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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SecurityChoice Classic (PFFS) - H0540-001-0 Benefit Details |
Antelope | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
SecurityChoice Plus (PFFS) - H0540-020-0 Benefit Details |
Antelope | $30.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
MedicareBlue PPO (Regional PPO) - R5566-005-0 Benefit Details |
Antelope | $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 | |||||||||
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 | |||||
Today's Options Premier 800 (PFFS) - H5421-057-0 Sanctioned Plan |
Antelope | $90.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Today's Options Premier 850F powered by CCRx (PFFS) - H5421-075-0 Sanctioned Plan |
Antelope | $100.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic and Preferred Brand Drugs: $4.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $80.00 Specialty Tier Drugs: 25% | $6,700 Browse Formulary | |||||
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