2013 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 |
|||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Adams | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Allen | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Benton | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Blackford | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Boone | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Brown | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Carroll | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Cass | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Clinton | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Decatur | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Delaware | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Elkhart | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Fayette | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Fountain | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Fulton | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Hamilton | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Hancock | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Hendricks | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Henry | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Howard | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Huntington | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Jackson | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Jay | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Jennings | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Johnson | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
La Porte | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Lagrange | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Lake | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Madison | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Marion | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Marshall | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Montgomery | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Morgan | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Pulaski | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Putnam | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Randolph | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Rush | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Shelby | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
St. Joseph | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Starke | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Steuben | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Tippecanoe | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Tipton | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Union | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Wabash | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Warren | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Wells | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
White | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
ADVANTAGE Select (PPO) in IN - H5508-005-0 Benefit Details |
Whitley | $0.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,100 Browse Formulary | |||||
|