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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IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Benton | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Blackford | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Boone | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $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 | |||||||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Brown | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Carroll | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Clay | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $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 | |||||||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Clinton | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Delaware | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Grant | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $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 | |||||||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Greene | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Hamilton | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Hancock | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $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 | |||||||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Hendricks | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Henry | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Howard | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $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 | |||||||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Jay | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Johnson | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Lawrence | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $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 | |||||||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Marion | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Monroe | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Morgan | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $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 | |||||||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Orange | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Owen | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Parke | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $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 | |||||||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Putnam | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Randolph | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Shelby | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $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 | |||||||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Tippecanoe | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Tipton | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Vermillion | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $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 | |||||||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
Vigo | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
IU Health Plans Medicare Choice (HMO-POS) in IN - H7220-004-0 Benefit Details |
White | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
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