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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Humana Gold Choice H8145-120 (PFFS) - H8145-120-0 Benefit Details |
Mesa | $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 |
Mesa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Rocky Mountain Green Plan (Cost) - H0602-042-0 Benefit Details |
Mesa | $7.00 | 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 | |||||||||
AB Basic Plan (Cost) - H0602-026-0 Benefit Details |
Mesa | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
Rocky Mountain Green Plan + Rx (Cost) - H0602-043-0 Benefit Details |
Mesa | $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 | |||||
Rocky Mountain Thrifty Plan (Cost) - H0602-027-0 Benefit Details |
Mesa | $45.00 | 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 | |||||||||
HumanaChoice H0623-001 (PPO) - H0623-001-0 Benefit Details |
Mesa | $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 | |||||
Humana Gold Choice H8145-123 (PFFS) - H8145-123-0 Benefit Details |
Mesa | $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) - H0602-001-0 Benefit Details |
Mesa | $74.00 | 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 | |||||||||
Rocky Mountain Thrifty Plan + Rx (Cost) - H0602-039-0 Benefit Details |
Mesa | $79.90 | $120 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $2.00 Non-Preferred Generic and Brand Drugs: $13.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $64.00 Specialty Tier Drugs: 30% | N/A Browse Formulary | |||||
Rocky Mountain Standard Plan + Rx (Cost) - H0602-017-0 Benefit Details |
Mesa | $116.10 | $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 |
Mesa | $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 | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) - H0602-019-0 Benefit Details |
Mesa | $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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