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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BCN Advantage Basic (HMO-POS) - H5883-004-2 Benefit Details |
Midland | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $5,000 Browse Formulary | |||||
HumanaChoice R5826-053 (Regional PPO) - R5826-053-0 Benefit Details |
Midland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice R5826-053 (Regional PPO) - R5826-053-0 Benefit Details |
Statewide | $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 | |||||||||
BCN Advantage Option 1 (HMO-POS) - H5883-001-2 Benefit Details |
Midland | $8.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,400 | ||||||
HumanaChoice H5470-005 (PPO) - H5470-005-0 Benefit Details |
Midland | $41.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $6.00 Non-Preferred Generic and Preferred Brand Drugs: $39.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $4,500 Browse Formulary | |||||
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HumanaChoice R5826-072 (Regional PPO) - R5826-072-0 Benefit Details |
Midland | $61.00 | $310 | 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 | |||||||||
HumanaChoice R5826-072 (Regional PPO) - R5826-072-0 Benefit Details |
Statewide | $61.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
Medicare Plus Blue PPO Vitality (PPO) - H9572-002-5 Benefit Details |
Midland | $64.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $5,500 Browse Formulary | |||||
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BCN Advantage Option 2 (HMO-POS) - H5883-002-2 Benefit Details |
Midland | $69.00 | $0 | Many Generics | Tier 1: tbd | $4,200 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 | |||||||||
HumanaChoice R5826-006 (Regional PPO) - R5826-006-0 Benefit Details |
Midland | $105.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $4,000 Browse Formulary | |||||
HumanaChoice R5826-006 (Regional PPO) - R5826-006-0 Benefit Details |
Statewide | $105.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $4,000 Browse Formulary | |||||
Medicare Plus Blue PPO Signature (PPO) - H9572-001-5 Benefit Details |
Midland | $154.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $5,000 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 | |||||||||
BCN Advantage Option 3 (HMO-POS) - H5883-003-2 Benefit Details |
Midland | $207.00 | $0 | Many Generics | Tier 1: tbd | $4,000 Browse Formulary | |||||
Medicare Plus Blue PPO Assure (PPO) - H9572-003-5 Benefit Details |
Midland | $219.00 | $0 | Many Generics | Tier 1: tbd | $4,000 Browse Formulary | |||||
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