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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Secure Blue (PPO) - H1302-004-0 Benefit Details |
Fremont | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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True Blue (HMO) - H1350-006-0 Benefit Details |
Fremont | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
Secure Blue (PPO) - H1302-001-0 Benefit Details |
Fremont | $43.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Preferred Brand Drugs: $31.00 Non-Preferred Brand Drugs: $41.00 Specialty Tier Drugs: 25% | $3,000 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 | |||||||||
Regence MedAdvantage (PPO) - H1304-001-0 Benefit Details |
Fremont | $48.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Regence MedAdvantage + Rx Classic (PPO) - H1304-002-0 Benefit Details |
Fremont | $89.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Non-Preferred Generic Drugs: $35.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $75.00 Injectable Drugs: 30% Specialty Tier Drugs: 30% | $3,400 Browse Formulary | |||||
True Blue Rx Option II (HMO) - H1350-010-0 Benefit Details |
Fremont | $116.00 | $260 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Preferred Brand Drugs: $31.00 Non-Preferred Brand Drugs: $41.00 Specialty Tier Drugs: 25% | $3,000 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 | |||||||||
True Blue Rx Option I (HMO) - H1350-001-0 Benefit Details |
Fremont | $135.00 | $0 | Many Generics | Preferred Generic Drugs: $6.00 Preferred Brand Drugs: $31.00 Non-Preferred Brand Drugs: $41.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Regence MedAdvantage + Rx Enhanced (PPO) - H1304-004-0 Benefit Details |
Fremont | $143.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 Non-Preferred Generic Drugs: $35.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $75.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% | $2,500 Browse Formulary | |||||
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