2014 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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Coordinated Choice Plan (HMO) in TX - H5928-037-0 Benefit Details |
El Paso | $26.30 | $310 | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $3,400 Browse Formulary | |||||
Coordinated Choice Plan (HMO) in CA - H5928-037-0 Benefit Details |
Alameda | $26.30 | $310 | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $3,400 Browse Formulary | |||||
Coordinated Choice Plan (HMO) in CA - H5928-037-0 Benefit Details |
Fresno | $26.30 | $310 | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $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 | |||||||||
Coordinated Choice Plan (HMO) in CA - H5928-037-0 Benefit Details |
Los Angeles | $26.30 | $310 | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $3,400 Browse Formulary | |||||
Coordinated Choice Plan (HMO) in CA - H5928-037-0 Benefit Details |
Orange | $26.30 | $310 | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $3,400 Browse Formulary | |||||
Coordinated Choice Plan (HMO) in CA - H5928-037-0 Benefit Details |
Riverside | $26.30 | $310 | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $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 | |||||||||
Coordinated Choice Plan (HMO) in CA - H5928-037-0 Benefit Details |
San Bernardino | $26.30 | $310 | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $3,400 Browse Formulary | |||||
Coordinated Choice Plan (HMO) in CA - H5928-037-0 Benefit Details |
San Diego | $26.30 | $310 | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $3,400 Browse Formulary | |||||
Coordinated Choice Plan (HMO) in CA - H5928-037-0 Benefit Details |
San Francisco | $26.30 | $310 | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $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 | |||||||||
Coordinated Choice Plan (HMO) in CA - H5928-037-0 Benefit Details |
Santa Clara | $26.30 | $310 | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $3,400 Browse Formulary | |||||
Coordinated Choice Plan (HMO) in CA - H5928-037-0 Benefit Details |
Stanislaus | $26.30 | $310 | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $3,400 Browse Formulary | |||||
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