2010 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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Univera Medicare PPO 102 (PPO) in NY - H3335-002-0 Benefit Details |
Allegany | $36.00 | $150 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $75.00 Tier 4: 25% | n/a Browse Formulary | |||||
Univera Medicare PPO 102 (PPO) in NY - H3335-002-0 Benefit Details |
Cattaraugus | $36.00 | $150 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $75.00 Tier 4: 25% | n/a Browse Formulary | |||||
Univera Medicare PPO 102 (PPO) in NY - H3335-002-0 Benefit Details |
Chautauqua | $36.00 | $150 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $75.00 Tier 4: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Univera Medicare PPO 102 (PPO) in NY - H3335-002-0 Benefit Details |
Erie | $36.00 | $150 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $75.00 Tier 4: 25% | n/a Browse Formulary | |||||
Univera Medicare PPO 102 (PPO) in NY - H3335-002-0 Benefit Details |
Genesee | $36.00 | $150 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $75.00 Tier 4: 25% | n/a Browse Formulary | |||||
Univera Medicare PPO 102 (PPO) in NY - H3335-002-0 Benefit Details |
Niagara | $36.00 | $150 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $75.00 Tier 4: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Univera Medicare PPO 102 (PPO) in NY - H3335-002-0 Benefit Details |
Orleans | $36.00 | $150 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $75.00 Tier 4: 25% | n/a Browse Formulary | |||||
Univera Medicare PPO 102 (PPO) in NY - H3335-002-0 Benefit Details |
Wyoming | $36.00 | $150 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $75.00 Tier 4: 25% | n/a Browse Formulary | |||||
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