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 (HMO) - H2654-004-0 Benefit Details |
Jefferson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $79.00 Specialty Tier Drugs: 33% | $4,500 Browse Formulary | |||||
AARP MedicareComplete Essential (HMO) - H2654-020-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,800 | ||||||
Care Improvement Plus Gold Rx (Regional PPO SNP) - R3444-009-0 Benefit Details |
Jefferson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $8.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 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 | |||||||||
Care Improvement Plus Gold Rx (Regional PPO SNP) - R3444-009-0 Benefit Details |
Statewide | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $8.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
Essence Advantage (HMO) - H2610-005-0 Benefit Details |
Jefferson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $34.00 Non-Preferred Generic and Non-Preferred Brand Drug: $69.00 Specialty Tier Drugs: 33% | $2,250 Browse Formulary | |||||
Essence Advantage Special Needs Plan (HMO SNP) - H2610-010-0 Benefit Details |
Jefferson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $34.00 Non-Preferred Generic and Non-Preferred Brand Drug: $69.00 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 | |||||||||
Gold Advantage Option 1 (HMO) - H2663-005-0 Benefit Details |
Jefferson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: 0% Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $69.00 Specialty Tier Drugs: 33% | $2,800 Browse Formulary | |||||
HumanaChoice R5826-067 (Regional PPO) - R5826-067-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice R5826-067 (Regional PPO) - R5826-067-0 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 | |||||||||
Mercy MedicareADVANTAGE (HMO) - H2667-003-0 Benefit Details |
Jefferson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $70.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Mercy MedicareADVANTAGE (PPO) - H2611-001-0 Benefit Details |
Jefferson | $11.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $7.00 Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $70.00 Specialty Tier Drugs: 33% | $3,500 Browse Formulary | |||||
Evercare Plan DH (HMO SNP) - H2654-024-0 Benefit Details |
Jefferson | $ 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 | |||||||||
Advantra Option 1 (HMO) - H2663-006-0 Benefit Details |
Jefferson | $22.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $4.00 Preferred Brand Drugs: $34.00 Non-Preferred Generic and Non-Preferred Brand Drug: $70.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
Care Improvement Plus Silver Rx (Regional PPO SNP) - R3444-008-0 Benefit Details |
Jefferson | $33.40 | $0 | 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: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Silver Rx (Regional PPO SNP) - R3444-008-0 Benefit Details |
Statewide | $33.40 | $0 | 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: 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 | |||||||||
Care Improvement Plus Dual Advantage (Regional PPO SNP) - R3444-011-0 Benefit Details |
Jefferson | $ 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 | Generic Drugs: $10.00 Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Dual Advantage (Regional PPO SNP) - R3444-011-0 Benefit Details |
Statewide | $ 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 | Generic Drugs: $10.00 Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
AARP MedicareComplete Choice (PPO) - H5507-001-0 Benefit Details |
Jefferson | $35.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $85.00 Specialty Tier Drugs: 33% | $3,900 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 | |||||||||
Essence Advantage Plus (HMO) - H2610-006-0 Benefit Details |
Jefferson | $37.00 | $0 | All Generics | Generic Drugs: $5.00 Preferred Brand Drugs: $29.00 Non-Preferred Generic and Non-Preferred Brand Drug: $59.00 Specialty Tier Drugs: 33% | $1,700 Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (Regional PPO) - R3444-012-0 Benefit Details |
Jefferson | $52.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $9.00 Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $95.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (Regional PPO) - R3444-012-0 Benefit Details |
Statewide | $52.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $9.00 Preferred Brand Drugs: $42.00 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 | |||||||||
HumanaChoice R5826-010 (Regional PPO) - R5826-010-0 Benefit Details |
Jefferson | $69.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
HumanaChoice R5826-010 (Regional PPO) - R5826-010-0 Benefit Details |
Statewide | $69.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
HumanaChoice H1716-006 (PPO) - H1716-006-0 Benefit Details |
Jefferson | $71.00 | $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 | |||||
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 | |||||||||
Advantra Option 2 (HMO-POS) - H2663-002-0 Benefit Details |
Jefferson | $88.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $4.00 Preferred Brand Drugs: $34.00 Non-Preferred Generic and Non-Preferred Brand Drug: $70.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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