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) - H0609-018-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 | ||||||
AARP MedicareComplete Plan 2 (HMO) - H0609-012-0 Benefit Details |
Jefferson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $80.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
Aetna Medicare Select Plan (HMO) - H6923-001-0 Sanctioned Plan |
Jefferson | $0.00 | $0 | n/a | Tier 1: Preferred Generic Drugs: $8.00 Tier 2: Non-Preferred Generic Drugs: $39.00 Tier 3: Preferred Brand Drugs: $40.00 Tier 4: Non-Preferred Brand Drugs: $80.00 Tier 5: 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 | |||||||||
Humana Gold Choice H8145-120 (PFFS) - H8145-120-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
new | new | new | |||||||||
HumanaChoice H0623-009 (PPO) - H0623-009-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Kaiser Permanente Senior Advantage Core (HMO) - H0630-013-0 Benefit Details |
Jefferson | $0.00 | $0 | All Generics | Generic Drugs: $10.00 Brand Drugs: $45.00 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 | |||||||||
SureValue Basic (HMO) - H5679-001-0 Benefit Details |
Jefferson | $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 | |||||
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Rocky Mountain Green Plan (Cost) - H0602-042-0 Benefit Details |
Jefferson | $7.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
Evercare Plan IP (PPO SNP) - H0620-002-0 Benefit Details |
Jefferson | $20.00 | $310 | 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 | |||||||||
Humana Gold Plus H5291-001 (HMO) - H5291-001-0 Benefit Details |
Jefferson | $20.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $75.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
Evercare Plan DH (HMO SNP) - H0624-001-0 Benefit Details |
Jefferson | $ 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 Select Plan (PPO) - H5521-028-0 Sanctioned Plan |
Jefferson | $24.50 | $0 | n/a | Tier 1: Preferred Generic Drugs: $8.00 Tier 2: Non-Preferred Generic Drugs: $38.00 Tier 3: Preferred Brand Drugs: $40.00 Tier 4: Non-Preferred Brand Drugs: $80.00 Tier 5: 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 | |||||||||
AB Basic Plan (Cost) - H0602-026-0 Benefit Details |
Jefferson | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
Aetna Medicare Premier Plan (HMO) - H6923-003-0 Sanctioned Plan |
Jefferson | $28.30 | $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 | |||||
Rocky MountainThrifty Plan (Cost) - H0602-029-0 Benefit Details |
Jefferson | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
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 | |||||||||
Colorado Access Advantage - Plan D (HMO SNP) - H0621-001-0 Benefit Details |
Jefferson | $ 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: $8.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
Colorado Access Advantage - Plan E (HMO) - H0621-006-0 Benefit Details |
Jefferson | $32.80 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 25% | $6,700 Browse Formulary | |||||
Colorado Access Advantage Select D (HMO SNP) - H0621-009-0 Benefit Details |
Jefferson | $ 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: $8.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 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 | |||||||||
Senior Advantage Medicare Medicaid Plan (HMO SNP) - H0630-014-0 Benefit Details |
Jefferson | $ 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 | |||||
Rocky Mountain Green Plan + Rx (Cost) - H0602-043-0 Benefit Details |
Jefferson | $39.20 | $115 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $2.00 Non-Preferred Generic and Brand Drugs: $9.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $63.00 Specialty Tier Drugs: 30% | $5,000 Browse Formulary | |||||
Kaiser Permanente Senior Advantage Silver (HMO) - H0630-015-0 Benefit Details |
Jefferson | $48.00 | $0 | All Generics | Generic Drugs: $10.00 Brand Drugs: $45.00 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 | |||||||||
SureValue Enhanced (HMO) - H5679-002-0 Benefit Details |
Jefferson | $52.00 | $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 | |||||
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AARP MedicareComplete Plan 1 (HMO) - H0609-007-0 Benefit Details |
Jefferson | $54.00 | $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: $80.00 Specialty Tier Drugs: 33% | $5,500 Browse Formulary | |||||
HumanaChoice H0623-001 (PPO) - H0623-001-0 Benefit Details |
Jefferson | $55.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 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 | |||||||||
Humana Gold Choice H8145-123 (PFFS) - H8145-123-0 Benefit Details |
Jefferson | $59.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $41.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
Rocky Mountain Standard Plan (Cost) - H0602-009-0 Benefit Details |
Jefferson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
Rocky Mountain Thrifty Plan + Rx (Cost) - H0602-036-0 Benefit Details |
Jefferson | $69.80 | $110 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $2.00 Non-Preferred Generic and Brand Drugs: $12.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $60.00 Specialty Tier Drugs: 30% | 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 | |||||||||
Kaiser Permanente Senior Advantage Plus Choice (HMO-POS) - H0630-019-0 Benefit Details |
Jefferson | $82.00 | $0 | All Generics | Generic Drugs: $10.00 Brand Drugs: $35.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
Rocky Mountain Standard Plan + Rx (Cost) - H0602-022-0 Benefit Details |
Jefferson | $135.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Non-Preferred Generic and Brand Drugs: $10.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $60.00 Specialty Tier Drugs: 33% | N/A Browse Formulary | |||||
Rocky Mountain Plus Plan (Cost) - H0602-003-0 Benefit Details |
Jefferson | $160.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
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 Gold (HMO) - H0630-016-0 Benefit Details |
Jefferson | $177.00 | $0 | All Generics | Generic Drugs: $8.00 Brand Drugs: $30.00 Specialty Tier Drugs: 25% | $2,350 Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) - H0602-019-0 Benefit Details |
Jefferson | $246.20 | $0 | All Generics | Generic Drugs: $8.50 Non-Preferred Generic and Brand Drugs: $8.50 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $58.00 Specialty Tier Drugs: 33% | N/A Browse Formulary | |||||
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