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2010 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) Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
Members In This Plan ID | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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Advocare Essence (HMO-POS) - H5211-003-0 Benefit Details |
Burnett | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,141 members | ||||||
HumanaChoice R5826-023 (Regional PPO) - R5826-023-0 Benefit Details |
Burnett | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 9,018 members | ||||||
HumanaChoice R5826-023 (Regional PPO) - R5826-023-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 9,018 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H5216-007 (PPO) - H5216-007-0 Benefit Details |
Burnett | $22.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | n/a Browse Formulary | |||||
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Advocare Essence Rx (HMO-POS) - H5211-002-0 Benefit Details |
Burnett | $25.00 | $0 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $60.00 Tier 4: 33% | 6,085 members Browse Formulary | |||||
UCare for Seniors Value (HMO-POS) - H4270-001-0 Benefit Details |
Burnett | $51.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 813 members | ||||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SmartValue Classic (PFFS) - H0540-094-0 Benefit Details |
Burnett | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 965 members | ||||||
HealthPartners Wisconsin Freedom Plan I (Cost) - H2462-015-0 Benefit Details |
Burnett | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | < 10 members | ||||||
Sterling Basic Plus (PFFS) - H5006-018-2 Benefit Details |
Burnett | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-065 (PFFS) - H2944-065-0 Benefit Details |
Burnett | $61.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 9,894 members Browse Formulary | |||||
UCare for Seniors Value Plus (HMO-POS) - H4270-003-0 Benefit Details |
Burnett | $61.50 | $0 | No Gap Coverage | Tier 1: $8.00 Tier 2: $30.00 Tier 3: $60.00 Tier 4: 25% | 2,157 members Browse Formulary | |||||
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SmartValue Plus (PFFS) - H0540-095-0 Benefit Details |
Burnett | $62.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $8.00 Tier 2 Preferred Brand Certain Generic Drugs: $44.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 802 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Today's Options Value (PFFS) - H5421-165-0 Benefit Details |
Burnett | $65.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,006 members | ||||||
Today's Options Value powered by CCRx (PFFS) - H5421-166-0 Benefit Details |
Burnett | $76.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 3,797 members Browse Formulary | |||||
Medica Prime Solution Value (Cost) - H2450-007-0 Benefit Details |
Burnett | $78.00 | $55 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | 191 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Sterling Option I (PFFS) - H5006-014-2 Benefit Details |
Burnett | $94.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
Today's Options Premier (PFFS) - H5421-163-0 Benefit Details |
Burnett | $104.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 6,062 members | ||||||
Sterling Option II (PFFS) - H5006-017-2 Benefit Details |
Burnett | $107.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Advocare Spirit (HMO-POS) - H5211-001-0 Benefit Details |
Burnett | $108.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 5,824 members | ||||||
Medica Prime Solution Basic w/Standard Rx - WI (Cost) - H2450-008-0 Benefit Details |
Burnett | $112.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | 429 members Browse Formulary | |||||
Sterling Option IV (PFFS) - H5006-016-2 Benefit Details |
Burnett | $120.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Classic (HMO-POS) - H4270-002-0 Benefit Details |
Burnett | $128.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $30.00 Tier 3: $60.00 Tier 4: 25% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic w/Enhanced Rx - WI (Cost) - H2450-010-0 Benefit Details |
Burnett | $141.90 | $0 | Many Generics | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | 14 members Browse Formulary | |||||
Advocare Spirit Rx (HMO-POS) - H5211-004-0 Benefit Details |
Burnett | $143.00 | $0 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $60.00 Tier 4: 33% | 7,572 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier powered by CCRx (PFFS) - H5421-164-0 Benefit Details |
Burnett | $151.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 2,969 members Browse Formulary | |||||
Medica Prime Solution Enhanced w/Standard Rx - WI (Cost) - H2450-011-0 Benefit Details |
Burnett | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | 813 members Browse Formulary | |||||
Humana Gold Choice H2944-066 (PFFS) - H2944-066-0 Benefit Details |
Burnett | $163.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 562 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Advocare Vitality (HMO-POS) - H5211-006-0 Benefit Details |
Burnett | $164.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
HumanaChoice R5826-009 (Regional PPO) - R5826-009-0 Benefit Details |
Burnett | $179.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
HumanaChoice R5826-009 (Regional PPO) - R5826-009-0 Benefit Details |
Statewide | $179.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Enhanced w/Enhanced Rx - WI (Cost) - H2450-009-0 Benefit Details |
Burnett | $187.90 | $0 | Many Generics | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | 129 members Browse Formulary | |||||
Advocare Vitality Rx (HMO-POS) - H5211-005-0 Benefit Details |
Burnett | $199.00 | $0 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $60.00 Tier 4: 33% | 3,214 members Browse Formulary | |||||
HealthPartners Wisconsin Freedom Plan II (Cost) - H2462-016-0 Benefit Details |
Burnett | $222.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | < 10 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HealthPartners Wisconsin Freedom Plan II Std Rx (Cost) - H2462-017-0 Benefit Details |
Burnett | $245.20 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% | < 10 members Browse Formulary | |||||
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