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 Plus (HMO-POS) - H3456-001-0 Benefit Details |
Davidson | $0.00 | $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% | $4,750 Browse Formulary | |||||
AARP MedicareComplete Plus Essential (HMO-POS) - H3456-020-0 Benefit Details |
Davidson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 | ||||||
Blue Medicare HMO Medical Only (HMO) - H3449-012-0 Benefit Details |
Davidson | $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 | |||||||||
Blue Medicare HMO Standard (HMO) - H3449-013-0 Benefit Details |
Davidson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Humana Gold Choice H8145-114 (PFFS) - H8145-114-0 Benefit Details |
Davidson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
Humana Gold Plus H1036-138 (HMO-POS) - H1036-138-0 Benefit Details |
Davidson | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic Drugs: $6.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 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 | |||||||||
HumanaChoice R5826-063 (Regional PPO) - R5826-063-0 Benefit Details |
Davidson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice R5826-063 (Regional PPO) - R5826-063-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice H3405-002 (PPO) - H3405-002-0 Benefit Details |
Davidson | $27.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $6.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $4,900 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 | |||||||||
Evercare Plan DH (HMO SNP) - H3456-016-0 Benefit Details |
Davidson | $ 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 | |||||
Today's Options Premier 700 (PFFS) - H6169-012-0 Sanctioned Plan |
Davidson | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
Today's Options Advantage 750B powered by CCRx (PPO) - H5378-183-0 Sanctioned Plan |
Davidson | $34.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic and Preferred Brand Drugs: $4.00 Non-Preferred Generic and Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $65.00 Specialty Tier Drugs: 29% | $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 | |||||||||
Evercare Plan IH (HMO SNP) - H3456-010-0 Benefit Details |
Davidson | $34.20 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Fidelis Secure Comfort (HMO SNP) - H5575-005-0 Benefit Details |
Davidson | $34.80 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
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Humana Gold Choice H8145-063 (PFFS) - H8145-063-0 Benefit Details |
Davidson | $42.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $7.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,500 Browse Formulary | |||||
new | new | new | |||||||||
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 | |||||||||
AARP MedicareComplete Choice (PPO) - H5516-001-0 Benefit Details |
Davidson | $45.00 | $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% | $4,200 Browse Formulary | |||||
HumanaChoice R5826-079 (Regional PPO) - R5826-079-0 Benefit Details |
Davidson | $58.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $5,900 Browse Formulary | |||||
HumanaChoice R5826-079 (Regional PPO) - R5826-079-0 Benefit Details |
Statewide | $58.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $5,900 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 | |||||||||
Blue Medicare PPO Enhanced (PPO) - H3404-001-0 Benefit Details |
Davidson | $62.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
HumanaChoice R5826-003 (Regional PPO) - R5826-003-0 Benefit Details |
Davidson | $64.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,900 Browse Formulary | |||||
HumanaChoice R5826-003 (Regional PPO) - R5826-003-0 Benefit Details |
Statewide | $64.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,900 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 | |||||||||
Today's Options Premier 750B powered by CCRx (PFFS) - H6169-032-0 Sanctioned Plan |
Davidson | $68.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic and Preferred Brand Drugs: $4.00 Non-Preferred Generic and Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $65.00 Specialty Tier Drugs: 29% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
Blue Medicare HMO Enhanced (HMO) - H3449-005-0 Benefit Details |
Davidson | $80.50 | $0 | Many Generics | Generic Drugs: $6.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $75.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Fidelis Secure Comfort Plus (HMO SNP) - H5575-006-0 Benefit Details |
Davidson | $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 | |||||||||
Fidelis Secure Independence (HMO SNP) - H5575-007-0 Benefit Details |
Davidson | $120.00 | $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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Blue Medicare PPO Enhanced Freedom (PPO) - H3404-002-0 Benefit Details |
Davidson | $169.80 | $0 | Many Generics | Generic Drugs: $6.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $75.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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