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 (HMO) - H0543-085-0 Benefit Details |
San Francisco | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 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 | |||||
Freedom Blue Classic (Regional PPO) - R9943-004-0 Benefit Details |
San Francisco | $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 | ||||||
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 |
San Francisco | $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 | |||||
Senior Advantage Medicare Medi-Cal Plan North (HMO SNP) - H0524-030-0 Benefit Details |
San Francisco | $ 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: $13.00 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 | |||||||||
CCHP Senior Select Program (HMO SNP) - H0571-005-0 Benefit Details |
San Francisco | $ 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 |
San Francisco | $ 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 | |||||
CCHP Senior Program (HMO) - H0571-001-0 Benefit Details |
San Francisco | $35.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Brand Drugs: $35.00 Specialty Tier Drugs: $100.00 | $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 | |||||||||
SCAN Options (HMO) - H5425-023-0 Benefit Details |
San Francisco | $49.00 | $0 | No additional gap coverage, only the Donut Hole Discount | 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 | |||||
SCAN Classic (HMO) - H5425-019-0 Benefit Details |
San Francisco | $59.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 Generic Drugs: $10.00 Preferred Brand Drugs: $35.00 Brand Drugs: $55.00 Specialty Tier Drugs: 33% | $5,000 Browse Formulary | |||||
Health Net Healthy Heart (HMO) - H0562-009-0 Sanctioned Plan |
San Francisco | $79.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $7.00 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 | |||||||||
Health Net Seniority Plus Green (HMO) - H0562-045-0 Sanctioned Plan |
San Francisco | $79.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) - H0524-032-0 Benefit Details |
San Francisco | $81.00 | $0 | All Generics | Generic Drugs: $10.00 Brand Drugs: $45.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
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