2011 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) Additional 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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Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Bernalillo | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Catron | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Chaves | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Cibola | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Colfax | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Curry | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
DeBaca | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Dona Ana | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Eddy | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Grant | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Guadalupe | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Harding | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Hidalgo | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Lea | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Lincoln | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Los Alamos | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Luna | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
McKinley | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Mora | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Otero | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Quay | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Rio Arriba | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Roosevelt | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
San Juan | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
San Miguel | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Sandoval | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Santa Fe | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Sierra | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Socorro | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Taos | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Torrance | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Union | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) in NM - H3206-001-0 Benefit Details |
Valencia | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
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