March 14, 2005 |
2005-R-0287 | |
OXFORD MEDICARE ADVANTAGE | ||
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By: Janet L. Kaminski, Associate Legislative Attorney | ||
You asked for a comparison of Oxford Health Plan’s New York and Connecticut Medicare Advantage plans and how it determines benefits.
SUMMARY
Oxford Health Plan created Oxford Medicare Advantage in 1992 as an alternative to traditional Medicare. Oxford Medicare Advantage combines Medicare Part A and Part B benefits, supplemental insurance, and preventive care. There are approximately 60,000 Oxford Medicare Advantage enrollees in the New York, New Jersey, and Connecticut tri-state area, according to Oxford’s web site (www. oxhp. com). Benefits, premiums, and copayments are subject to federal approval. Benefits are determined by Medicare payment rates, which are set separately for each county.
In Connecticut, Oxford Medicare Advantage is only available in New Haven County. It is more widely available in New York and New Jersey. Table 1 compares the New York Oxford Medicare Advantage Signature Plan with the Connecticut plan. There are other plans available in New York, but the “signature” plan is the most popular based on membership. A summary of benefits for the Connecticut plan is enclosed and is available on Oxford’s web site. Summaries for New York and New Jersey plans are also available at https: //www. oxhp. com/oxford_medicare_advantage/html/doma_bsc. html.
Table 1: Oxford Medicare Advantage Plan Comparison —
New York and Connecticut
Oxford Medicare Advantage Signature Plan (New York) |
Oxford Medicare Advantage Plan (Connecticut) | |
Referrals Required? |
No |
Yes |
Monthly Premium |
$ 0 |
$ 0 |
PCP Copay |
$ 15 |
$ 10 |
Specialist Copay |
$ 25 |
$ 25 |
Routine Physical |
$ 0 |
$ 0 |
Generic Drugs |
No annual limit; $ 15 co-pay |
Not applicable |
Brand Name Drugs |
$ 1,100 annual limit; member cost is the greater of $ 25 or 50% of the drug (preferred), or the greater of $ 50 or 50% (non-preferred) |
Not applicable |
Inpatient Hospital Care |
$ 80 inpatient facility co-payment per day (not to exceed $ 640 out-of-pocket per hospital stay); $ 150 inpatient hospital surgery co-payment |
$ 80 inpatient facility co-payment per day (not to exceed $ 640 out-of-pocket per hospital stay); $ 150 inpatient hospital surgery co-payment |
Outpatient Hospital Care |
$ 250 ambulatory facility co-payment; $ 100 ambulatory surgery physician co-payment |
$ 250 ambulatory facility co-payment; $ 100 ambulatory surgery physician co-payment |
Deductible |
Not applicable |
Not applicable |
Source:
Oxford Health Plan
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