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 Choice (Regional PPO) - R7444-001-0 Benefit Details |
Statewide | $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% | $4,400 Browse Formulary | |||||
AARP MedicareComplete Choice (Regional PPO) - R7444-001-0 Benefit Details |
Windham | $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% | $4,400 Browse Formulary | |||||
ConnectiCare VIP Option 3 (HMO-POS) - H3528-008-0 Benefit Details |
Windham | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 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 | |||||||||
ConnectiCare VIP Prime 1 (HMO) - H3528-001-0 Benefit Details |
Windham | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $4,900 Browse Formulary | |||||
ConnectiCare VIP Prime 4 (HMO) - H3528-003-0 Benefit Details |
Windham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 | ||||||
MediBlue Essential (HMO) - H5854-004-0 Benefit Details |
Windham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,000 | ||||||
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 | |||||||||
MediBlue Value (HMO) - H5854-005-0 Benefit Details |
Windham | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $6,000 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Essential (HMO) - H0755-032-0 Benefit Details |
Windham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
UnitedHealthcare MedicareComplete Plan 2 (HMO) - H0755-031-0 Benefit Details |
Windham | $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: $89.00 Specialty Tier Drugs: 33% | $4,900 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 | |||||||||
Evercare Plan DP (PPO SNP) - H0710-002-0 Benefit Details |
Windham | $ 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) - H0710-001-0 Benefit Details |
Windham | $30.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
MediBlue Plus (HMO) - H5854-002-0 Benefit Details |
Windham | $75.00 | $0 | Many Generics | Generic Drugs: 0% Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: 0% | $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 | |||||||||
ConnectiCare VIP Prime 3 (HMO) - H3528-002-0 Benefit Details |
Windham | $109.00 | $0 | Many Generics | Tier 1: tbd | $2,900 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Plan 1 (HMO) - H0755-030-0 Benefit Details |
Windham | $119.00 | $0 | Some Generics | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $82.00 Specialty Tier Drugs: 33% | $2,900 Browse Formulary | |||||
ConnectiCare VIP Option 1 (HMO-POS) - H3528-006-0 Benefit Details |
Windham | $168.00 | $0 | Many Generics | Tier 1: tbd | $5,500 Browse Formulary | |||||
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