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) - H5883-004-3 Benefit Details |
Washtenaw | $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 |
Statewide | $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 |
Washtenaw | $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) - H5883-001-3 Benefit Details |
Washtenaw | $24.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,400 | ||||||
Fidelis Secure Comfort (HMO SNP) - H2323-005-0 Benefit Details |
Washtenaw | $34.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
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Medicare Plus Blue PPO Vitality (PPO) - H9572-002-4 Benefit Details |
Washtenaw | $54.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $5,500 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 | |||||||||
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 | |||||
HumanaChoice R5826-072 (Regional PPO) - R5826-072-0 Benefit Details |
Washtenaw | $61.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
BCN Advantage Option 2 (HMO-POS) - H5883-002-3 Benefit Details |
Washtenaw | $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 | |||||||||
PriorityMedicare Value (HMO-POS) - H2320-021-0 Benefit Details |
Washtenaw | $83.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $9.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $81.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
HAP Senior Plus - Expanded Network (HMO-POS) - H2312-008-0 Benefit Details |
Washtenaw | $95.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Fidelis Secure Comfort Plus (HMO SNP) - H2323-006-0 Benefit Details |
Washtenaw | $98.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $30.00 Non-Preferred Generic and Non-Preferred Brand Drug: $65.00 Specialty Tier Drugs: 33% | n/a 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 | |||||||||
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 | |||||
HumanaChoice R5826-006 (Regional PPO) - R5826-006-0 Benefit Details |
Washtenaw | $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 | |||||
HAP Senior Plus - Expanded Network (HMO-POS) - H2312-007-0 Benefit Details |
Washtenaw | $113.00 | $110 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic Drugs: $10.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: 30% Specialty Tier Drugs: 30% | $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 | |||||||||
PriorityMedicare (HMO-POS) - H2320-019-0 Benefit Details |
Washtenaw | $122.10 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $8.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Medicare Plus Blue PPO Signature (PPO) - H9572-001-4 Benefit Details |
Washtenaw | $129.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $5,000 Browse Formulary | |||||
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Fidelis Secure Independence (HMO SNP) - H2323-007-0 Benefit Details |
Washtenaw | $149.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $30.00 Non-Preferred Generic and Non-Preferred Brand Drug: $65.00 Specialty Tier Drugs: 33% | n/a 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 | |||||||||
Alliance Medicare PPO (PPO) - H2322-001-0 Benefit Details |
Washtenaw | $150.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic Drugs: $10.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: 33% Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
PriorityMedicare Select (PPO) - H4875-015-0 Benefit Details |
Washtenaw | $153.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $8.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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HAP Senior Plus - Expanded Network (HMO-POS) - H2312-010-0 Benefit Details |
Washtenaw | $158.00 | $0 | All Generics | Preferred Generic Drugs: $5.00 Generic Drugs: $5.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: 33% 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 | |||||||||
Alliance Medicare PPO (PPO) - H2322-004-0 Benefit Details |
Washtenaw | $183.00 | $0 | All Generics | Preferred Generic Drugs: $4.00 Generic Drugs: $8.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: 33% Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
Medicare Plus Blue PPO Assure (PPO) - H9572-003-4 Benefit Details |
Washtenaw | $185.00 | $0 | Many Generics | Tier 1: tbd | $4,000 Browse Formulary | |||||
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BCN Advantage Option 3 (HMO-POS) - H5883-003-3 Benefit Details |
Washtenaw | $193.00 | $0 | Many Generics | Tier 1: tbd | $4,000 Browse Formulary | |||||
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