2011 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
Erickson Advantage Champion (HMO-POS SNP) in CO - H5652-004-0 Benefit Details |
Douglas | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Erickson Advantage Champion (HMO-POS SNP) in IL - H5652-004-0 Benefit Details |
DuPage | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Erickson Advantage Champion (HMO-POS SNP) in IL - H5652-004-0 Benefit Details |
Lake | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Erickson Advantage Champion (HMO-POS SNP) in KS - H5652-004-0 Benefit Details |
Johnson | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Erickson Advantage Champion (HMO-POS SNP) in MD - H5652-004-0 Benefit Details |
Baltimore | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Erickson Advantage Champion (HMO-POS SNP) in MD - H5652-004-0 Benefit Details |
Montgomery | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Erickson Advantage Champion (HMO-POS SNP) in MD - H5652-004-0 Benefit Details |
Prince George's | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Erickson Advantage Champion (HMO-POS SNP) in MA - H5652-004-0 Benefit Details |
Essex | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Erickson Advantage Champion (HMO-POS SNP) in MA - H5652-004-0 Benefit Details |
Plymouth | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Erickson Advantage Champion (HMO-POS SNP) in MI - H5652-004-0 Benefit Details |
Oakland | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Erickson Advantage Champion (HMO-POS SNP) in MI - H5652-004-0 Benefit Details |
Wayne | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Erickson Advantage Champion (HMO-POS SNP) in NJ - H5652-004-0 Benefit Details |
Monmouth | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Erickson Advantage Champion (HMO-POS SNP) in NJ - H5652-004-0 Benefit Details |
Morris | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Erickson Advantage Champion (HMO-POS SNP) in PA - H5652-004-0 Benefit Details |
Bucks | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Erickson Advantage Champion (HMO-POS SNP) in PA - H5652-004-0 Benefit Details |
Delaware | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Erickson Advantage Champion (HMO-POS SNP) in TX - H5652-004-0 Benefit Details |
Collin | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Erickson Advantage Champion (HMO-POS SNP) in TX - H5652-004-0 Benefit Details |
Harris | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Erickson Advantage Champion (HMO-POS SNP) in VA - H5652-004-0 Benefit Details |
Fairfax | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
-- |
|