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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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AARP MedicareComplete Plus (HMO-POS) - H5253-011-0 Benefit Details |
Waushara | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $38.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $72.00 Tier 4 Specialty: 33% | 13,865 members Browse Formulary | |||||
Advocare Essence (HMO-POS) - H5211-003-0 Benefit Details |
Waushara | $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 |
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 R5826-023 (Regional PPO) - R5826-023-0 Benefit Details |
Waushara | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 9,018 members | ||||||
Network PlatinumSelect (PPO) - H5215-008-0 Benefit Details |
Waushara | $0.00 | $0 | No Gap Coverage | Preferred Generic: $7.00 Non-Preferred Generic: $7.00 Preferred Brand: $26.00 Non-Preferred Brand: $53.00 Specialty: 25% | 8,291 members Browse Formulary | |||||
SecureHorizons MedicareDirect Plan 3 (PFFS) - H5435-003-0 Benefit Details |
Waushara | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 24,942 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Advocare Essence Rx (HMO-POS) - H5211-002-0 Benefit Details |
Waushara | $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 | |||||
Evercare Plan MH-POS (HMO-POS) - H5253-029-0 Benefit Details |
Waushara | $25.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $45.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $85.00 Tier 4 Specialty: 33% | 296 members Browse Formulary | |||||
SecureHorizons MedicareDirect Plan 100 (PFFS) - H5435-020-0 Benefit Details |
Waushara | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 4,121 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Network PlatinumPlus (PPO) - H5215-001-0 Benefit Details |
Waushara | $28.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 4,306 members | ||||||
Evercare Plan DH (HMO) - H5253-024-0 Benefit Details |
Waushara | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) - H5216-003-0 Benefit Details |
Waushara | $30.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $75.00 Specialty: 33% | 6,041 members Browse Formulary | |||||
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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) - H5421-055-0 Benefit Details |
Waushara | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 5,383 members | ||||||
SecureHorizons MedicareDirect Rx Plan 150 (PFFS) - H5435-027-0 Benefit Details |
Waushara | $35.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $42.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $80.00 Tier 4 Specialty: 33% | 4,555 members Browse Formulary | |||||
Network Cares (PPO) - H5215-007-0 Benefit Details |
Waushara | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $94.00 Specialty: 33% | 821 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 powered by CCRx (PFFS) - H5421-073-0 Benefit Details |
Waushara | $51.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 10,805 members Browse Formulary | |||||
SmartValue Classic (PFFS) - H0540-094-0 Benefit Details |
Waushara | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 965 members | ||||||
Humana Gold Choice H2944-065 (PFFS) - H2944-065-0 Benefit Details |
Waushara | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Network PlatinumPlus Pharmacy (PPO) - H5215-002-0 Benefit Details |
Waushara | $62.00 | $0 | Many Generics | Preferred Generic: $7.00 Non-Preferred Generic: $7.00 Preferred Brand: $26.00 Non-Preferred Brand: $53.00 Specialty: 25% | 10,340 members Browse Formulary | |||||
SmartValue Plus (PFFS) - H0540-095-0 Benefit Details |
Waushara | $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 | |||||
Network PlatinumPremier (PPO) - H5215-006-0 Benefit Details |
Waushara | $66.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,336 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier (PFFS) - H5421-049-0 Benefit Details |
Waushara | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 8,597 members | ||||||
Advocare Spirit (HMO-POS) - H5211-001-0 Benefit Details |
Waushara | $108.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 5,824 members | ||||||
Today's Options Premier powered by CCRx (PFFS) - H5421-067-0 Benefit Details |
Waushara | $112.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 4,339 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Network PlatinumPremier Pharmacy (PPO) - H5215-005-0 Benefit Details |
Waushara | $115.00 | $0 | Many Generics | Preferred Generic: $7.00 Non-Preferred Generic: $7.00 Preferred Brand: $26.00 Non-Preferred Brand: $53.00 Specialty: 25% | 6,491 members Browse Formulary | |||||
Advocare Spirit Rx (HMO-POS) - H5211-004-0 Benefit Details |
Waushara | $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 | |||||
Humana Gold Choice H2944-066 (PFFS) - H2944-066-0 Benefit Details |
Waushara | $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 |
Waushara | $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 |
Statewide | $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 |
Waushara | $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 | |||||||||
Advocare Vitality Rx (HMO-POS) - H5211-005-0 Benefit Details |
Waushara | $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 | |||||
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