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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HumanaChoice R5826-065 (Regional PPO) - R5826-065-0 Benefit Details |
Perry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | ||||||
SecureHorizons MedicareDirect Essential (PFFS) - H5435-001-0 Benefit Details |
Perry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,200 | ||||||
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 | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) - H5435-024-0 Benefit Details |
Perry | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,800 Browse Formulary | |||||
Sterling Basic (PFFS) - H5006-018-5 Benefit Details |
Perry | $15.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
Sterling Option I (PFFS) - H5006-014-2 Benefit Details |
Perry | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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 | |||||||||
UnitedHealthcare Dual Complete Preferred (HMO SNP) - H0251-002-0 Benefit Details |
Perry | $ 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 | |||||
Sterling Option II (PFFS) - H5006-017-5 Benefit Details |
Perry | $50.70 | $200 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $4.00 Generic Drugs: $18.00 Preferred Brand Drugs: $40.00 Specialty Tier Drugs: 25% | $4,000 Browse Formulary | |||||
HumanaChoice R5826-001 (Regional PPO) - R5826-001-0 Benefit Details |
Perry | $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 | |||||
Today's Options Premier 800 (PFFS) - H5421-049-0 Sanctioned Plan |
Perry | $60.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Today's Options Premier 850E powered by CCRx (PFFS) - H5421-073-0 Sanctioned Plan |
Perry | $80.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic and Preferred Brand Drugs: $4.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Generic and Non-Preferred Brand Drug: $70.00 Specialty Tier Drugs: 25% | $6,700 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 Ruby (PPO) - H7917-013-0 Benefit Details |
Perry | $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 | |||||
BlueAdvantage Emerald (PPO) - H7917-026-0 Benefit Details |
Perry | $99.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 | ||||||
Today's Options Premier 450A powered by CCRx (PFFS) - H5421-067-0 Sanctioned Plan |
Perry | $142.00 | $150 | Many Generics, Some Brands | Generic and Preferred Brand Drugs: $4.00 Non-Preferred Generic and Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $65.00 Specialty Tier Drugs: 29% | $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 | |||||||||
BlueAdvantage Diamond (PPO) - H7917-009-0 Benefit Details |
Perry | $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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