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 Essential (HMO) - H0543-121-0 Benefit Details |
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
AARP MedicareComplete Plan 2 (HMO) - H0543-138-0 Benefit Details |
Orange | $0.00 | $0 | Some Generics | Preferred Generic Drugs: $3.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $85.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
AARP MedicareComplete Premier (HMO) - H0543-004-0 Benefit Details |
Orange | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $85.00 Specialty Tier Drugs: 33% | $5,900 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 | |||||||||
Aetna Medicare Select Plan (HMO) - H0523-002-0 Sanctioned Plan |
Orange | $0.00 | $0 | n/a | Tier 1: Preferred Generic Drugs: $9.00 Tier 2: Non-Preferred Generic Drugs: $36.00 Tier 3: Preferred Brand Drugs: $40.00 Tier 4: Non-Preferred Brand Drugs: $85.00 Tier 5: Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
ARTA Medicare Health Plan (HMO) - H5948-001-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Generic Drugs: $5.00 Preferred Brand Drugs: $30.00 Brand Drugs: $60.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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Blue Cross Senior Secure Plan I (HMO) - H0564-006-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $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 | |||||||||
Blue Shield 65 Plus (HMO) - H0504-015-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: tbd | $6,700 Browse Formulary | |||||
Blue Shield 65 Plus Choice Plan (HMO) - H0504-021-0 Benefit Details |
Orange (Partial) | $0.00 | $0 | Many Generics | Tier 1: tbd | $6,700 Browse Formulary | |||||
Care1st Medicare Advantage Value Plus Plan (HMO) - H5928-006-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic Drugs: 0% Generic Drugs: $5.00 Preferred Brand Drugs: $30.00 Non-Preferred Generic and Non-Preferred Brand Drug: $50.00 Specialty Tier Drugs: 30% | $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 | |||||||||
CareMore Breathe (HMO SNP) - H0544-014-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Preferred Generic Drugs: 0% Generic Drugs: $5.00 Brand Drugs: 0% Preferred Brand Drugs: $25.00 Non-Preferred Generic and Non-Preferred Brand Drug: $50.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
CareMore Connect (HMO SNP) - H0544-003-0 Benefit Details |
Orange | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | All Generics | Preferred Generic Drugs: 0% Generic Drugs: 0% Brand Drugs: 25% Preferred Brand Drugs: 25% Non-Preferred Generic and Non-Preferred Brand Drug: 25% Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
CareMore Diabetes (HMO SNP) - H0544-004-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Preferred Generic Drugs: 0% Generic Drugs: $5.00 Brand Drugs: 0% Preferred Brand Drugs: $25.00 Non-Preferred Generic and Non-Preferred Brand Drug: $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 | |||||||||
CareMore Heart (HMO SNP) - H0544-013-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Preferred Generic Drugs: 0% Generic Drugs: $5.00 Brand Drugs: 0% Preferred Brand Drugs: $25.00 Non-Preferred Generic and Non-Preferred Brand Drug: $50.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
CareMore Touch (HMO SNP) - H0544-005-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Preferred Generic Drugs: 0% Generic Drugs: $5.00 Brand Drugs: 0% Preferred Brand Drugs: $25.00 Non-Preferred Generic and Non-Preferred Brand Drug: $50.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
CareMore Value Plus (HMO) - H0544-002-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Preferred Generic Drugs: 0% Generic Drugs: $5.00 Brand Drugs: 0% Preferred Brand Drugs: $25.00 Non-Preferred Generic and Non-Preferred Brand Drug: $60.00 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 | |||||||||
Central Health Medicare Plan (HMO) - H5649-001-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, Few Brands | Preferred Generic Drugs: 0% Non-Preferred Generic Drugs: $5.00 Brand Drugs: $10.00 Preferred Brand Drugs: $25.00 Non-Preferred Brand Drugs: $50.00 Specialty Tier Drugs: 33% | $2,000 Browse Formulary | |||||
Citizens Choice Healthplan (HMO) - H3815-001-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Generic Drugs: 0% Preferred Brand Drugs: $15.00 Non-Preferred Brand Drugs: $50.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
Freedom Blue Classic (Regional PPO) - R9943-004-0 Benefit Details |
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,300 | ||||||
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 | |||||||||
Freedom Blue Classic (Regional PPO) - R9943-004-0 Benefit Details |
Orange (Partial) | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,300 | ||||||
Freedom Blue Classic (Regional PPO) - R9943-004-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,300 | ||||||
Freedom Blue Plan I (Regional PPO) - R9943-001-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $3,300 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 | |||||||||
Freedom Blue Plan I (Regional PPO) - R9943-001-0 Benefit Details |
Orange (Partial) | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $3,300 Browse Formulary | |||||
Freedom Blue Plan I (Regional PPO) - R9943-001-0 Benefit Details |
Statewide | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $3,300 Browse Formulary | |||||
Golden State Medicare Health Plan, Golden (HMO) - H2241-001-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Generic Drugs: 0% Preferred Brand Drugs: $28.00 Non-Preferred Generic and Non-Preferred Brand Drug: $50.00 Specialty Tier Drugs: 25% | $6,700 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 | |||||||||
Health Net Healthy Heart Plan 1 (HMO) - H0562-082-0 Sanctioned Plan |
Orange | $0.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 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 Seniority Plus Green (HMO) - H0562-044-0 Sanctioned Plan |
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Health Net Seniority Plus Ruby Plan 1 (HMO) - H0562-083-0 Sanctioned Plan |
Orange | $0.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 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 | |||||
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 | |||||||||
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) - H0524-003-0 Benefit Details |
Orange | $0.00 | $0 | All Generics | Generic Drugs: $5.00 Brand Drugs: $35.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
MD Care Advantage 1 MAPD (HMO) - H7731-001-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Generic Drugs: 0% Preferred Brand Drugs: $19.00 Brand Drugs: $59.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
MD Care Advantage Select MA (HMO) - H7731-007-0 Benefit Details |
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | |||||||||
Salud con Health Net Medicare Advantage (HMO) - H0562-085-0 Sanctioned Plan |
Orange | $0.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 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 | |||||
SCAN Classic (HMO) - H5425-007-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic Drugs: $4.00 Generic Drugs: $8.00 Preferred Brand Drugs: $37.00 Brand Drugs: $65.00 Specialty Tier Drugs: 33% | $5,000 Browse Formulary | |||||
SCAN Healthy at Home (HMO SNP) - H9104-007-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic Drugs: $4.00 Generic Drugs: $8.00 Preferred Brand Drugs: $37.00 Brand Drugs: $65.00 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 | |||||||||
SCAN Options (HMO) - H5425-014-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 Generic Drugs: $10.00 Preferred Brand Drugs: $45.00 Brand Drugs: $75.00 Specialty Tier Drugs: 33% | $5,000 Browse Formulary | |||||
StartSmart with CareMore (HMO) - H0544-007-0 Benefit Details |
Orange | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic Drugs: $8.00 Brand Drugs: $25.00 Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $65.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP) - H0524-029-0 Benefit Details |
Orange | $ 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 | Generic Drugs: $12.00 Brand Drugs: $44.00 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 | |||||||||
Care1st Dual Plus Value Plan (HMO SNP) - H5928-005-0 Benefit Details |
Orange | $ 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 | |||||
Aetna Medicare Premier Plan (HMO) - H0523-057-0 Sanctioned Plan |
Orange | $21.70 | $0 | n/a | Tier 1: Preferred Generic Drugs: $5.00 Tier 2: Non-Preferred Generic Drugs: $35.00 Tier 3: Preferred Brand Drugs: $45.00 Tier 4: Non-Preferred Brand Drugs: $85.00 Tier 5: Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
Evercare Plan DH (HMO SNP) - H0543-079-0 Benefit Details |
Orange | $ 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 Seniority Plus Amber I (HMO SNP) - H0562-055-0 Sanctioned Plan |
Orange | $ 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 Seniority Plus Amber II (HMO SNP) - H0562-070-0 Sanctioned Plan |
Orange | $ 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 | |||||
Arta Medicare Health Plan (HMO SNP) - H5948-002-0 Benefit Details |
Orange | $ 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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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 | |||||||||
Easy Choice Plus Plan (HMO) - H5087-002-0 Benefit Details |
Orange | $32.30 | $0 | Many Generics | Preferred Generic Drugs: 0% Non-Preferred Generic and Preferred Brand Drugs: 25% Non-Preferred Brand Drugs: 25% Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
OneCare (HMO SNP) - H5433-001-0 Benefit Details |
Orange | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | All Generics | Generic Drugs: 0% Brand Drugs: 0% | n/a Browse Formulary | |||||
Brand New Day (HMO SNP) - H0838-020-0 Benefit Details |
Orange | $33.80 | $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 | |||||||||
Health Net Healthy Heart Plan 2 (HMO) - H0562-071-0 Sanctioned Plan |
Orange | $39.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 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 | |||||
My Choice (HMO-POS) - H5425-026-0 Benefit Details |
Orange | $40.00 | $0 | Many Generics | Preferred Generic Drugs: $4.00 Generic Drugs: $8.00 Preferred Brand Drugs: $37.00 Brand Drugs: $65.00 Specialty Tier Drugs: 33% | $1,050 Browse Formulary | |||||
CareMore ESRD (HMO SNP) - H0544-015-0 Benefit Details |
Orange | $370.40 | $0 | All Generics, All Brands | Preferred Generic Drugs: 0% Generic Drugs: $5.00 Brand Drugs: 0% Preferred Brand Drugs: $25.00 Non-Preferred Generic and Non-Preferred Brand Drug: $50.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
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