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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PremierCare Choice (HMO) - H3818-004-0 Benefit Details |
Umatilla | $21.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
PremierCare Plus (HMO SNP) - H3818-002-0 Benefit Details |
Umatilla | $ 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 | |||||
PremierCare Choice Rx (HMO) - H3818-003-0 Benefit Details |
Umatilla | $44.00 | $175 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Generic and Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 28% | $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 | |||||||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Umatilla | $64.10 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
PremierCare Value Rx (HMO) - H3818-014-0 Benefit Details |
Umatilla | $95.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Generic and Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 30% | $2,500 Browse Formulary | |||||
ODS Advantage PPORX Select (PPO) - H3813-003-0 Benefit Details |
Umatilla | $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 | |||||||||
PremierCare Advantage Rx (HMO) - H3818-001-0 Benefit Details |
Umatilla | $140.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Generic and Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 30% | $2,500 Browse Formulary | |||||
PremierCare Select Rx (HMO SNP) - H3818-015-0 Benefit Details |
Umatilla | $144.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic, Preferred Brand and Non-Preferred Brand D: 0% Generic Drugs: $7.00 Generic and Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $60.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
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