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 |
Hampshire | $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 |
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 | |||||
Tufts Medicare Preferred HMO Basic (HMO) - H2256-027-2 Benefit Details |
Hampshire | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | |||||||||
HNE Medicare Basic No Rx (HMO) - H8578-009-0 Benefit Details |
Hampshire | $6.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Fallon Senior Plan Saver (HMO) - H9001-010-0 Benefit Details |
Hampshire | $28.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Tufts Medicare Preferred HMO Basic Rx (HMO) - H2256-026-2 Benefit Details |
Hampshire | $35.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 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 | |||||||||
Tufts Medicare Preferred HMO Value (HMO) - H2256-019-8 Benefit Details |
Hampshire | $42.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HNE Medicare Basic (HMO) - H8578-007-0 Benefit Details |
Hampshire | $52.00 | $0 | All Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Fallon Senior Plan Saver Basic Rx (HMO) - H9001-011-0 Benefit Details |
Hampshire | $54.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Non-Preferred Generic and Preferred Brand Drugs: $20.00 Non-Preferred Generic and Non-Preferred Brand Drug: $55.00 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 | |||||||||
Fallon Senior Plan Saver Enhanced Rx (HMO) - H9001-013-0 Benefit Details |
Hampshire | $65.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $3.00 Non-Preferred Generic and Preferred Brand Drugs: $15.00 Non-Preferred Generic and Non-Preferred Brand Drug: $55.00 | $3,400 Browse Formulary | |||||
HNE Medicare Premium No Rx (HMO) - H8578-003-0 Benefit Details |
Hampshire | $70.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Tufts Medicare Preferred HMO Prime (HMO) - H2256-016-6 Benefit Details |
Hampshire | $72.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | |||||||||
Tufts Medicare Preferred HMO Value Rx (HMO) - H2256-018-8 Benefit Details |
Hampshire | $77.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
HNE Medicare Plus (HMO) - H8578-004-0 Benefit Details |
Hampshire | $80.00 | $0 | All Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Fallon Senior Plan Standard (HMO) - H9001-001-0 Benefit Details |
Hampshire | $96.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | |||||||||
Tufts Medicare Preferred HMO Prime Rx (HMO) - H2256-015-6 Benefit Details |
Hampshire | $107.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Medicare PPO Blue PlusRx (PPO) - H2230-002-0 Benefit Details |
Hampshire | $134.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Fallon Senior Plan Standard Rx (HMO) - H9001-015-0 Benefit Details |
Hampshire | $138.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $3.00 Non-Preferred Generic and Preferred Brand Drugs: $25.00 Non-Preferred Generic and Non-Preferred Brand Drug: $65.00 | $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 | |||||||||
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) - H2256-001-6 Benefit Details |
Hampshire | $139.90 | $0 | Many Generics | Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $32.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
HNE Medicare Premium (HMO) - H8578-001-0 Benefit Details |
Hampshire | $142.00 | $0 | All Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
HNE Medicare Freedom (HMO-POS) - H8578-010-0 Benefit Details |
Hampshire | $158.00 | $0 | All Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $65.00 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 | |||||||||
Medicare HMO Blue PlusRx (HMO) - H2261-005-0 Benefit Details |
Hampshire | $181.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
Fallon Senior Plan Plus Enhanced Rx (HMO) - H9001-017-0 Benefit Details |
Hampshire | $198.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $3.00 Non-Preferred Generic and Preferred Brand Drugs: $15.00 Non-Preferred Generic and Non-Preferred Brand Drug: $55.00 | $3,400 Browse Formulary | |||||
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