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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HealthyAdvantage (HMO) - H4454-012-0 Benefit Details |
Bedford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HealthyAdvantage Preferred (HMO) - H4454-002-0 Benefit Details |
Bedford | $0.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 Generic Drugs: $12.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
HumanaChoice R5826-065 (Regional PPO) - R5826-065-0 Benefit Details |
Bedford | $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 | |||||||||
HumanaChoice R5826-065 (Regional PPO) - R5826-065-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Windsor Medicare Extra Emerald Plan (HMO) - H5698-062-0 Benefit Details |
Bedford | $0.00 | $0 | Some Generics | Preferred Generic Drugs: $5.00 Generic Drugs: $12.00 Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $68.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
Windsor Medicare Extra Silver Plan (HMO) - H5698-035-0 Benefit Details |
Bedford | $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 | |||||||||
HealthyAdvantage Premier (HMO-POS) - H4454-030-0 Benefit Details |
Bedford | $26.00 | $0 | Many Generics | Preferred Generic Drugs: $5.00 Generic Drugs: $12.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
TotalCare (HMO SNP) - H4454-020-0 Benefit Details |
Bedford | $ 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 | |||||
UnitedHealthcare Dual Complete Preferred (HMO SNP) - H0251-002-0 Benefit Details |
Bedford | $ 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) - H5698-036-0 Benefit Details |
Bedford | $35.00 | $0 | Some Generics | Preferred Generic Drugs: $3.00 Generic Drugs: $10.00 Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $65.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Fusion Plan (HMO SNP) - H5698-141-0 Benefit Details |
Bedford | $50.00 | $0 | Some Generics | Preferred Generic Drugs: $5.00 Generic Drugs: $10.00 Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $60.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
HumanaChoice R5826-001 (Regional PPO) - R5826-001-0 Benefit Details |
Bedford | $59.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,900 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 R5826-001 (Regional PPO) - R5826-001-0 Benefit Details |
Statewide | $59.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,900 Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) - H5698-156-0 Benefit Details |
Bedford | $85.00 | $0 | Some Generics | Preferred Generic Drugs: $5.00 Generic Drugs: $10.00 Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $60.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
BlueAdvantage Ruby (PPO) - H7917-013-0 Benefit Details |
Bedford | $92.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $8.00 Preferred Brand Drugs: $45.00 Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $4,900 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 | |||||||||
BlueAdvantage Emerald (PPO) - H7917-026-0 Benefit Details |
Bedford | $99.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 | ||||||
Windsor Medicare Extra Diamond Plan (HMO) - H5698-068-0 Benefit Details |
Bedford | $145.00 | $0 | Some Generics | Preferred Generic Drugs: $5.00 Generic Drugs: $10.00 Preferred Brand Drugs: $39.00 Non-Preferred Generic and Non-Preferred Brand Drug: $65.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
BlueAdvantage Diamond (PPO) - H7917-009-0 Benefit Details |
Bedford | $154.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Preferred Brand Drugs: $30.00 Brand Drugs: $75.00 Specialty Tier Drugs: 33% | $4,400 Browse Formulary | |||||
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