2011 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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AHM_Basic (HMO) - H5774-003-0 Benefit Details |
Toa Baja | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
AHM_Classic (HMO) - H5774-008-0 Benefit Details |
Toa Baja | $0.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 Non-Preferred Generic Drugs: $10.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $50.00 Specialty Tier Drugs: 33% | $2,500 Browse Formulary | |||||
AHM_Classic Plus (HMO SNP) - H5774-009-0 Benefit Details |
Toa Baja | $0.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 Non-Preferred Generic Drugs: $10.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $50.00 Specialty Tier Drugs: 33% | n/a 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 | |||||||||
AHM_Opal (HMO-POS) - H5774-014-0 Benefit Details |
Toa Baja | $0.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 Non-Preferred Generic Drugs: $10.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $50.00 Specialty Tier Drugs: 33% Supplemental Drugs: 0% | $2,500 Browse Formulary | |||||
AHM_Platino Plus (HMO SNP) - H5774-019-0 Benefit Details |
Toa Baja | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
AHM_Standard (HMO) - H5774-005-0 Benefit Details |
Toa Baja | $0.00 | $0 | Many Generics | Preferred Generic Drugs: $2.00 Non-Preferred Generic Drugs: $4.00 Preferred Brand Drugs: $25.00 Non-Preferred Brand Drugs: $40.00 Specialty Tier Drugs: 33% Supplemental Drugs: 0% | $2,500 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 | |||||||||
Dorado (HMO) - H4004-025-0 Benefit Details |
Toa Baja | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Elite Dorado (HMO-POS) - H4004-015-0 Benefit Details |
Toa Baja | $0.00 | $0 | Some Generics | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $29.00 Non-Preferred Brand Drugs: $50.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
First Care+Plus (HMO) - H5887-001-0 Benefit Details |
Toa Baja | $0.00 | $0 | All Generics | Generic Drugs: $4.00 Preferred Brand Drugs: $20.00 Non-Preferred Brand Drugs: $30.00 Specialty Tier Drugs: 25% | $6,700 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 | |||||||||
First+Plus Advantage (PPO) - H4011-001-0 Benefit Details |
Toa Baja | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
First+Plus Advantage Plus (PPO) - H4011-003-0 Benefit Details |
Toa Baja | $0.00 | $0 | All Generics | Generic Drugs: $5.00 Preferred Brand Drugs: $20.00 Non-Preferred Brand Drugs: $30.00 Specialty Tier Drugs: 25% | $6,700 Browse Formulary | |||||
First+Plus Complete (HMO SNP) - H5887-007-0 Benefit Details |
Toa Baja | $0.00 | $0 | All Generics | Generic Drugs: $3.00 Preferred Brand Drugs: $15.00 Non-Preferred Brand Drugs: $30.00 Specialty Tier Drugs: 25% | n/a 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 | |||||||||
First+Plus Titanio (HMO SNP) - H5887-006-0 Benefit Details |
Toa Baja | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | All Generics | Generic Drugs: 0% Preferred Brand Drugs: $10.00 Non-Preferred Brand Drugs: $20.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
Humana Gold Plus H4007-010 (HMO) - H4007-010-0 Benefit Details |
Toa Baja | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $5.00 Non-Preferred Generic and Preferred Brand Drugs: $25.00 Non-Preferred Brand Drugs: $50.00 Specialty Tier Drugs: 33% | $5,000 Browse Formulary | |||||
Humana Gold Plus H4007-012 (HMO) - H4007-012-0 Benefit Details |
Toa Baja | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: 0% Preferred Brand Drugs: $20.00 Non-Preferred Brand Drugs: $40.00 | $3,500 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 | |||||||||
Humana Gold Plus SNP-DE H4007-005 (HMO SNP) - H4007-005-0 Benefit Details |
Toa Baja | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
MAPFRE Medicare Excel (HMO-POS) - H5821-001-0 Benefit Details |
Toa Baja | $0.00 | $0 | Many Generics | Generic Drugs: $3.00 Preferred Brand Drugs: 25% Non-Preferred Brand Drugs: 25% Specialty Tier Drugs: 25% | $6,700 Browse Formulary | |||||
MAPFRE Medicare Excel Extended (HMO-POS) - H5821-013-0 Benefit Details |
Toa Baja | $0.00 | $0 | Many Generics | Generic Drugs: $3.00 Preferred Brand Drugs: $25.00 Non-Preferred Brand Drugs: $35.00 Specialty Tier Drugs: 30% | $6,700 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 | |||||||||
MAPFRE Medicare Excel VIP (HMO) - H5821-020-0 Benefit Details |
Toa Baja | $0.00 | $0 | Many Generics | Generic Drugs: $2.00 Preferred Brand Drugs: $15.00 Non-Preferred Brand Drugs: $45.00 Specialty Tier Drugs: 30% | $6,700 Browse Formulary | |||||
MCS Classicare MA (HMO) - H4006-001-0 Benefit Details |
Toa Baja | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
MCS Classicare Premium A (HMO) - H4006-007-0 Benefit Details |
Toa Baja | $0.00 | $0 | Many Generics | Generic Drugs: $6.00 Preferred Brand Drugs: $27.00 Non-Preferred Brand Drugs: $52.00 Specialty Tier Drugs: 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 | |||||||||
Medicare en el Hogar Plus (HMO SNP) - H4004-035-0 Benefit Details |
Toa Baja | $0.00 | $0 | Some Generics | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $29.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
Medicare y Mucho Mas - BASICO SELECT (HMO) - H4003-015-0 Benefit Details |
Toa Baja | $0.00 | $0 | Some Generics | Preferred Generic Drugs: $2.00 Preferred Brand Drugs: $29.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
Medicare y Mucho Mas - DIAMANTE CHOICE (HMO SNP) - H4003-017-0 Benefit Details |
Toa Baja | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | All Generics, All Brands | Preferred Generic Drugs: 0% Preferred Brand Drugs: 0% Specialty Tier Drugs: 50% | n/a 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 | |||||||||
Medicare y Mucho Mas - ELITE (HMO-POS) - H4003-001-0 Benefit Details |
Toa Baja | $0.00 | $0 | Some Generics | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $29.00 Non-Preferred Brand Drugs: $50.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
Medicare y Mucho Mas - Original (HMO) - H4003-018-0 Benefit Details |
Toa Baja | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Medicare y Mucho Mas - SUPREMO (HMO SNP) - H4003-009-0 Benefit Details |
Toa Baja | $0.00 | $0 | Some Generics | Preferred Generic Drugs: $3.00 Generic Drugs: $5.00 Brand Drugs: $20.00 Preferred Brand Drugs: $45.00 Specialty Tier Drugs: 25% | n/a 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 | |||||||||
Medicare y Mucho Mas - Unico (HMO) - H4003-019-0 Benefit Details |
Toa Baja | $0.00 | $0 | Some Generics | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $25.00 Non-Preferred Brand Drugs: $50.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
PMC Max (HMO) - H4004-050-0 Benefit Details |
Toa Baja | $0.00 | $0 | Some Generics | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $25.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
Premier Preferred (HMO SNP) - H4004-048-0 Benefit Details |
Toa Baja | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a 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 | |||||||||
Triple-S Medicare Optimo (PPO) - H4005-001-0 Benefit Details |
Toa Baja | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Triple-S Medicare Optimo Premier (HMO) - H5732-001-0 Benefit Details |
Toa Baja | $0.00 | $0 | Many Generics | Generic Drugs: $5.00 Preferred Brand Drugs: $30.00 Brand Drugs: $45.00 Non-Preferred Brand Drugs: $50.00 Specialty Tier Drugs: 25% | $6,700 Browse Formulary | |||||
Triple-S Medicare Optimo Select (HMO) (HMO) - H4012-008-0 Benefit Details |
Toa Baja | $0.00 | $0 | Many Generics | Generic Drugs: 0% Preferred Brand Drugs: $5.00 Non-Preferred Brand Drugs: $15.00 Specialty Tier Drugs: 25% | $6,700 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 | |||||||||
Triple-S Medicare Selecto with Medicare Platino (HMO SNP) - H4012-003-0 Benefit Details |
Toa Baja | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
MCS Classicare Especial (HMO SNP) - H5577-002-0 Benefit Details |
Toa Baja | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Triple-S Medicare Optimo Plus (PPO) - H4005-004-0 Benefit Details |
Toa Baja | $24.00 | $0 | Many Generics | Generic Drugs: $5.00 Preferred Brand Drugs: $25.00 Brand Drugs: $45.00 Non-Preferred Brand Drugs: 25% Specialty Tier Drugs: 25% | $6,700 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 | |||||||||
HumanaChoice H2029-001 (PPO) - H2029-001-0 Benefit Details |
Toa Baja | $31.30 | $0 | Some Generics, Few Brands | Preferred Generic Drugs: $4.00 Non-Preferred Generic and Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $50.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium B (HMO-POS) - H4006-008-0 Benefit Details |
Toa Baja | $81.30 | $0 | Many Generics | Generic Drugs: $4.00 Preferred Brand Drugs: $24.00 Non-Preferred Brand Drugs: $44.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
MCS Classicare Ideal D (HMO SNP) - H4006-013-0 Benefit Details |
Toa Baja | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
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