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 |
Carroll | $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 |
Carroll | $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 | |||||
Kaiser Permanente Medicare Plus Basic no D AB (Cost) - H2150-017-0 Benefit Details |
Carroll | $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 | |||||||||
Kaiser Permanente Medicare Plus Std w/D AB (Cost) - H2150-009-0 Benefit Details |
Carroll | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
Kaiser Permanente Medicare Plus Std w/o D AB (Cost) - H2150-022-0 Benefit Details |
Carroll | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Aetna Medicare Standard Plan (HMO) - H2112-007-0 Sanctioned Plan |
Carroll | $10.80 | $0 | n/a | Tier 1: Preferred Generic Drugs: $8.00 Tier 2: Non-Preferred Generic Drugs: $38.00 Tier 3: Preferred Brand Drugs: $40.00 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 | |||||||||
Aetna Medicare Premier Plan (HMO) - H2112-014-0 Sanctioned Plan |
Carroll | $27.30 | $0 | n/a | Tier 1: Preferred Generic Drugs: $8.00 Tier 2: Non-Preferred Generic Drugs: $38.00 Tier 3: Preferred Brand Drugs: $45.00 Tier 4: Non-Preferred Brand Drugs: $80.00 Tier 5: Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
Evercare Plan IP (PPO SNP) - H2111-001-0 Benefit Details |
Carroll | $28.80 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Amerivantage Specialty + Rx (HMO SNP) - H5896-007-0 Benefit Details |
Carroll | $ 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 | |||||
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 | |||||||||
Bravo Traditions (HMO SNP) - H2108-020-0 Benefit Details |
Carroll | $34.30 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Aetna Medicare Standard Plan (PPO) - H5521-036-0 Sanctioned Plan |
Carroll | $37.50 | $100 | n/a | Tier 1: Preferred Generic Drugs: $6.00 Tier 2: Non-Preferred Generic Drugs: $24.00 Tier 3: Preferred Brand Drugs: $38.00 Tier 4: Non-Preferred Brand Drugs: $70.00 Tier 5: Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
Kaiser Permanente Medicare Plus High w/o D AB (Cost) - H2150-021-0 Benefit Details |
Carroll | $59.00 | 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 | |||||||||
Care Improvement Plus Gold Rx (HMO SNP) - H5665-002-0 Benefit Details |
Carroll | $84.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 30% | n/a Browse Formulary | |||||
Kaiser Permanente Medicare Plus High w/D AB (Cost) - H2150-002-0 Benefit Details |
Carroll | $96.00 | $0 | All Generics | Tier 1: tbd | $3,400 Browse Formulary | |||||
Bravo Premier Plus (HMO-POS) - H2108-026-0 Benefit Details |
Carroll | $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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