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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Medica Prime Solution Value Thrift with Rx (Cost) - H2450-007-0 Benefit Details |
Sargent | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
MedicareBlue PPO (Regional PPO) - R5566-005-0 Benefit Details |
Sargent | $71.30 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: 13% Preferred Brand Drugs: 26% Non-Preferred Brand Drugs: 50% Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
MedicareBlue PPO (Regional PPO) - R5566-005-0 Benefit Details |
Statewide | $71.30 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: 13% Preferred Brand Drugs: 26% Non-Preferred Brand Drugs: 50% Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Sol. Value Plus w/Thrift Rx - ND/SD (Cost) - H2450-026-0 Benefit Details |
Sargent | $89.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) - H2450-027-0 Benefit Details |
Sargent | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Basic with Thrift Rx - ND/SD (Cost) - H2450-020-0 Benefit Details |
Sargent | $113.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 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 | |||||||||
Medica Prime Solution Basic w/Standard Rx - ND/SD (Cost) - H2450-012-0 Benefit Details |
Sargent | $122.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced w/Thrift Rx - ND/SD (Cost) - H2450-021-0 Benefit Details |
Sargent | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Std Rx - ND/SD (Cost) - H2450-014-0 Benefit Details |
Sargent | $170.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,000 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 | |||||||||
Medica Prime Solution Basic w/Enhanced Rx - ND/SD (Cost) - H2450-013-0 Benefit Details |
Sargent | $175.30 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Sol. Enhanced w/Enhanced Rx - ND/SD (Cost) - H2450-015-0 Benefit Details |
Sargent | $223.30 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
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