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 Choice (PPO) - H3812-001-0 Benefit Details |
Lane | $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: $80.00 Specialty Tier Drugs: 33% | $3,900 Browse Formulary | |||||
Health Net Violet Option 2 (PPO) - H5520-005-0 Sanctioned Plan |
Lane | $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 | |||||
Evercare Plan IP (PPO SNP) - H3812-005-0 Benefit Details |
Lane | $28.90 | $310 | 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 | |||||||||
Trillium Advantage Dual (HMO SNP) - H2174-001-0 Benefit Details |
Lane | $ 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 | Preferred Generic Drugs: 0% Preferred Brand and Non-Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $95.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
Trillium Advantage TLC Community ISNP (HMO SNP) - H2174-005-0 Benefit Details |
Lane | $35.30 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Trillium Advantage TLC ISNP (HMO SNP) - H2174-003-0 Benefit Details |
Lane | $35.30 | $310 | 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 | |||||||||
Health Net Aqua (PPO) - H5520-001-0 Sanctioned Plan |
Lane | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Providence Medicare Choice (HMO-POS) - H9047-035-0 Benefit Details |
Lane | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Regence MedAdvantage (PPO) - H3817-001-0 Benefit Details |
Lane | $45.00 | 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 | |||||||||
AARP MedicareComplete (HMO) - H3805-007-0 Benefit Details |
Lane | $49.00 | $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: $80.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Lane | $64.10 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Trillium Advantage (HMO) - H2174-004-0 Benefit Details |
Lane | $67.00 | 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 | |||||||||
Providence Medicare Choice + RX (HMO-POS) - H9047-024-0 Benefit Details |
Lane | $71.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
Regence MedAdvantage + Rx Classic (PPO) - H3817-002-0 Benefit Details |
Lane | $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 | |||||
Providence Medicare Extra (HMO) - H9047-033-0 Benefit Details |
Lane | $87.00 | 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 | |||||||||
Health Net Violet Option 1 (PPO) - H5520-002-0 Sanctioned Plan |
Lane | $99.00 | $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 | |||||
Regence MedAdvantage + Rx Enhanced (PPO) - H3817-003-0 Benefit Details |
Lane | $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 |
Lane | $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 | |||||||||
Providence Medicare Extra + RX (HMO) - H9047-001-0 Benefit Details |
Lane | $128.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $2,500 Browse Formulary | |||||
Trillium Advantage Rx (HMO) - H2174-002-0 Benefit Details |
Lane | $135.00 | $0 | Many Generics | Generic Drugs: $9.00 Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $56.00 | $2,500 Browse Formulary | |||||
Health Net Healthy Heart (PPO) - H5520-009-0 Sanctioned Plan |
Lane | $139.00 | $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 | |||||
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