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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Bravo Achieve (HMO SNP) - H2108-030-0 Benefit Details |
New Castle | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Generic Drugs: $15.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% Generic and Brand Drugs: $10.00 | n/a Browse Formulary | |||||
Bravo Classic (HMO) - H2108-022-0 Benefit Details |
New Castle | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $8.00 Generic Drugs: $15.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
Aetna Medicare Standard Plan (HMO) - H5813-003-0 Sanctioned Plan |
New Castle | $6.60 | $0 | n/a | Tier 1: Preferred Generic Drugs: $8.00 Tier 2: Non-Preferred Generic Drugs: $34.00 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 | |||||
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 IP (PPO SNP) - H2111-001-0 Benefit Details |
New Castle | $28.80 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Aetna Medicare Premier Plan (HMO) - H5813-006-0 Sanctioned Plan |
New Castle | $32.00 | $0 | n/a | Tier 1: Preferred Generic Drugs: $5.00 Tier 2: Non-Preferred Generic Drugs: $25.00 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 | |||||
Bravo Traditions (HMO SNP) - H2108-020-0 Benefit Details |
New Castle | $34.30 | $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 | |||||||||
Aetna Medicare Premier Plan (PPO) - H8684-001-0 Sanctioned Plan |
New Castle | $47.50 | $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 | |||||
Bravo Premier Plus (HMO-POS) - H2108-026-0 Benefit Details |
New Castle | $97.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $8.00 Generic Drugs: $15.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
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