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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ATRIO Bronze Rx (PPO) - H6743-001-0 Benefit Details |
Douglas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $90.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
CareSource Silver (HMO) - H3810-006-0 Benefit Details |
Douglas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Health Net Violet Option 2 (PPO) - H5520-006-0 Sanctioned Plan |
Douglas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $7.00 Preferred Brand Drugs: $41.00 Non-Preferred Generic and Non-Preferred Brand Drug: $79.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% | $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 | |||||||||
ATRIO Silver (PPO) - H6743-002-0 Benefit Details |
Douglas | $32.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
new | new | new | |||||||||
ATRIO MyAdvantage SNP (HMO SNP) - H3814-007-0 Benefit Details |
Douglas | $ 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 | |||||
Health Net Aqua (PPO) - H5520-003-0 Sanctioned Plan |
Douglas | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
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 | |||||||||
Regence MedAdvantage (PPO) - H3817-001-0 Benefit Details |
Douglas | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Douglas | $64.10 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
ATRIO Silver Rx (PPO) - H6743-003-0 Benefit Details |
Douglas | $66.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $6.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $75.00 Specialty Tier Drugs: 33% | $3,400 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 | |||||||||
CareSource Gold (HMO) - H3810-001-0 Benefit Details |
Douglas | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,000 | ||||||
CareSource Silver Plus Rx (HMO) - H3810-007-0 Benefit Details |
Douglas | $71.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Non-Preferred Generic and Brand Drugs: $39.00 Non-Preferred Brand Drugs: $69.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Regence MedAdvantage + Rx Classic (PPO) - H3817-002-0 Benefit Details |
Douglas | $80.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Non-Preferred Generic Drugs: $35.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $75.00 Injectable Drugs: 30% Specialty Tier Drugs: 30% | $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 | |||||||||
Health Net Violet Option 1 (PPO) - H5520-004-0 Sanctioned Plan |
Douglas | $85.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Preferred Brand Drugs: $38.00 Non-Preferred Generic and Non-Preferred Brand Drug: $76.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% | $2,500 Browse Formulary | |||||
CareSource - SNP (HMO SNP) - H3810-002-0 Benefit Details |
Douglas | $ 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 | |||||
CareSource Platinum (HMO-POS) - H3810-004-0 Benefit Details |
Douglas | $113.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $500 | ||||||
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 | |||||||||
Health Net Healthy Heart (PPO) - H5520-010-0 Sanctioned Plan |
Douglas | $123.00 | $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 Injectable Drugs: 33% Specialty Tier Drugs: 33% | $1,750 Browse Formulary | |||||
Regence MedAdvantage + Rx Enhanced (PPO) - H3817-003-0 Benefit Details |
Douglas | $127.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 Non-Preferred Generic Drugs: $35.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $75.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% | $2,500 Browse Formulary | |||||
ODS Advantage PPORX Select (PPO) - H3813-003-0 Benefit Details |
Douglas | $127.30 | $120 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: 10% Generic and Brand Drugs: 32% Brand Drugs: 50% Specialty Tier Drugs: 30% | $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 | |||||||||
CareSource Gold Plus Rx (HMO) - H3810-003-0 Benefit Details |
Douglas | $127.80 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Non-Preferred Generic and Brand Drugs: $39.00 Non-Preferred Brand Drugs: $69.00 Specialty Tier Drugs: 33% | $2,000 Browse Formulary | |||||
ATRIO Gold Rx (PPO) - H6743-004-0 Benefit Details |
Douglas | $133.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $4.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $75.00 Specialty Tier Drugs: 33% | $1,750 Browse Formulary | |||||
new | new | new | |||||||||
ATRIO Platinum Rx (PPO) - H6743-005-0 Benefit Details |
Douglas | $162.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $4.00 Preferred Brand Drugs: $25.00 Non-Preferred Brand Drugs: $50.00 Specialty Tier Drugs: 33% | $1,300 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 | |||||||||
CareSource Platinum Plus Rx (HMO-POS) - H3810-005-0 Benefit Details |
Douglas | $175.10 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Non-Preferred Generic and Brand Drugs: $39.00 Non-Preferred Brand Drugs: $69.00 Specialty Tier Drugs: 33% | $500 Browse Formulary | |||||
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