Compare Benefits
| BENEFIT |
ORIGINAL MEDICARE
(Deductible and Patient Responsibility based on 2008 Medicare) |
VANTAGE BASIC |
VANTAGE PREMIUM |
| EMERGENCY ROOM |
80/20 after $135 deductible |
$50 ER copay per visit - world-wide |
$50 ER copay per visit - world-wide |
| EYEGLASSES OR CONTACT LENSES (not after cataract surgery) |
Not Covered |
Not Covered |
Vantage will cover $100/year towards eyeglasses or contact lenses |
| ANNUAL ROUTINE EYE EXAMS |
Not Covered |
$35 copay per visit |
$25 copay per visit |
| INPATIENT HOSPITAL |
Days 1-60: Patient Respon $1,024 deductible
Days 61-90: Patient Respon $256/day
Days 91-150: Patient Respon $512/day |
$250/day up to $1000 maximum copay per admission
No day limits |
$100 copay per admission
No day limits |
| INPATIENT HOSPITAL PHYSICIAN |
80/20 after $135 deductible |
100% covered - no deductible |
100% covered - no deductible |
| OFFICE VISIT / PCP |
80/20 after $135 deductible |
$10 copay per visit |
$5 copay per visit |
| OFFICE VISIT / SPECIALIST |
80/20 after $135 deductible |
$35 copay per visit |
$25 copay per visit |
| OUTPATIENT SURGERY SERVICES |
Facility/Physician 80/20 after $135 deductible |
$250 copay per visit |
$100 copay per visit |
| PRESCRIPTION DRUGS (PART D) |
Must pay separate PART D premium. Deductible and coinsurance apply |
No deductible
No separate premium
4-tier copay: $6/$32/$64
25% coinsurance for specialty drugs
No coverage through "doughnut hole" |
No deductible
No separate premium
4-tier copay: $6/$32/$64
25% coinsurance for specialty drugs
$6 generic copay through "doughnut hole" |
| FLU SHOTS |
Covered |
Covered |
Covered |
MAJOR DIAGNOSTIC TEST
(MRI, CT SCAN, STRESS TEST)
see complete list in Evidence of Coverage |
80/20 after $135 deductible |
$250 copay per visit |
$50 copay per visit |
| X-RAYS |
80/20 after $135 deductible |
100% covered - no deductible |
100% covered - no deductible |
| Lab |
100% covered - no deductible |
100% covered - no deductible |
100% covered - no deductible |
| HOME HEALTH |
100% covered - limited days |
100% covered - no day limits |
100% covered - no day limits |
The above benefit table was originally published in approved document H5576_1005_CY08 CMS 10/19/2007.
This comparison is not a complete comparison and one should refer to the evidence of coverage (eoc) for complete details.
Please note actual benefits may vary if you are choosing Vantage through an employer.
This page was last modified January 16, 2008
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