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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AARP MedicareComplete Plan 1 (HMO) - H0303-013-0 Benefit Details |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $85.00 Specialty Tier Drugs: 33% | $5,400 Browse Formulary | |||||
AARP MedicareComplete Plus (HMO-POS) - H0316-002-0 Benefit Details |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $85.00 Specialty Tier Drugs: 33% | $4,200 Browse Formulary | |||||
Any, Any, Any Gold (PFFS) - H8098-001-0 Benefit Details |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $4.00 Generic Drugs: $15.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
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 | |||||||||
Any, Any, Any Gold MA Only (PFFS) - H8098-003-0 Benefit Details |
Pima | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
CareMore Breathe (HMO SNP) - H2593-005-0 Benefit Details |
Pima | $0.00 | $0 | All Generics | Preferred Generic Drugs: 0% Generic Drugs: $5.00 Brand Drugs: 0% Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
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CareMore Diabetes (HMO SNP) - H2593-006-0 Benefit Details |
Pima | $0.00 | $0 | All Generics | Preferred Generic Drugs: 0% Generic Drugs: $5.00 Brand Drugs: 0% Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
CareMore Heart (HMO SNP) - H2593-013-0 Benefit Details |
Pima | $0.00 | $0 | All Generics | Preferred Generic Drugs: 0% Generic Drugs: $5.00 Brand Drugs: 0% Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
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CareMore Touch (HMO SNP) - H2593-003-0 Benefit Details |
Pima | $0.00 | $0 | All Generics | Preferred Generic Drugs: 0% Generic Drugs: $5.00 Brand Drugs: 0% Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
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CareMore Value Plus (HMO) - H2593-001-0 Benefit Details |
Pima | $0.00 | $0 | All Generics | Preferred Generic Drugs: 0% Generic Drugs: $5.00 Brand Drugs: $25.00 Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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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 | |||||||||
e-Any, Any, Any Gold Direct (PFFS) - H8098-005-0 Benefit Details |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic Drugs: $15.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
Health Net Green (HMO) - H0351-030-0 Sanctioned Plan |
Pima | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Health Net Ruby 4 (HMO) - H0351-035-0 Sanctioned Plan |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $7.00 Preferred Brand Drugs: $41.00 Non-Preferred Generic and Non-Preferred Brand Drug: $82.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% | $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 | |||||||||
Humana Gold Plus H0307-009 (HMO-POS) - H0307-009-0 Benefit Details |
Pima | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $7.00 Non-Preferred Generic and Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,000 Browse Formulary | |||||
HumanaChoice R5826-070 (Regional PPO) - R5826-070-0 Benefit Details |
Pima | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
HumanaChoice R5826-070 (Regional PPO) - R5826-070-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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 | |||||||||
SCAN Classic (HMO) - H9385-002-0 Benefit Details |
Pima | $0.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 Generic Drugs: $10.00 Preferred Brand Drugs: $40.00 Brand Drugs: $65.00 Specialty Tier Drugs: 33% | $5,000 Browse Formulary | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H0321-002-0 Benefit Details |
Pima | $ 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 | |||||
Evercare Plan IP (PPO SNP) - H0319-001-0 Benefit Details |
Pima | $24.60 | $310 | 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 | |||||||||
Evercare Plan DH (HMO SNP) - H0303-034-0 Benefit Details |
Pima | $ 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 | |||||
Health Net Amber (HMO SNP) - H0351-029-0 Sanctioned Plan |
Pima | $ 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 | Preferred Generic Drugs: $2.00 Preferred Brand Drugs: $38.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Injectable Drugs: 25% Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
Mercy Care Advantage (HMO SNP) - H5580-001-0 Benefit Details |
Pima | $ 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 | |||||||||
University Physicians Care Advantage (HMO SNP) - H7352-002-0 Benefit Details |
Pima | $ 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 | |||||
Health Choice Generations (HMO SNP) - H5587-001-0 Benefit Details |
Pima | $ 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 | |||||
Health Choice Generations (HMO SNP) - H5587-002-0 Benefit Details |
Pima | $ 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 | |||||||||
Health Net Ruby 1 (HMO) - H0351-014-0 Sanctioned Plan |
Pima | $33.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $84.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Health Net Jade (HMO SNP) - H0351-038-0 Sanctioned Plan |
Pima | $39.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $4.00 Preferred Brand Drugs: $44.00 Non-Preferred Generic and Non-Preferred Brand Drug: $84.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
HumanaChoice H0317-004 (PPO) - H0317-004-0 Benefit Details |
Pima | $53.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $6.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $82.00 Specialty Tier Drugs: 33% | $5,000 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 | |||||||||
Any, Any, Any Platinum (PFFS) - H8098-009-0 Benefit Details |
Pima | $69.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: 0% Generic Drugs: $3.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
HumanaChoice R5826-014 (Regional PPO) - R5826-014-0 Benefit Details |
Pima | $91.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,000 Browse Formulary | |||||
HumanaChoice R5826-014 (Regional PPO) - R5826-014-0 Benefit Details |
Statewide | $91.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,000 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 Choice H8145-103 (PFFS) - H8145-103-0 Benefit Details |
Pima | $139.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $7.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
HumanaChoice R5826-076 (Regional PPO) - R5826-076-0 Benefit Details |
Pima | $150.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,000 Browse Formulary | |||||
HumanaChoice R5826-076 (Regional PPO) - R5826-076-0 Benefit Details |
Statewide | $150.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,000 Browse Formulary | |||||
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