advantage Plus
40
HIP Combined
41
HIP Combined
42
HIP Combined
43
HIP UFT
44
HIP of Greater NY
45
HIP of Greater NY
46
HIP/Managed Long Term Care
47
Hamaspik Choice/Managed Long Term Care
48
Health Advantage/Elant Choice
49
HealthFirst
50
HealthFirst
(continued)
Created on 11/07/2017
5
HI4
MEDICAID HMOs
New York (NY)
51
HealthFirst
52
HealthFirst/Medicaid Advantage Plus
53
HealthNow
54
HealthNow
55
HealthNow
56
Hudson Health Plan
57
Hudson Health Plan
58
Hudson Health Plan
59
Independent Care Systems
60
Independent Health/Hudson Valley & WNY
61
Independent Health/Hudson Valley & WNY
62
Independent Health/HudsonValley & WNY
63
Independent Living for Seniors
(continued)
Created on 11/07/2017
6
HI4
MEDICAID HMOs
New York (NY)
64
Integra/Managed Long Term Care
65
Liberty Healyh Advantage/Medicaid Advantage
66
MVP Health Plan
67
MVP Health Plan
68
MVP Health Plan
69
Managed Health Inc./Medicaid Advantage
70
MetroPlus Health Plan
71
MetroPlus Health Plan
72
MetroPlus Health Plan
73
MetroPlus Health Plan Special Needs
74
MetroPlus Health Plan Special Needs
75
MetroPlus/Managed Long Term Care
(continued)
Created on 11/07/2017
7
HI4
MEDICAID HMOs
New York (NY)
76
MetroPlus/Medicaid Advantage
77
Montefiore HMO/Managed Long Term Care
78
NYS Catholic Health Plan/Fidelis
79
NYS Catholic Health Plan/Fidelis
80
NYS Catholic Health Plan/Fidelis
81
NYS Catholic Health Plan/Medicaid Advantage
82
NYS Catholic Health Plan/Medicaid Advantage
Plus
83
North Shore - LIJ Health Plan/Managed Long
Term Care
84
PACE CNY
85
Prime Health Choice
86
SCHC Total Care
(continued)
Created on 11/07/2017
8
HI4
MEDICAID HMOs
New York (NY)
87
Senior Health Partners
88
Senior Netwok Health
89
Senior Whole Health/Managed Long Term Care
90
Senior Whole Health/Medicaid Advantage Plus
91
Today's Options
92
Today's Options
93
Todays Option
94
Total Aging in Place
95
Total Senior Care
96
Touchstone/Prestige/Medicaid Advantage
97
United HealthCare
98
United HealthCare
(continued)
Created on 11/07/2017
9
HI4
MEDICAID HMOs
New York (NY)
99
United HealthCare
100
United HealthCare/Managed Long Term Care
101
United HealthCare/Medicaid Advantage
102
Univera Community Health
103
Univera Community Health
104
Univera Community Health
105
VNA HomeCare Options/Managed Long Term
Care
106
VNS Choice
107
VNS Choice Plus/Medicaid Advantage Plus
108
VNS Choice Special Needs
109
VNS Choice Special Needs
110
VNS Choice/Medicaid Advantage
(continued)
Created on 11/07/2017
10
HI4
MEDICAID HMOs
New York (NY)
111
Village Care
112
WellCare
113
WellCare
114
WellCare
115
WellCare Advocate
116
WellCare/Medicaid Advantage
117
WellCare/Medicaid Advantage Plus
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
New York (NY)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Only state-operated exchanges serve New York
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
New York (NY)
1 AIDS Drug Assistance Program
2 New York Elderly Pharmaceutical Insurance
Coverage (EPIC)
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Ohio (OH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Gateway Health Medicare Assured (Gateway
Health Medicare Assured)
2
Reid Health Alliance Medicare HMO (Health
Alliance Medicare)
3
Anthem MediBlue Access (Anthem Blue Cross
and Blue Shield)
4
The Health Plan SecureChoice - Option II (The
Health Plan)
5
SummaCare Medicare (SummaCare Medicare
Advantage Plans)
6
Humana (Humana WI Health Organization
Insurance Corp)
7
The Health Plan SecureCare - Option (The
Health Plan)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Ohio (OH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
Anthem MediBlue (Anthem Blue Cross and Blue
Shield)
9
Aetna Medicare OH Connect Gold (Aetna
Medicare)
10
Premier Health Advantage (Premier Health Plan)
11
Humana Gold Choice (Humana Insurance
Company)
12
PrimeTime Health Plan (PrimeTime Health Plan)
13
AARP MedicareComplete Plan
(UnitedHealthcare)
14
MedMutual Advantage (Medical Mutual of Ohio)
(continued)
Created on 11/07/2017
3
HI2
MEDICARE ADVANTAGE PLANS
Ohio (OH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
15 HumanaChoice (Humana Insurance Company)
16 Advantra Silver (Coventry Health Care)
17 MediGold Flexible Choice (MediGold)
18 CareSource Advantage (CareSource)
19 Paramount Elite (Paramount Elite)
20 UPMC for Life (UPMC Health Plan)
21 Aetna Medicare (Aetna Medicare)
22 Classic Plus (RiverLink Health)
23 MeridianCare (MeridianCare)
24 Allwell Medicare (Allwell)
25 MediGold (MediGold)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Ohio (OH)
1
Ohio Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Ohio (OH)
1 Buckeye Health Plan
2 CareSource
3 McGregor PACE
4 Molina Healthcare of Ohio
5 Paramount Advantage
6 TriHealth Senior Link
7 United Healthcare Community Plan of Ohio
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Ohio (OH)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Ambetter Balanced Care (Buckeye Community
Health Plan)
2
Ambetter Secure Care Free PCP Visits (Buckeye
Community Health Plan)
3
AultCare [Tier] (AultCare Insurance Company)
4
AultCare [Tier] Select (AultCare Insurance
Company)
5
AultCare [Tier] Standard Select (AultCare
Insurance Company)
6
CareSource Federal Simple Choice [Tier]
(CareSource)
7
CareSource Federal Simple Choice [Tier] Dental
and (CareSource)
8
CareSource Low Premium [Tier] (CareSource)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Ohio (OH)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
9
CareSource Low Premium [Tier] Dental and
(CareSource)
10
CareSource [Tier] (CareSource)
11
CareSource [Tier] Dental and (CareSource)
12
Classic [Tier] (Oscar Insurance Corporation of
Ohio)
13
Market Mercy (Medical Health Insuring Corp. of
Ohio)
14
Market NE Ohio (Medical Health Insuring Corp.
of Ohio)
15
Market OhioHealth (Medical Health Insuring
Corp. of Ohio)
(continued)
Created on 11/07/2017
3
HI5
HEALTHCARE MARKETPLACE PLANS
Ohio (OH)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
16
Market ProMedica (Medical Health Insuring Corp.
of Ohio)
17
Market Young Adult Essentials Mercy (Medical
Health Insuring Corp. of Ohio)
(continued)
Created on 11/07/2017
4
HI5
HEALTHCARE MARKETPLACE PLANS
Ohio (OH)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
18
Market Young Adult Essentials NE Ohio (Medical
Health Insuring Corp. of Ohio)
19
Market Young Adult Essentials OhioHealth
(Medical Health Insuring Corp. of Ohio)
20
Market Young Adult Essentials ProMedica
(Medical Health Insuring Corp. of Ohio)
21
Molina Marketplace Options [Tier] (Molina
Healthcare of Ohio, Inc.)
22
Molina Marketplace [Tier] (Molina Healthcare of
Ohio, Inc.)
23
Paramount [Tier] (Paramount Insurance
Company)
(continued)
Created on 11/07/2017
5
HI5
HEALTHCARE MARKETPLACE PLANS
Ohio (OH)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
24
Saver [Tier] (Oscar Insurance Corporation of
Ohio)
25
Simple Secure (Oscar Insurance Corporation of
Ohio)
(continued)
Created on 11/07/2017
6
HI5
HEALTHCARE MARKETPLACE PLANS
Ohio (OH)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
26 Simple [Tier] (Oscar Insurance Corporation of Ohio)
27 SummaCare Value SCConnect Network and Free
PCP Visits (Summa Insurance Company, Inc.)
28 SummaCare [Tier] SCConnect Network (Summa
Insurance Company, Inc.)
29 SummaCare [Tier] SCConnect Network and Free
PCP Visits (Summa Insurance Company, Inc.)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Ohio (OH)
1 Ohio HIV Drug Assistance Program (OHDAP)
2 Ohio's Best Rx
3 Ohio Healthy Families
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Oklahoma (OK)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Blue Cross Medicare Advantage Basic (Blue
Cross Blue Shield of OK)
2
AARP MedicareComplete SecureHorizons Plan
(UnitedHealthcare)
3
Senior Health Plan (CommunityCare Senior
Health Plan (HMO))
4
Advantage (CommunityCare Advantage Medicare
Plan (HMO))
5
Humana (Humana WI Health Organization
Insurance Corp)
6
UnitedHealthcare MedicareDirect
(UnitedHealthcare)
7
Humana Gold Choice (Humana Insurance
Company)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Oklahoma (OK)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
Advantra Freedom (Coventry Health Care)
9
HumanaChoice (Humana Insurance Company)
10 Coventry (Coventry Health Care)
11 Generations (GlobalHealth)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Oklahoma (OK)
1
SoonerCare
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Oklahoma (OK)
1
Cherokee Elder Care
2
SoonerCare Choice
3
SoonerRide
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Oklahoma (OK)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Blue Advantage [Tier] (Blue Cross Blue Shield of
Oklahoma)
2 Blue Preferred Security (Blue Cross Blue Shield of
Oklahoma)
3 Blue Preferred [Tier] (Blue Cross Blue Shield of
Oklahoma)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Oklahoma (OK)
1
HIV Drug Assistance Program
2
Rx for Oklahoma
3
Insure Oklahoma
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Pennsylvania (PA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Gateway Health Medicare Assured (Gateway
Health Medicare Assured)
2
Humana Gold Plus (Humana WI Health
Organization Insurance Corp)
3
Community Blue Medicare (Highmark Senior
Health Company)
4
Community Blue Medicare HMO (Highmark
Choice Company)
5
Health Partners Medicare (Health Partners
Medicare)
6
Freedom Blue PPO (Highmark Senior Health
Company)
7
BlueJourney (Keystone Health Plan Central, Inc.)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Pennsylvania (PA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
AARP MedicareComplete Choice
(UnitedHealthcare)
9
Humana Gold Choice (Humana Insurance
Company)
10
Humana Value Plus (Humana Insurance
Company)
11
Psers Hop (Employer Pdp) (Psers Hop Program)
12
Security Blue HMO (Highmark Choice Company)
13
Personal Choice 65 (Personal Choice 65 PPO)
14
Geisinger Gold Preferred (Geisinger Gold)
(continued)
Created on 11/07/2017
3
HI2
MEDICARE ADVANTAGE PLANS
Pennsylvania (PA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
15
Spartan Plan PA (Sunrise Advantage Plan)
16
AARP MedicareComplete (UnitedHealthcare)
17
Cigna-HealthSpring (Cigna-HealthSpring)
18
HumanaChoice (Humana Insurance Company)
19
Clover Health PA Green (CLOVER HEALTH)
20
Advantra (HealthAmerica Pennsylvania)
21
Erickson Advantage (UnitedHealthcare)
22
Vibra Health Plan (Vibra Health Plan)
23
UPMC for Life PPO (UPMC Health Plan)
24
UPMC for Life (UPMC Health Plan)
25
Aetna Medicare (Aetna Medicare)
(continued)
Created on 11/07/2017
4
HI2
MEDICARE ADVANTAGE PLANS
Pennsylvania (PA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
26
Geisinger Gold (Geisinger Gold)
27
Keystone 65 (Keystone 65 HMO)
28
AdvantraOne (HealthAmerica)
29
Allwell Medicare (Allwell)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Pennsylvania (PA)
1 Pennsylvania Medical Assistance (MA) (Medicaid)
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Pennsylvania (PA)
1
AETNA Better Health
2
Adams County HealthChoices-Community Care
Behavioral Health Organization
3
Adult Community Autism Program
4
Albright LIFE H-
5
Alleghency County HealthChoices - Community
Care Behavioral Health Organization
6
AmeriHealth Caritas
7
AmeriHealth Northeast
8
Armstrong-Indiana Counties
HealthChoices-Value Behavioral Health of
Pennsylvania
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
Pennsylvania (PA)
9
Beaver County HealthChoices-Value Behavioral
Health of Pennsylvania
10
Behavioral Health Services of
Somerset-Bedford-PerformCare
(continued)
Created on 11/07/2017
3
HI4
MEDICAID HMOs
Pennsylvania (PA)
11
Berks County HealthChoices-Community Care
Behavioral Health Organization
12
Blair County HealthChoices-Community Care
Behavioral Health Organization
13
Bucks County HealthChoices-Magellan
Behavioral Health of Pennsylvania
14
Butler County HealthChoices-Value Behavioral
Health of Pennsylvania
15
Cambria County HealthChoices-Value Behavioral
Health of Pennsylvania
16
Carbon-Monroe-Pike Joinder Board-Community
Care Behavioral Health Organization
17
Chester County HealthChoices-Community Care
Behavioral Health Organization
18
Community LIFE H-
19
Coventry Cares Health Plan
(continued)
Created on 11/07/2017
4
HI4
MEDICAID HMOs
Pennsylvania (PA)
20
Cumberland County HealthChoices-PerformCare
21
Dauphin County HealthChoices- PerformCare
22
Delaware County HealthChoices-Magellan
Behavioral Health of Pennsylvania
23
Erie County HealthChoices-Community Care
Behavioral Health Organization
24
Fayette County HealthChoices-Value Behavioral
Health of Pennsylvania
25
Gateway Health Plan
26
Geisinger Health Plan
27
Greene County
28
Health Partners of Philadelphia, Inc.
29
Keystone First
(continued)
Created on 11/07/2017
5
HI4
MEDICAID HMOs
Pennsylvania (PA)
30
LIFE Geisinger H-
31
LIFE NWPA H-
32
LIFE St. Mary H-
33
LIFE U-Penn H-
34
LIFE-Pittsburgh H-
35
Lancaster County HealthChoices-PerformCare
36
Lawrence County HealthChoices-Value
Behavioral Health of Pennsylvania
37
Lebanon County HealthChoices-PerformCare
38
Lehigh County HealthChoices-Magellan
Behavioral Health of Pennsylvania
39
LogistiCare, Inc.
40
Lycoming-Clinton Joinder Board-Community
Care Behavioral Health Organization
(continued)
Created on 11/07/2017
6
HI4
MEDICAID HMOs
Pennsylvania (PA)
41
Mercy LIFE H-
42
Montgomery County HealthChoices-Magellan
Behavioral Health of Pennsylvania
43
New Courtland LIFE H-
44
North Central State Option
45
Northampton County HealthChoices-Magellan
Behavioral Health of Pennsylvania
46
Northeast Behavioral Health Care
Consortium-Community Care Behavioral Health
Organization
47
Northwest Behavioral Health Partnership-Value
Behavioral Health of Pennsylvania
48
Perry County HealthChoices-PerformCare
(continued)
Created on 11/07/2017
7
HI4
MEDICAID HMOs
Pennsylvania (PA)
49
Philadelphia County HealthChoices-Community
Behavioral Health
50
Senior LIFE Altoona H(continued)
Created on 11/07/2017
8
HI4
MEDICAID HMOs
Pennsylvania (PA)
51
Senior LIFE Greensburg H-
52
Senior LIFE Johnstown H-
53
Senior LIFE Lehigh H-
54
Senior LIFE Washington
55
Senior LIFE York H-
56
SpiriTrust LIFE H-
57
Tuscarora Managed Care Alliance-PerformCare
58
UPMC for You, Inc.
59
United Healthcare Community Plan of
Pennsylvania
60
VieCare Beaver H-
61
VieCare Butler H(continued)
Created on 11/07/2017
9
HI4
MEDICAID HMOs
Pennsylvania (PA)
62 Washington County HealthChoices-Value
Behavioral Health of Pennsylvania
63 Westmoreland County HealthChoices-Value
Behavioral Health of Pennsylvania
64 York County HealthChoices-Community Care
Behavioral Health Organization
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Pennsylvania (PA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Geisinger Marketplace (Geisinger Health Plan)
2
Geisinger Marketplace Extra (Geisinger Health
Plan)
3
Geisinger Marketplace Select (Geisinger Health
Plan)
4
Geisinger Marketplace Value (Geisinger Health
Plan)
5
Keystone [Tier] (Keystone Health Plan East, Inc)
6
Keystone [Tier] Proactive (Keystone Health Plan
East, Inc)
7
Major Events Community Blue (Highmark Inc.)
8
Personal Choice [Tier] (Independence Blue Cross
(QCC Ins. Co.))
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Pennsylvania (PA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
9
Personal Choice [Tier] Reserve (Independence
Blue Cross (QCC Ins. Co.))
10
Tower UPMC Advantage [Tier] Tower Network
(UPMC Health Options, Inc.)
11
UPMC Advantage Inside Advantage for
Individuals [Tier] Premium Network (UPMC
Health Options, Inc.)
12
UPMC Advantage [Tier] Partner Network (UPMC
Health Options, Inc.)
13
UPMC Advantage [Tier] Premium Network
(UPMC Health Options, Inc.)
14
UPMC Advantage [Tier] Select Network (UPMC
Health Options, Inc.)
15
[Tier] (Capital Advantage Assurance Company)
(continued)
Created on 11/07/2017
3
HI5
HEALTHCARE MARKETPLACE PLANS
Pennsylvania (PA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
16
my Direct Blue (Highmark Choice Company)
17
my Direct Blue (Highmark Health Insurance
Company)
(continued)
Created on 11/07/2017
4
HI5
HEALTHCARE MARKETPLACE PLANS
Pennsylvania (PA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
18 my Direct Blue (Highmark Inc.)
19 my Direct Blue Conemaugh (Highmark Inc.)
20 my Direct Blue Lehigh Valley (Highmark Health
Insurance Company)
21 my Direct Blue Lehigh Valley Major Events
(Highmark Health Insurance Company)
22 my Direct Blue Major Events (Highmark Health
Insurance Company)
23 my Lehigh Valley Flex Blue (First Priority Health)
24 my Priority Blue Flex (First Priority Health)
25 my Priority Blue Major Events (First Priority Health)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Pennsylvania (PA)
1 AIDS Drug Assistance Program
2 Pennsylvania PACE Needs Enhancement Tier
(PACENET)
3 Pennsylvania Pharmaceutical Assistance Contract for
the Elderly (PACE)
4 Special Pharmaceutical Benefits Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Puerto Rico (PR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Humana Gold Plus (HUMANA HEALTH PLANS
OF PUERTO RICO, INC.)
2
HumanaChoice Value (Humana Insurance of
Puerto Rico, Inc.)
3
Orion Constellation Health (Constellation Health)
4
First+Plus - Advantage (Medicare y Mucho Más)
5
CMC Care Advantage (CMC Care Advantege)
6
PMC - Max Extra (PMC Medicare Choice)
7
MCS Classicare (MCS Classicare)
8
Olympus (Constellation Health)
9
Apollo (Constellation Health)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Puerto Rico (PR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10
Óptimo (Triple-S Advantage)
11
MMM (Medicare y Mucho Más)
12
Basic (Triple S Advantage)
13
Royal (Triple S Advantage)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Puerto Rico (PR)
1
Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Puerto Rico (PR)
1
APS
2
Medicare Platino American Health Medicare
3
Medicare Platino Constellation
4
Medicare Platino First Medical/First Plus
5
Medicare Platino Humana Puerto Rico
6
Medicare Platino MCS Advantage
7
Medicare Platino MMM Healthcare Inc.
8
Medicare Platino PMC Medicare Choice
9
Medicare Platino Triple S
10 Triple S
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Puerto Rico (PR)
1
AIDS Drug Assistance Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
South Carolina (SC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
BlueCross Secure (Blue Cross Blue Shield of
South Carolina)
2
Care Improvement Plus Medicare Advantage
(UnitedHealthcare)
3
BlueCross Total (Blue Cross Blue Shield of South
Carolina)
4
AFC Care (America's 1st Choice of South
Carolina)
5
Cigna-HealthSpring Preferred
(Cigna-HealthSpring)
6
Humana Gold Plus (Arcadian Health Plan, Inc.)
7
Humana Gold Choice (Humana Insurance
Company)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
South Carolina (SC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
Aetna Medicare Premier Plan (Aetna Medicare)
9
AARP MedicareComplete (UnitedHealthcare)
10 HumanaChoice (Humana Insurance Company)
11 Allwell Medicare (Allwell)
12 EON CHOICE (Eon Health)
13 EON SELECT (Eon Health)
14 WellCare (WellCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
South Carolina (SC)
1
Healthy Connections
Created on 11/07/2017
1
HI4
MEDICAID HMOs
South Carolina (SC)
1 Absolute Total Care
2 Advicare
3 BlueChoice Healthplan Medicaid
4 Molina HealthCare of South Carolina
5 Palmetto Senior Care
6 Select Health of South Carolina
7 South Carolina Solutions
8 The Oaks
9 WellCare of South Carolina
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
South Carolina (SC)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 BlueEssentials HD [Tier] (Blue Cross and Blue Shield
of South Carolina)
2 BlueEssentials [Tier] (Blue Cross and Blue Shield of
South Carolina)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
South Carolina (SC)
1 AIDS Drug Assistance Plan
2 Gap Assistance Pharmacy Program for Seniors
(GAPS)
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Tennessee (TN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1 BlueAdvantage (BlueCross BlueShield of Tennessee)
2 Aetna Medicare Premier Plan (Aetna Medicare)
3 Humana Gold Plus (Cariten Health Plan Inc.)
4 Aetna Medicare Value Plan (Aetna Medicare)
5 AARP MedicareComplete (UnitedHealthcare)
6 Cigna-HealthSpring (Cigna-HealthSpring)
7 HumanaChoice (Humana Insurance Company)
8 Amerivantage (Amerigroup)
9 WellCare (WellCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Tennessee (TN)
1
TennCare
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Tennessee (TN)
1
Alexian Brothers Community Services
2
Amerigroup
3
DentaQuest USA Insurance Company
4
Magellan Health Services
5
UnitedHealthcare Community Plan - East TN
6
UnitedHealthcare Community Plan - Middle TN
7
UnitedHealthcare Community Plan - West TN
8
Volunteer State Health Plan
9
Volunteer State Health Plan
10 Volunteer State Health Plan
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Tennessee (TN)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 Backup [Tier] (Oscar Insurance Company of Texas)
2 Cigna Connect (Cigna Health and Life Insurance
Company)
3 Classic [Tier] (Oscar Insurance Company of Texas)
4 Simple Secure (Oscar Insurance Company of Texas)
5 Simple [Tier] (Oscar Insurance Company of Texas)
6 [Tier] G Network S (BlueCross BlueShield of
Tennessee)
7 [Tier] S Network S (BlueCross BlueShield of
Tennessee)
8 [Tier]Network S (BlueCross BlueShield of Tennessee)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Tennessee (TN)
1 CoverRX
2 Tennessee HIV Drug Assistance Program
3 Bridges to Care
4 AccessTN
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Texas (TX)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Blue Cross Medicare Advantage Choice (Blue
Cross Blue Shield of Texas)
2
Blue Cross Medicare Advantage (Blue Cross and
Blue Shield of Texas)
3
CHRISTUS Health Plan Generations (CHRISTUS
Health Plan Generations)
4
Care Improvement Plus Medicare Advantage
(UnitedHealthcare)
5
TexanPlus Classic (Universal American, A
WellCare Company)
6
Memorial Hermann Advantage (Memorial
Hermann Health Plan)
7
SeniorCare Advantage (Baylor Scott & White
Health Plan)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Texas (TX)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
Care N' Care Classic (Care N' Care Insurance
Company)
9
Care N' Care Choice (Care N’ Care Insurance
Company)
10
Vital Traditions (Baylor Scott & White Health
Plan)
11
Care1st AdvantageOptimum Plan (Care1st
Health Plan)
12
UnitedHealthcare MedicareDirect
(UnitedHealthcare)
13
TexanPlus (Universal American, A WellCare
Company)
14
AARP MedicareComplete Choice
(UnitedHealthcare)
(continued)
Created on 11/07/2017
3
HI2
MEDICARE ADVANTAGE PLANS
Texas (TX)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
15
SeniorCare (Baylor Scott & White Health Plan)
16
Humana Gold Choice (Humana Insurance
Company)
17
AARP MedicareComplete Plan
(UnitedHealthcare)
18
Humana Gold Plus (Humana Health Plan, Inc.)
19
KelseyCare Advantage (KelseyCare Advantage)
20
AARP MedicareComplete (UnitedHealthcare)
21
Cigna-HealthSpring (Cigna-HealthSpring)
22
HumanaChoice (Humana Insurance Company)
(continued)
Created on 11/07/2017
4
HI2
MEDICARE ADVANTAGE PLANS
Texas (TX)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
23 Clover Health TX Green (CLOVER HEALTH)
24 Erickson Advantage (UnitedHealthcare)
25 Prominence (Prominence Health Plan)
26 Aetna Medicare (Aetna Medicare)
27 Allwell Medicare (Allwell)
28 Amerivantage (Amerigroup)
29 WellCare (WellCare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Texas (TX)
1
Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Texas (TX)
1
Aetna
2
Amerigroup
3
Amerigroup Texas
4
Bienvivir Senior Health Services
5
Blue Cross Blue Shield
6
Christus
7
Cigna-Health Spring
8
Community First
9
Community Health Choice
10
Cook Children's
11
DentaQuest
12
Driscoll Children's
13
EL Paso First
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
Texas (TX)
14
First Care
15
Logisticare
16
MCNA
17
MTM
18
Molina
19
Molina Healthcare
20
Multiple Primary Care Providers
21
Parkland Health First
22
Scott and White
23
Sendero
24
Seton
25
Silver Star Health Network
26
Superior HealthPlan
(continued)
Created on 11/07/2017
3
HI4
MEDICAID HMOs
Texas (TX)
27
Superior HealthPlan
28
Superior HealthPlan
29
Texas Children Health Plan
30
The Basics at Jan Werner
31
United Healthcare
32
United Healthcare
33
ValueOptions
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Texas (TX)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Ambetter Balanced Care (Celtic Insurance
Company)
2
Ambetter Essential Care (Celtic Insurance
Company)
3
Ambetter Secure Care Free PCP Visits (Celtic
Insurance Company)
4
Blue Advantage Plus [Tier] (Blue Cross Blue
Shield of Texas)
5
Blue Advantage Security (Blue Cross Blue Shield
of Texas)
6
Blue Advantage [Tier] Three PCP Visits (Blue
Cross Blue Shield of Texas)
7
Blue Advantage [Tier] Two PCP Visits (Blue
Cross Blue Shield of Texas)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Texas (TX)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
8
CHP TX [Tier] (CHRISTUS Health Plan)
9
CHP TX [Tier] HD (CHRISTUS Health Plan)
(continued)
Created on 11/07/2017
3
HI5
HEALTHCARE MARKETPLACE PLANS
Texas (TX)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
10
CHP TX [Tier] LD (CHRISTUS Health Plan)
11
Classic [Tier] (Oscar Insurance Company of
Texas)
12
Community Health Choice [Tier] (Community
Health Choice, Inc.)
13
Community Health Choice [Tier] High Deductible
Health Compatible (Community Health Choice,
Inc.)
14
Community Health Choice [Tier] Limited Network
(Community Health Choice, Inc.)
15
IdealCare Complete by Sendero Healths
(Sendero Health Plans, inc.)
16
IdealCare Essential by Sendero Healths
(Sendero Health Plans, inc.)
(continued)
Created on 11/07/2017
4
HI5
HEALTHCARE MARKETPLACE PLANS
Texas (TX)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
17
IdealCare Total by Sendero Healths (Sendero
Health Plans, inc.)
18
IdealCare by Sendero Healths (Sendero Health
Plans, inc.)
(continued)
Created on 11/07/2017
5
HI5
HEALTHCARE MARKETPLACE PLANS
Texas (TX)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
19
Molina Marketplace Choice [Tier] (Molina
Healthcare of Texas, Inc.)
20
Molina Marketplace Options [Tier] (Molina
Healthcare of Texas, Inc.)
21
Molina Marketplace [Tier] (Molina Healthcare of
Texas, Inc.)
22
Saver [Tier] (Oscar Insurance Company of
Texas)
23
Simple Secure (Oscar Insurance Company of
Texas)
24
Simple [Tier] (Oscar Insurance Company of
Texas)
25
[Tier] (SHA, LLC DBA FirstCare Health Plans)
26
[Tier] H S (SHA, LLC DBA FirstCare Health
Plans)
(continued)
Created on 11/07/2017
6
HI5
HEALTHCARE MARKETPLACE PLANS
Texas (TX)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
27 [Tier] Simple Choice (SHA, LLC DBA FirstCare
Health Plans)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Texas (TX)
1 Texas HIV State Pharmacy Assistance Program
(SPAP)
2 Texas Kidney Health Care Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Utah (UT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
The Uprehs Prime Medicare Plan (Union Pacific
Railroad Employes Health Systems)
2
Regence MedAdvantage (Regence BlueCross
BlueShield of Utah)
3
UnitedHealthcare MedicareComplete Choice
(UnitedHealthcare)
4
Humana Gold Plus (Humana Medical Plan of
Utah, Inc.)
5
Healthy Advantage Plus (Molina Healthcare of
Utah)
6
AARP MedicareComplete (UnitedHealthcare)
7
HumanaChoice (Humana Insurance Company)
8
Altius Advantra (Altius Health Plans)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Utah (UT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9
SelectHealth Advantage (SelectHealth)
10
Aetna Medicare (Aetna Medicare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Utah (UT)
1
Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Utah (UT)
1
Bear River Mental Health
2
Central Utah Mental Health
3
Davis Behavioral Health
4
Delta Dental
5
Four Corners Community Behavioral Health
6
Health Choice Utah
7
Healthy U
8
Logisticare Solutions
9
Molina
10
Molina Plus
11
Northeastern Counseling Center
12
Optum Health
13
Premier Access
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
Utah (UT)
14
Salt Lake Valley Mental Health
15
SelectHealth
16
Southwest Center
17
UNI Home
18
Wasatch Mental Health
19
Weber Mental Health
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Utah (UT)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Healthy Preferred [Tier] (University of Utah
Health Insurance Plans)
2
Healthy Preferred [Tier]s before Deductible
(University of Utah Health Insurance Plans)
3
Healthy Premier [Tier] (University of Utah Health
Insurance Plans)
4
Healthy Premier [Tier]s before Deductible
(University of Utah Health Insurance Plans)
5
Select Med Benchmark Expanded [Tier]
(SelectHealth)
6
Select Med Benchmark [Tier] (SelectHealth)
7
Select Med Expanded [Tier] limited office visit
waiver (SelectHealth)
8
Select Med Healtve Expanded [Tier] Qualified
(SelectHealth)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Utah (UT)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
9
Select Med Healtve [Tier] Qualified (SelectHealth)
10
Select Med [Tier] (SelectHealth)
11
Select Med [Tier] deductible for office visits
(SelectHealth)
12
Select Med [Tier] limited office visit waiver
(SelectHealth)
13
Select Value Benchmark Expanded [Tier]
(SelectHealth)
14
Select Value Benchmark [Tier] (SelectHealth)
15
Select Value Expanded [Tier] limited office visit
waiver (SelectHealth)
(continued)
Created on 11/07/2017
3
HI5
HEALTHCARE MARKETPLACE PLANS
Utah (UT)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
16
Select Value Healtve Expanded [Tier] Qualified
(SelectHealth)
17
Select Value Healtve [Tier] Qualified
(SelectHealth)
(continued)
Created on 11/07/2017
4
HI5
HEALTHCARE MARKETPLACE PLANS
Utah (UT)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
18 Select Value Healtve [Tier] qualified Rewards
(SelectHealth)
19 Select Value [Tier] (SelectHealth)
20 Select Value [Tier] deductible for office visits
(SelectHealth)
21 Select Value [Tier] limited office visit waiver
(SelectHealth)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Utah (UT)
1 Utah AIDS Drug Assistance Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Virginia (VA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Innovation Health Medicare Connection Plan
(Innovation Health)
2
Piedmont Select Medicare Option (Piedmont
Medicare Advantage)
3
Innovation Health Medicare Voyager Plan
(Innovation Health)
4
Anthem MediBlue Access (Anthem Blue Cross
and Blue Shield)
5
Molina Medicare Options (Molina Healthcare of
Virginia)
6
Humana (Humana WI Health Organization
Insurance Corp)
7
Kaiser Permanente Medicare Plus (Kaiser
Permanente)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Virginia (VA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
UnitedHealthcare MedicareDirect
(UnitedHealthcare)
9
Humana Gold Plus (Arcadian Health Plan, Inc.)
10
Humana Gold Choice (Humana Insurance
Company)
11
Virginia Premier Advantage (Virginia Premier)
12
Spartan Plan VA (Sunrise Advantage Plan)
13
AARP MedicareComplete (UnitedHealthcare)
14
HumanaChoice (Humana Insurance Company)
15
Anthem MediBlue (Anthem HealthKeepers)
16
Erickson Advantage (UnitedHealthcare)
(continued)
Created on 11/07/2017
3
HI2
MEDICARE ADVANTAGE PLANS
Virginia (VA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
17
Optima Medicare (Optima Medicare)
18
Aetna Medicare (Aetna Medicare)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Virginia (VA)
1
Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Virginia (VA)
1
AllCare for Seniors
2
Blue Ridge PACE
3
Carilion Clinic Medicare Resources, LLC (d/b/a
MajestaCare)
4
Centra PACE - Farmville
5
Centra PACE - Lynchburg
6
Coventry Cares of Virginia
7
Healthkeepers, Inc.
8
INOVA Cares for Seniors PACE
9
INTotal Health
10
Kaiser Foundation Health Plan of the Mid-Atlantic
States, INC
11
Kissito PACE
12
Mountain Empire for Older Citizens PACE
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
Virginia (VA)
13
Optima Family Care
14
Riverside PACE - Hampton
15
Riverside PACE - Manchester
16
Riverside PACE - McTavish
17
Riverside PACE - Newport News
18
Riverside PACE - Petersburg
19
Sentara PACE - Churchland
20
Sentara PACE - Virginia Beach
21
Virginia Premier Health Plan
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Virginia (VA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Anthem HealthKeepers [Tier] X (HealthKeepers,
Inc.)
2
Anthem HealthKeepers [Tier] X for
(HealthKeepers, Inc.)
3
BlueChoice Young Adult (CareFirst BlueChoice,
Inc.)
4
BlueChoice [Tier] (CareFirst BlueChoice, Inc.)
5
BluePreferred [Tier] (Group Hospitalization and
Medical Services Inc.)
6
Cigna Connect (Cigna Health and Life Insurance
Company)
7
HealthyBlue [Tier] (CareFirst BlueChoice, Inc.)
8
HealthyBlue [Tier] (Group Hospitalization and
Medical Services Inc.)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Virginia (VA)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
9
KP VA Standard [Tier] (Kaiser Foundation Health
Plan of the Mid-Atlantic States, Inc.)
10 KP VA [Tier] (Kaiser Foundation Health Plan of the
Mid-Atlantic States, Inc.)
11 OptimaFit [Tier] M (Optima Health Plan)
12 OptimaFit [Tier] M Select (Optima Health Plan)
13 [Tier] (Piedmont Community HealthCare HMO, Inc.)
14 [Tier] Standard (Piedmont Community HealthCare
HMO, Inc.)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Virginia (VA)
1 Virginia AIDS Drug Assistance Program
2 Virginia HIV SPAP
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Washington (WA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Kaiser Permanente Medicare Advantage (Kaiser
Foundation Health Plan of WA)
2
Premera Blue Cross Medicare Advantage
(Premera Blue Cross Medicare Advantage)
3
Community HealthFirst MA (Community
HealthFirst Medicare Advantage Plan)
4
Regence BlueAdvantage HMO (Regence
BlueCross BlueShield of Oregon)
5
Molina Medicare Options (Molina Healthcare of
Washington, Inc.)
6
Kaiser Permanente Senior Advantage (Kaiser
Permanente)
7
PacificSource Medicare MyCare (PacificSource
Medicare)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Washington (WA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
Regence MedAdvantage (Regence BlueShield Of
Idaho)
9
Providence Medicare (Providence Health
Assurance)
10
Health Alliance NW (Health Alliance Northwest)
11
Health Net (Health Net Life Insurance Company)
12
Humana Gold Plus (Arcadian Health Plan, Inc.)
13
Asuris TruAdvantage (Asuris Northwest Health)
14
AARP MedicareComplete (UnitedHealthcare)
15
HumanaChoice (Humana Insurance Company)
(continued)
Created on 11/07/2017
3
HI2
MEDICARE ADVANTAGE PLANS
Washington (WA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
16
Soundpath Health (Soundpath Health)
17
Amerivantage Classic (AMERIGROUP)
18
Aetna Medicare (Aetna Medicare)
19
Allwell Medicare (Allwell)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Washington (WA)
1
Apple Health (Medicaid)
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Washington (WA)
1
Amerigroup
2
Amerigroup Washington Inc
3
Community Choice
4
Community Health Plan of WA
5
Community Health Plan of WA
6
Community Health Plan of Washington
7
Coordinated Care
8
Coordinated Care
9
Molina Health Care
10
Molina Health Care
11
Molina Health Care
12
Multiple Primary Care Providers
13
Multiple Transportation Brokers
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
Washington (WA)
14
Multiple regional support networks
15
Northwest Regional Council
16
Optumhealth
17
Providence Elder Place
18
SE WA Aging and Long Term Care
19
United Health Care
20
United Health Care
21
United Health Care Community Plan
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Washington (WA)
1 Early Intervention Program
2 Washington State Health Insurance Pool
3 Basic Health
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Wisconsin (WI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
Medical Associates (Medical Associates Clinic
Health Plan of Wisconsi)
2
Humana Gold Plus (Humana WI Health
Organization Insurance Corp)
3
Care Improvement Plus Medicare Advantage
(UnitedHealthcare)
4
Anthem MediBlue Access (Anthem Blue Cross
and Blue Shield)
5
Anthem MediBlue Plus (Anthem Blue Cross and
Blue Shield)
6
NetworkPrime (Network Health Medicare
Advantage Plans)
7
Secure Saver (Security Health Plan of
Wisconsin, Inc.)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
Wisconsin (WI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
Assurance (Security Health Plan of Wisconsin,
Inc.)
9
HealthPartners Wisconsin Freedom
(HealthPartners)
10
Network (Network Health Medicare Advantage
Plans)
11
Essence (Security Health Plan of Wisconsin, Inc.)
12
Promise (Security Health Plan of Wisconsin, Inc.)
13
Medica Prime Solution (Medica Insurance
Company)
14
Esteem (Security Health Plan of Wisconsin, Inc.)
(continued)
Created on 11/07/2017
3
HI2
MEDICARE ADVANTAGE PLANS
Wisconsin (WI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
15
Spirit (Security Health Plan of Wisconsin, Inc.)
16
Surety (Security Health Plan of Wisconsin, Inc.)
17
Humana Gold Choice (Humana Insurance
Company)
18
Gundersen Senior Preferred (Senior Preferred)
19
ProHealth Senior Preferred (Senior Preferred)
20
UW Health Senior Preferred (Senior Preferred)
21
AARP MedicareComplete (UnitedHealthcare)
22
HumanaChoice (Humana Insurance Company)
(continued)
Created on 11/07/2017
4
HI2
MEDICARE ADVANTAGE PLANS
Wisconsin (WI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
23 DeanCare Gold (Dean Health Plan, Inc.)
24 Aetna Medicare (Aetna Medicare)
25 Dean Advantage (Dean Advantage)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Wisconsin (WI)
1
BadgerCare Plus
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Wisconsin (WI)
1
Anthem Blue Cross Blue Shield
2
Care Wisconsin
3
Care Wisconsin
4
Care Wisconsin Health Plan, Inc.
5
Children Come First
6
Children’s Community Health Plan
7
Children’s Hospital of Wisconsin is contracted
8
Community Care Connections of Wisconsin
9
Community Care Health Plan, Inc.
10
Community Care, Inc.
11
Community Care, Inc.
12
Compcare
(continued)
Created on 11/07/2017
2
HI4
MEDICAID HMOs
Wisconsin (WI)
13
Compcare
14
ContinuUs
15
Dean Health Plan
16
Group Health Cooperative Of Eau Claire
17
Group Health Cooperative Of Eau Claire
18
Group Health Cooperative Of South Central WI
19
Gundersen Health Plan
20
Health Tradition Health Plan
21
Independent Care
22
Independent Care
23
Independent Care Health Plan
24
Lakeland Care District
(continued)
Created on 11/07/2017
3
HI4
MEDICAID HMOs
Wisconsin (WI)
25
Managed Health Services
26
Managed Health Services
27
MercyCare Insurance Company
28
Molina Health Plan
29
Molina Health Plan
30
My Choice Family Care
31
Network Health Plan
32
Network Health Plan
33
Northern Bridges
34
Physicians Plus Health Plan
35
Security Health Plan
36
Trilogy Health Insurance
37
Trilogy Health Insurance
(continued)
Created on 11/07/2017
4
HI4
MEDICAID HMOs
Wisconsin (WI)
38
UnitedHealthcare of WI
39
UnitedHealthcare of WI
40
Unity Health Plan
41
Western Wisconsin Cares
42
WrapAround Milwaukee
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1
Atlas Individual Plus [Tier] (HealthPartners
Insurance Company)
2
Atlas Individual [Tier] (HealthPartners Insurance
Company)
3
Beloit One [Tier] (Unity Health Plans Insurance
Corporation)
4
Beloit One [Tier] Deductible (Unity Health Plans
Insurance Corporation)
5
Beloit One [Tier] Deductible Dental (Unity Health
Plans Insurance Corporation)
6
Beloit One [Tier] First (Unity Health Plans
Insurance Corporation)
(continued)
Created on 11/07/2017
2
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
7
Beloit One [Tier] First Dental (Unity Health Plans
Insurance Corporation)
8
Beloit One [Tier] Healthy You PCP (Unity Health
Plans Insurance Corporation)
(continued)
Created on 11/07/2017
3
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
9
Beloit One [Tier] Healthy You PCP Dental (Unity
Health Plans Insurance Corporation)
10
Beloit One [Tier] Maintenance PCP (Unity Health
Plans Insurance Corporation)
11
Beloit One [Tier] Maintenance PCP Dental (Unity
Health Plans Insurance Corporation)
12
Beloit One [Tier] Standard (Unity Health Plans
Insurance Corporation)
13
Beloit One [Tier] Standard PCP (Unity Health
Plans Insurance Corporation)
14
Beloit One [Tier] Value PCP (Unity Health Plans
Insurance Corporation)
15
Beloit One [Tier] Value PCP Dental (Unity Health
Plans Insurance Corporation)
16
Dean Focus Network [Tier] E (Dean Health Plan)
(continued)
Created on 11/07/2017
4
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
17
Dean Focus Network [Tier] Value (Dean Health
Plan)
18
Dean [Tier] Classic (Dean Health Plan)
19
Dean [Tier] E (Dean Health Plan)
20
Dean [Tier] Plus (Dean Health Plan)
21
Dean [Tier] Safety Net (Dean Health Plan)
22
Dean [Tier] Value (Dean Health Plan)
23
Elite [Tier] (Unity Health Plans Insurance
Corporation)
24
Elite [Tier] Deductible (Unity Health Plans
Insurance Corporation)
(continued)
Created on 11/07/2017
5
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
25
Elite [Tier] Deductible Dental (Unity Health Plans
Insurance Corporation)
26
Elite [Tier] First (Unity Health Plans Insurance
Corporation)
(continued)
Created on 11/07/2017
6
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
27
Elite [Tier] First Dental (Unity Health Plans
Insurance Corporation)
28
Elite [Tier] Healthy You PCP (Unity Health Plans
Insurance Corporation)
29
Elite [Tier] Healthy You PCP Dental (Unity Health
Plans Insurance Corporation)
30
Elite [Tier] Maintenance PCP (Unity Health Plans
Insurance Corporation)
31
Elite [Tier] Maintenance PCP Dental (Unity
Health Plans Insurance Corporation)
32
Elite [Tier] Standard (Unity Health Plans
Insurance Corporation)
(continued)
Created on 11/07/2017
7
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
33
Elite [Tier] Standard PCP (Unity Health Plans
Insurance Corporation)
34
Elite [Tier] Value PCP (Unity Health Plans
Insurance Corporation)
(continued)
Created on 11/07/2017
8
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
35
Elite [Tier] Value PCP Dental (Unity Health Plans
Insurance Corporation)
36
En Aurora Bellin [Tier] (Common Ground
Healthcare Cooperative)
37
Engage by Medica [Tier] (Medica Health Plans of
Wisconsin)
38
Engage by Medica [Tier] Plus (Medica Health
Plans of Wisconsin)
39
Gundersen Health System R [Tier] (Unity Health
Plans Insurance Corporation)
40
Gundersen Health System R [Tier] Deductible
(Unity Health Plans Insurance Corporation)
(continued)
Created on 11/07/2017
9
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
41
Gundersen Health System R [Tier] Deductible
Dental (Unity Health Plans Insurance
Corporation)
42
Gundersen Health System R [Tier] First (Unity
Health Plans Insurance Corporation)
(continued)
Created on 11/07/2017
10
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
43
Gundersen Health System R [Tier] First Dental
(Unity Health Plans Insurance Corporation)
44
Gundersen Health System R [Tier] Healthy You
PCP (Unity Health Plans Insurance Corporation)
45
Gundersen Health System R [Tier] Healthy You
PCP Dental (Unity Health Plans Insurance
Corporation)
46
Gundersen Health System R [Tier] Maintenance
PCP (Unity Health Plans Insurance Corporation)
47
Gundersen Health System R [Tier] Maintenance
PCP Dental (Unity Health Plans Insurance
Corporation)
48
Gundersen Health System R [Tier] Standard
(Unity Health Plans Insurance Corporation)
(continued)
Created on 11/07/2017
11
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
49
Gundersen Health System R [Tier] Standard
PCP (Unity Health Plans Insurance Corporation)
50
Gundersen Health System R [Tier] Value PCP
(Unity Health Plans Insurance Corporation)
(continued)
Created on 11/07/2017
12
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
51
Gundersen Health System R [Tier] Value PCP
Dental (Unity Health Plans Insurance
Corporation)
52
HDHP [Tier] (Aspirus Arise Health Plan of
Wisconsin, Inc.)
53
Medica Individual Choice [Tier] (Medica Health
Plans of Wisconsin)
54
Medica Individual Choice [Tier] H S (Medica
Health Plans of Wisconsin)
55
Medica Individual Choice [Tier] H SPlus (Medica
Health Plans of Wisconsin)
56
Medica Individual Choice [Tier] Plus (Medica
Health Plans of Wisconsin)
(continued)
Created on 11/07/2017
13
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
57
MercyCare [Tier] Option (MercyCare HMO, Inc.)
58
MercyCare [Tier] OptionSimple Choice
(MercyCare HMO, Inc.)
(continued)
Created on 11/07/2017
14
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
59
Pioneer One [Tier] (Unity Health Plans Insurance
Corporation)
60
Pioneer One [Tier] Deductible (Unity Health
Plans Insurance Corporation)
61
Pioneer One [Tier] Deductible Dental (Unity
Health Plans Insurance Corporation)
62
Pioneer One [Tier] First (Unity Health Plans
Insurance Corporation)
63
Pioneer One [Tier] First Dental (Unity Health
Plans Insurance Corporation)
64
Pioneer One [Tier] Healthy You PCP (Unity
Health Plans Insurance Corporation)
(continued)
Created on 11/07/2017
15
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
65
Pioneer One [Tier] Healthy You PCP Dental
(Unity Health Plans Insurance Corporation)
66
Pioneer One [Tier] Maintenance PCP (Unity
Health Plans Insurance Corporation)
(continued)
Created on 11/07/2017
16
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
67
Pioneer One [Tier] Maintenance PCP Dental
(Unity Health Plans Insurance Corporation)
68
Pioneer One [Tier] Standard (Unity Health Plans
Insurance Corporation)
69
Pioneer One [Tier] Standard PCP (Unity Health
Plans Insurance Corporation)
70
Pioneer One [Tier] Value PCP (Unity Health
Plans Insurance Corporation)
71
Pioneer One [Tier] Value PCP Dental (Unity
Health Plans Insurance Corporation)
72
Prestige [Tier] (Network Health Plan)
73
Prestige [Tier] Essential (Network Health Plan)
(continued)
Created on 11/07/2017
17
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
74
Prestige [Tier] HDHP (Network Health Plan)
75
Prime [Tier] (Unity Health Plans Insurance
Corporation)
(continued)
Created on 11/07/2017
18
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
76
Prime [Tier] Deductible (Unity Health Plans
Insurance Corporation)
77
Prime [Tier] Deductible Dental (Unity Health
Plans Insurance Corporation)
78
Prime [Tier] First (Unity Health Plans Insurance
Corporation)
79
Prime [Tier] First Dental (Unity Health Plans
Insurance Corporation)
80
Prime [Tier] Healthy You PCP (Unity Health
Plans Insurance Corporation)
81
Prime [Tier] Healthy You PCP Dental (Unity
Health Plans Insurance Corporation)
(continued)
Created on 11/07/2017
19
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
82
Prime [Tier] Maintenance PCP (Unity Health
Plans Insurance Corporation)
83
Prime [Tier] Maintenance PCP Dental (Unity
Health Plans Insurance Corporation)
(continued)
Created on 11/07/2017
20
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
84
Prime [Tier] Standard (Unity Health Plans
Insurance Corporation)
85
Prime [Tier] Standard PCP (Unity Health Plans
Insurance Corporation)
86
Prime [Tier] Value PCP (Unity Health Plans
Insurance Corporation)
87
Prime [Tier] Value PCP Dental (Unity Health
Plans Insurance Corporation)
88
ProHealth [Tier] (Unity Health Plans Insurance
Corporation)
89
ProHealth [Tier] Deductible (Unity Health Plans
Insurance Corporation)
(continued)
Created on 11/07/2017
21
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
90
ProHealth [Tier] Deductible Dental (Unity Health
Plans Insurance Corporation)
91
ProHealth [Tier] First (Unity Health Plans
Insurance Corporation)
(continued)
Created on 11/07/2017
22
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
92
ProHealth [Tier] First Dental (Unity Health Plans
Insurance Corporation)
93
ProHealth [Tier] Healthy You PCP (Unity Health
Plans Insurance Corporation)
94
ProHealth [Tier] Healthy You PCP Dental (Unity
Health Plans Insurance Corporation)
95
ProHealth [Tier] Maintenance PCP (Unity Health
Plans Insurance Corporation)
96
ProHealth [Tier] Maintenance PCP Dental (Unity
Health Plans Insurance Corporation)
97
ProHealth [Tier] Standard (Unity Health Plans
Insurance Corporation)
(continued)
Created on 11/07/2017
23
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
98
ProHealth [Tier] Standard PCP (Unity Health
Plans Insurance Corporation)
99
ProHealth [Tier] Value PCP (Unity Health Plans
Insurance Corporation)
(continued)
Created on 11/07/2017
24
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
100
ProHealth [Tier] Value PCP Dental (Unity Health
Plans Insurance Corporation)
101
Select (Security Health Plan of Wisconsin, Inc.)
102
Select HDHP (Security Health Plan of Wisconsin,
Inc.)
103
Select Protection (Security Health Plan of
Wisconsin, Inc.)
104
Select [Tier] Ded MOOP ( Group Health
Cooperative of South Central Wisconsin)
105
Select [Tier] Simple Choice ( Group Health
Cooperative of South Central Wisconsin)
106
Select [Tier]Ded MOOP ( Group Health
Cooperative of South Central Wisconsin)
107
Simple Choice HDHP [Tier] (Aspirus Arise Health
Plan of Wisconsin, Inc.)
(continued)
Created on 11/07/2017
25
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
108
Simple Choice [Tier] (Aspirus Arise Health Plan
of Wisconsin, Inc.)
109
Together Standard [Tier] (Children's Community
Health Plan)
110
Together [Tier] (Children's Community Health
Plan)
111
Together [Tier] HDHP (Children's Community
Health Plan)
112
Together [Tier] Select (Children's Community
Health Plan)
113
[Tier] (Aspirus Arise Health Plan of Wisconsin,
Inc.)
(continued)
Created on 11/07/2017
26
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
114
[Tier] Ded MOOP ( Group Health Cooperative of
South Central Wisconsin)
115
[Tier] Simple Choice ( Group Health Cooperative
of South Central Wisconsin)
(continued)
Created on 11/07/2017
27
HI5
HEALTHCARE MARKETPLACE PLANS
Wisconsin (WI)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
116 [Tier]Ded MOOP ( Group Health Cooperative of
South Central Wisconsin)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Wisconsin (WI)
1 Wisconsin AIDS/HIV Drug Assistance Program
2 Wisconsin Chronic Disease Program
3 Wisconsin SeniorCare
4 BadgerCare Plus
5 Health Insurance Risk Sharing Program (HIRSP)
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
West Virginia (WV)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1
United Mine Workers Of America
Hlth & Retirement
2
Freedom Blue PPO Standard (Highmark Senior
Solutions Company)
3
AARP MedicareComplete Choice Plan
(UnitedHealthcare)
4
The Health Plan SecureChoice (The Health Plan)
5
Humana Gold Choice (Humana Insurance
Company)
6
Humana Value Plus (Humana Insurance
Company)
7
The Health Plan SecureCare (The Health Plan)
(continued)
Created on 11/07/2017
2
HI2
MEDICARE ADVANTAGE PLANS
West Virginia (WV)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
8
HumanaChoice (Humana Insurance Company)
9
Advantra Gold (Coventry Health Care)
10 AdvantraOne (Coventry Health Care)
11 Advantra (Coventry Health Care)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
West Virginia (WV)
1
West Virginia Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
West Virginia (WV)
1
Coventry Cares
2
Multiple primary care providers
3
The Health Plan
4
Unicare
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
West Virginia (WV)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 CareSource Federal Simple Choice [Tier]
(CareSource West Virginia Co.)
2 CareSource Federal Simple Choice [Tier] Dental and
(CareSource West Virginia Co.)
3 CareSource Low Premium [Tier] (CareSource West
Virginia Co.)
4 CareSource Low Premium [Tier] Dental and
(CareSource West Virginia Co.)
5 CareSource [Tier] (CareSource West Virginia Co.)
6 CareSource [Tier] Dental and (CareSource West
Virginia Co.)
7 Major Events Blue (Highmark Blue Cross Blue Shield
West Virginia)
8 my Connect Blue WV (Highmark Blue Cross Blue
Shield West Virginia)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
West Virginia (WV)
1 West Virginia AIDS Drug Assistance Program
Created on 11/07/2017
1
HI2
MEDICARE ADVANTAGE PLANS
Wyoming (WY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1 UnitedHealthcare MedicareDirect (UnitedHealthcare)
2 Altius Advantra Select (Altius Health Plans)
Created on 11/07/2017
1
HI3
MEDICAID PROGRAM NAMES
Wyoming (WY)
1
Medicaid
Created on 11/07/2017
1
HI4
MEDICAID HMOs
Wyoming (WY)
1 Cheyenne Regional Medical Center PACE
Created on 11/07/2017
1
HI5
HEALTHCARE MARKETPLACE PLANS
Wyoming (WY)
Marketplace plan names often have tiers in their
names (Bronze/Silver/Gold/Platinum, Catastrophic)
1 BlueSelect [Tier] Balance (Blue Cross Blue Shield of
Wyoming)
2 BlueSelect [Tier] Classic (Blue Cross Blue Shield of
Wyoming)
3 BlueSelect [Tier] Core (Blue Cross Blue Shield of
Wyoming)
4 BlueSelect [Tier] HealthPlus (Blue Cross Blue Shield
of Wyoming)
5 BlueSelect [Tier] Value (Blue Cross Blue Shield of
Wyoming)
Created on 11/07/2017
1
HI6
PUBLIC ASSISTANCE PLANS
Wyoming (WY)
1 AIDS Drug Assistance Program
2 Wyoming Prescription Drug Assistance Program
(PDAP)
HIT1
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
(continued)
Updated July 28, 2014
HIT1
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
(1-877-363-6337)
(Co-pays subject to change)
5007334 (9/01 T85)
Updated July 28, 2014
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
Updated July 28, 2014
IA1
Monthly Mortgage Payments
A. Less than $250
B. $250 – less than $500
C. $500 – less than $1,000
D. $1,000 – less than $3,000
E. $3,000 – less than $5,000
F. $5,000 or more
Updated August 1, 2015
IA2
Present Value of
Home/Apartment/Condo
A. Less than $50,000
B. $50,000 – less than $75,000
C. $75,000 – less than $100,000
D. $100,000 – less than $200,000
E. $200,000 – less than $300,000
F. $300,000 – less than $500,000
G. $500,000 – less than $750,000
H. $750,000 or more
Updated August 1, 2015
IA3
Monthly Rent
A. Less than $250
B. $250 – less than $500
C. $500 – less than $1,000
D. $1,000 – less than $3,000
E. $3,000 – less than $5,000
F. $5,000 or more
Updated August 1, 2015
IA4
Retirement Plans
• 401(k)
• 403(b)
• IRA
• Keogh
Updated August 1, 2015
IA5
Combined Monthly Social
Security or Railroad Retirement
Amount
A. Less than $1,300
B. $1,300 – less than $1,700
C. $1,700 – less than $2,200
D. $2,200 – less than $2,600
E. $2,600 or more
Updated August 1, 2015
IA6
Individual Monthly Social
Security or Railroad
Retirement Amount
A. Less than $700
B. $700 – less than $1,000
C. $1,000 – less than $1,300
D. $1,300 – less than $1,600
E. $1,600 or more
Updated August 1, 2015
IA7
Combined Monthly
Supplemental Security
Income Amount
A. Less than $300
B. $300 – less than $700
C. $700 – less than $1,000
D. $1,000 or more
Updated August 1, 2015
IA8
Individual Monthly
Supplemental Security
Income Amount
A. Less than $100
B. $100 – less than $200
C. $200 – less than $400
D. $400 – less than $700
E. $700 or more
Updated August 1, 2015
IA9
Combined Monthly Veterans
Administration Income
Amount
A. Less than $1,000
B. $1,000 – less than $1,400
C. $1,400 – less than $1,800
D. $1,800 – less than $2,200
E. $2,200 or more
Updated August 1, 2015
IA10
Individual Monthly Veterans
Administration Income
Amount
A. Less than $500
B. $500 – less than $700
C. $700 – less than $900
D. $900 – less than $1,100
E. $1,100 or more
Updated August 1, 2015
IA11
Combined Monthly Pension
Payment
A. Less than $600
B. $600 – less than $1,300
C. $1,300 – less than $2,100
D. $2,100 – less than $5,900
E. $5,900 or more
Updated August 1, 2015
IA12
Individual Monthly Pension
Payment
A. Less than $400
B. $400 – less than $900
C. $900 – less than $1,600
D. $1,600 – less than $3,800
E. $3,800 or more
Updated August 1, 2015
IA13
Combined Total Retirement
Accounts
A. Less than $34,000
B. $34,000 – less than $82,000
C. $82,000 – less than $175,000
D. $175,000 – less than $413,000
E. $413,000 or more
Updated August 1, 2015
IA14
Individual Total Retirement
Accounts
A. Less than $20,000
B. $20,000 – less than $47,000
C. $47,000 – less than $92,000
D. $92,000 – less than $218,000
E. $218,000 or more
Updated August 1, 2015
IA15
Combined Monthly Amount
Received from Retirement
Account
A. Less than $200
B. $200 – less than $500
C. $500 – less than $1,000
D. $1,000 – less than $2,500
E. $2,500 or more
Updated August 1, 2015
IA16
Individual Monthly Amount
Received from Retirement
Account
A. Less than $100
B. $100 – less than $300
C. $300 – less than $700
D. $700 – less than $1,700
E. $1,700 or more
Updated August 1, 2015
IA17
Combined Amount Received
from Retirement Account Last
Year
A. Less than $2,400
B. $2,400 – less than $6,000
C. $6,000 – less than $12,000
D. $12,000 – less than $30,000
E. $30,000 or more
Updated August 1, 2015
IA18
Individual Amount Received
from Retirement Account Last
Year
A. Less than $1,200
B. $1,200 – less than $3,600
C. $3,600 – less than $8,400
D. $8,400 – less than $20,400
E. $20,400 or more
Updated August 1, 2015
IA19
Combined Mutual
Funds/Stocks/Bonds Not Part
of Retirement Account
A. Less than $9,000
B. $9,000 – less than $18,000
C. $18,000 – less than $93,000
D. $93,000 – less than $350,000
E. $350,000 or more
Updated August 1, 2015
IA20
IAQ35C- Mutual
Funds/Stocks/Bonds Not Part
of Retirement Account
A. Less than $600
B. $600 – less than $5,000
C. $5,000 – less than $16,000
D. $16,000 – less than $62,000
E. $62,000 or more
Updated August 1, 2015
IA21
IAC26A- Mutual
Funds/Stocks/Bonds Not Part
of Retirement Account
A. Less than $8,000
B. $8,000 – less than $62,000
C. $62,000 – less than $192,000
D. $192,000 – less than $213,000
E. $213,000 or more
Updated August 1, 2015
IA22
IAQ36C- Mutual
Funds/Stocks/Bonds Not Part
of Retirement Account
A. Less than $300
B. $300 – less than $2,500
C. $2,500 – less than $8,000
D. $8,000 – less than $37,000
E. $37,000 or more
Updated August 1, 2015
IA23
IAQ38B – All Accounts Last
Month
A. Less than $11,000
B. $11,000 – less than $25,000
C. $25,000 – less than $50,000
D. $50,000 – less than $108,000
E. $108,000 or more
Updated August 1, 2015
IA24
IAQ38C – All Accounts Last
Month
A. Less than $2,000
B. $2,000 – less than $7,000
C. $7,000 – less than $17,000
D. $17,000 – less than $57,000
E. $57,000 or more
Updated August 1, 2015
IA25
IAQ39B/IAQ40B – All Accounts
Last Month
A. Less than $8,000
B. $8,000 – less than $13,000
C. $13,000 – less than $28,000
D. $28,000 – less than $54,000
E. $54,000 or more
Updated August 1, 2015
IA26
IAQ39C/IAQ40C – All Accounts
Last Month
A. Less than $500
B. $500 – less than $1,900
C. $1,900 – less than $5,000
D. $5,000 – less than $20,000
E. $20,000 or more
Updated August 1, 2015
IA27
IAQ41 – Combined Interest and
Dividends Last Year
A. Less than $200
B. $200 – less than $1,000
C. $1,000 – less than $4,000
D. $4,000 – less than $16,000
E. $16,000 or more
Updated August 1, 2015
IA28
IAQ42B/IAQ43B – Individual
Interest and Dividend Income
A. Less than $400
B. $400 – less than $1,000
C. $1,000 – less than $2,000
D. $2,000 – less than $11,000
E. $11,000 or more
Updated August 1, 2015
IA29
IAQ44A – Value of Business,
Farm, or Real Estate
A. Less than $30,000
B. $30,000 – less than $101,000
C. $101,000 – less than $247,000
D. $247,000 – less than $703,000
E. $703,000 or more
Updated August 1, 2015
IA30
IAQ45B/IAQ46A – Value of
Business, Farm, or Real Estate
A. Less than $18,000
B. $18,000 – less than $68,000
C. $68,000 – less than $122,000
D. $122,000 – less than $293,000
E. $293,000 or more
Updated August 1, 2015
IA31
IAQ47B – Income from
Businesses or Property
A. Less than $3,600
B. $3,600 – less than $12,000
C. $12,000 – less than $25,000
D. $25,000 – less than $64,000
E. $64,000 or more
Updated August 1, 2015
IA32
IAQ48B/IAQ49B – Income from
Businesses or Property
A. Less than $3,600
B. $3,600 – less than $7,200
C. $7,200 – less than $14,000
D. $14,000 – less than $38,000
E. $38,000 or more
Updated August 1, 2015
IA33
IAQ51A – Total Combined
Income
A. Less than $5,000
B. $5,000 - less than $10,000
C. $10,000 - less than $15,000
D. $15,000 - less than $20,000
E. $20,000 - less than $25,000
F. $25,000 - less than $30,000
G. $30,000 - less than $40,000
H. $40,000 - less than $50,000
I.
$50,000 - less than $66,000
J. $66,000 - less than $109,000
K. $109,000 or more
Updated May 3, 2017
IA34
IAQ51B – Total Income
A. Less than $5,000
B. $5,000 - less than $10,000
C. $10,000 - less than $15,000
D. $15,000 - less than $20,000
E. $20,000 - less than $25,000
F. $25,000 - less than $30,000
G. $30,000 - less than $40,000
H. $40,000 - less than $50,000
I. $50,000 - less than $66,000
J. $66,000 - less than $109,000
K. $109,000 or more
Updated May 3, 2017
IA35
Lump Sum Payments
A. Insurance Settlement
B. Pension Settlement
C. Inheritance (or Trust)
D. Gift
E. Lawsuit
Updated May 4, 2016
IA36
Present Value of Vehicles
A. Less than $2,500
B. $2,500 – less than $5,000
C. $5,000 – less than $7,500
D. $7,500 – less than $10,000
E. $10,000 – less than $20,000
F. $20,000 or more
Updated May 4, 2016
IU1
Long Term Care Places
●
Skilled nursing homes
●
Intermediate care facilities
●
Board and care homes
●
Nursing home units in hospitals
●
Facilities for the intellectually disabled
●
Psychiatric facilities
●
Group homes
Updated January 10, 2018
KN1
• Very easy
• Somewhat easy
• Somewhat difficult
• Very difficult
Updated July 28, 2014
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
Updated July 28, 2014
KN3
• Very interested
• Somewhat interested
• Not very interested
• Not at all interested
Updated January 13, 2016
KN4
• Very easy
• Somewhat easy
• Somewhat difficult
• Very difficult
Updated January 11, 2017
KN5
• At least once every year
• Once every few years
• Rarely
• Never
• Only once when first signed up for drug
plan
• Only once when first signed up for
Medicare
• Just signed up for Medicare
Updated January 11, 2017
KN6
• Completely agree
• Somewhat agree
• Somewhat disagree
• Completely disagree
Updated January 11, 2017
KN7
• Very satisfied
• Satisfied
• Dissatisfied
• Very Dissatisfied
Updated January 11, 2017
KN8
Updated January 10, 2018
KN9
• Very easy
• Somewhat easy
• Somewhat difficult
• Very difficult
Updated January 11, 2017
MP1
Health Practitioners Who Are Not
Medical Doctors
● Acupuncturist
● Chiropractor
● Podiatrist (foot doctor)
● Homeopath
● Naturopath
● Any other kind of health provider who is
not a medical doctor
Updated January 2019
MP2
Mental Health Professionals
• Psychiatrist
• Psychologist
• Clinical social worker
• Licensed professional counselor
Updated July 28, 2014
MP3
Therapists
• Physical therapist
• Speech therapist
• (Intravenous) I.V. therapist
• Massage therapist
• Occupational therapist
• Respiratory therapist
Updated July 28, 2014
MP4
Other Medical Persons
• Nurse
• Nurse practitioner
• Paramedic (not including ambulance
services)
• Physician's assistant
Updated July 28, 2014
MP5
Other Types of Medical Places
• Health clinic
• Neighborhood health center
• Rural health clinic
• Infirmary
• Mental health clinic
• Urgent care center
• Any other place
Updated July 28, 2014
MP6
• 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
Updated July 24, 2017
NA1
• 12 oz. beer
• 5 oz. glass of wine
• One and a half ounces of liquor
Updated August 3, 2016
OM1
Orthopedic Items
• Crutches
• Canes
• Wheelchairs
• Walkers
• Corrective shoes or inserts
• Support stockings
• Braces or supports
Updated July 28, 2014
OM2
Diabetic Equipment or Supplies
• Syringes
• Test paper
• Test strips
• Blood monitoring kits
Updated July 28, 2014
OM3
Prostheses
• Artificial leg or arm
• Mastectomy prosthesis
• Artificial or glass eye
Updated July 28, 2014
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 (such as cuffs or
monitors)
Updated July 28, 2014
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
Updated July 28, 2014
PM1
• Thought it would cost too much
• Didn’t think medicine would help
condition
• Was afraid of medicine
reactions/contraindications
• Don’t like to take medicine
• Didn’t think medicine was necessary
• Not covered by insurance/not on plan
formulary
• Trouble obtaining medicine
• Obtained/used samples
• Used another medicine as a substitution
Updated July 24, 2017
RX1
• Very easy
• Somewhat easy
• Somewhat difficult
• Very difficult
Updated July 28, 2014
RX2
• 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
Updated July 28, 2014
RX3
• Very satisfied
• Satisfied
• Dissatisfied
• Very dissatisfied
Updated July 28, 2014
RX4
• Extremely confident
• Very confident
• Moderately confident
• Slightly confident
• Not confident
Updated July 28, 2014
RX5
● Often
● Sometimes
● Never
Updated May 2 2018
SC1
• Very satisfied
• Satisfied
• Dissatisfied
• Very dissatisfied
Updated July 28, 2014
SC2
• Very Likely
• Likely
• Unlikely
• Very Unlikely
Updated July 24, 2017
SC3
• Always
• Usually
• Sometimes
• Never
Updated July 24, 2017
US1
• Allergy/Immunology
• Anesthesiology
• Cardiology (Heart)
• Dermatology (Skin)
• Endocrinology/ Metabolism (Diabetes, Thyroid)
• Family Practice
• Gastroenterology
• General Practice
• General Surgery
• Geriatrics (Elderly)
• Gynecology - Obstetrics
• Hematology (Blood)
• Hospital Residence
• Internal Medicine (Internist)
• Nephrology (Kidneys)
• Neurology
(continued)
Updated January 10, 2018
US1
• Nuclear Medicine
• Oncology (Tumors, Cancer)
• Ophthalmology (Eyes)
• Orthopedics
• Osteopathy (Do)
• Otorhinolaryngology (Ear, Nose, Throat)
• Pathology
• Phys Med/Rehab
• Physician’s Assistant
• Plastic Surgery
• Proctology
• Psychiatry/Psychiatrist
• Pulmonary (Lungs)
• Radiology
• Rheumatology (Arthritis)
• Thoracic Surgery (Chest)
• Urology
Updated January 10, 2018
US2
• Very Well
• Well
• Not Well
• Not at All
Updated January 10, 2018
US3
US3
• Professional Interpreter
• Staff Person At Medical Provider’s
Office
• Family Member
• Friend
• Someone Else
• Does Best That Can In English
Updated January 10, 2018
US4
• Never
• Sometimes
• Usually
• Always
Updated January 10, 2018
US5
• Yes, Definitely
• Yes, Somewhat
• No
Updated January 10, 2018
US6
• Strongly Agree
• Agree
• Disagree
• Strongly Disagree
Updated January 10, 2018
US7
0 Hard to Manage
1
2
3
4
5
6
7
8
9
10 Easy to Manage
Updated January 10, 2018
| File Type | application/pdf |
| File Title | 2019 MCBS Community Showcards |
| Subject | MCBS, Community, Showcards |
| Author | Alanah Raykovich |
| File Modified | 2018-05-08 |
| File Created | 2017-09-26 |