2012 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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HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Brown | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Door | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Florence | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 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 | |||||||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Fond du Lac | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Forest | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Green Lake | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 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 | |||||||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Kewaunee | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Langlade | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Manitowoc | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 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 | |||||||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Marathon | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Marinette | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Marquette | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 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 | |||||||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Menominee | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Oconto | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Outagamie | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 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 | |||||||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Portage | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Shawano | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Sheboygan | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 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 | |||||||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Waupaca | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Waushara | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) in WI - H5216-003-0 Benefit Details |
Winnebago | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
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