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 |
Klamath | $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 | |||||||||
ATRIO Silver (PPO) - H6743-002-0 Benefit Details |
Klamath | $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 |
Klamath | $ 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 | |||||||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Klamath | $64.10 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
ATRIO Silver Rx (PPO) - H6743-003-0 Benefit Details |
Klamath | $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 | |||||||||
Clear One Essentials + Rx Plan (HMO) - H3864-014-0 Benefit Details |
Klamath | $68.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic and Non-Preferred Generic Drugs: $10.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 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 | |||||||||
Clear One Practical Value Plan (HMO) - H3864-002-0 Benefit Details |
Klamath | $99.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Clear One Premier Traditional Plan (HMO-POS) - H3864-001-0 Benefit Details |
Klamath | $114.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
ODS Advantage PPORX Select (PPO) - H3813-003-0 Benefit Details |
Klamath | $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 | |||||||||
Clear One Practical Value + Rx Plan (HMO) - H3864-006-0 Benefit Details |
Klamath | $132.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic and Non-Preferred Generic Drugs: $10.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
ATRIO Gold Rx (PPO) - H6743-004-0 Benefit Details |
Klamath | $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 |
Klamath | $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 | |||||||||
Clear One Premier Traditional + Rx Plan (HMO-POS) - H3864-007-0 Benefit Details |
Klamath | $167.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic and Non-Preferred Generic Drugs: $4.00 Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $60.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
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