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 Essential (HMO) - H3659-054-0 Benefit Details |
Stark | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,350 | ||||||
AARP MedicareComplete Plan 1 (HMO) - H3659-003-0 Benefit Details |
Stark | $0.00 | $0 | Some Generics | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $44.00 Non-Preferred Generic and Non-Preferred Brand Drug: $84.00 Specialty Tier Drugs: 33% | $3,350 Browse Formulary | |||||
AARP MedicareComplete Plan 2 (HMO) - H3659-031-0 Benefit Details |
Stark | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $79.00 Specialty Tier Drugs: 33% | $3,800 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 | |||||||||
Anthem Senior Advantage Basic (HMO) - H3655-013-0 Benefit Details |
Stark | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $3,400 Browse Formulary | |||||
Blue Medicare Access Classic (Regional PPO) - R5941-007-0 Benefit Details |
Stark | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
Blue Medicare Access Classic (Regional PPO) - R5941-007-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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 Access Value (Regional PPO) - R5941-008-0 Benefit Details |
Stark | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $4,800 Browse Formulary | |||||
Blue Medicare Access Value (Regional PPO) - R5941-008-0 Benefit Details |
Statewide | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $4,800 Browse Formulary | |||||
HumanaChoice R5826-021 (Regional PPO) - R5826-021-0 Benefit Details |
Stark | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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 R5826-021 (Regional PPO) - R5826-021-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
PrimeTime Health Plan Basic - MA Only (HMO-POS) - H3664-014-0 Benefit Details |
Stark | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
SecureCare - Option I (HMO) - H3672-014-0 Benefit Details |
Stark | $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 | |||||||||
SummaCare Secure Classic (HMO-POS) - H3660-043-0 Benefit Details |
Stark | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
SummaCare Secure Core (HMO) - H3660-044-0 Benefit Details |
Stark | $0.00 | $0 | All Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $90.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
WellCare Value (HMO) - H0117-005-0 Benefit Details |
Stark | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $3.00 Preferred Brand Drugs: $39.00 Non-Preferred Brand Drugs: $69.00 Specialty Tier Drugs: 33% | $3,800 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 H3619-014 (PPO) - H3619-014-0 Benefit Details |
Stark | $18.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $6.00 Non-Preferred Generic and Preferred Brand Drugs: $37.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $4,800 Browse Formulary | |||||
SecureChoice - Option I (PPO) - H8604-002-0 Benefit Details |
Stark | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Evercare Plan DH (HMO SNP) - H3659-056-0 Benefit Details |
Stark | $ 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 | |||||||||
Anthem Senior Advantage Plus (HMO) - H3655-030-0 Benefit Details |
Stark | $29.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $3,000 Browse Formulary | |||||
Buckeye Community Health Plan (HMO SNP) - H0908-001-0 Benefit Details |
Stark | $ 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: 0% Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $95.00 Injectable Drugs: $95.00 | n/a Browse Formulary | |||||
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Evercare Plan IP (PPO SNP) - H2406-001-0 Benefit Details |
Stark | $29.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | 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 | |||||||||
WellCare Access (HMO SNP) - H0117-007-0 Benefit Details |
Stark | $ 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: $3.00 Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $79.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
SummaCare Secure Silver (HMO-POS) - H3660-029-0 Benefit Details |
Stark | $30.00 | $0 | All Generics | Generic Drugs: $4.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Anthem Medicare Preferred Standard (PPO) - H5529-001-0 Benefit Details |
Stark | $34.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $4,500 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 | |||||||||
Basic-Select (HMO-POS) - H3664-018-0 Benefit Details |
Stark | $35.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $77.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Anthem Medicare Preferred Select (PPO) - H5529-004-0 Benefit Details |
Stark | $55.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $3,800 Browse Formulary | |||||
HumanaChoice R5826-080 (Regional PPO) - R5826-080-0 Benefit Details |
Stark | $61.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $8,500 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 R5826-080 (Regional PPO) - R5826-080-0 Benefit Details |
Statewide | $61.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $8,500 Browse Formulary | |||||
PrimeTime Health Plan Plus (HMO-POS) - H3664-017-0 Benefit Details |
Stark | $63.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $6.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $75.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
HumanaChoice R5826-007 (Regional PPO) - R5826-007-0 Benefit Details |
Stark | $71.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $7.00 Non-Preferred Generic and Preferred Brand Drugs: $39.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,000 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 | |||||||||
HumanaChoice R5826-007 (Regional PPO) - R5826-007-0 Benefit Details |
Statewide | $71.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $7.00 Non-Preferred Generic and Preferred Brand Drugs: $39.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,000 Browse Formulary | |||||
SecureCare - Option II (HMO) - H3672-013-0 Benefit Details |
Stark | $71.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: 50% Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Humana Gold Choice H8145-033 (PFFS) - H8145-033-0 Benefit Details |
Stark | $91.00 | $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% | $6,700 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 | |||||||||
SecureChoice - Option II (PPO) - H8604-001-0 Benefit Details |
Stark | $91.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: 50% Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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PrimeTime Health Plan Prime PPO (PPO) - H3620-001-0 Benefit Details |
Stark | $109.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
SecureCare - Option III (HMO) - H3672-016-0 Benefit Details |
Stark | $112.00 | $0 | Many Generics | Generic Drugs: $3.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: 50% 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 | |||||||||
SummaCare Secure Gold (HMO-POS) - H3660-028-0 Benefit Details |
Stark | $120.00 | $0 | All Generics | Generic Drugs: $4.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
PrimeTime Health Plan Premier (HMO-POS) - H3664-012-0 Benefit Details |
Stark | $128.00 | $0 | All Generics | Generic Drugs: $6.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $60.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
SecureChoice - Option III (PPO) - H8604-005-0 Benefit Details |
Stark | $132.00 | $0 | Many Generics | Generic Drugs: $3.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: 50% Specialty Tier Drugs: 33% | $3,400 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 | |||||||||
SummaCare Secure Platinum (HMO-POS) - H3660-032-0 Benefit Details |
Stark | $278.00 | $0 | All Generics | Generic Drugs: $4.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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