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 R5826-063 (Regional PPO) - R5826-063-0 Benefit Details |
Falls Church City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice R5826-063 (Regional PPO) - R5826-063-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Kaiser Permanente Medicare Plus Basic no D AB (Cost) - H2150-017-0 Benefit Details |
Falls Church City | $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 | |||||||||
Kaiser Permanente Medicare Plus Std w/D AB (Cost) - H2150-009-0 Benefit Details |
Falls Church City | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
Kaiser Permanente Medicare Plus Std w/o D AB (Cost) - H2150-022-0 Benefit Details |
Falls Church City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Aetna Medicare Value Plan (HMO) - H4910-005-0 Sanctioned Plan |
Falls Church City | $28.00 | $0 | n/a | Tier 1: Preferred Generic Drugs: $8.00 Tier 2: Non-Preferred Generic Drugs: $36.00 Tier 3: Preferred Brand Drugs: $37.00 Tier 4: Non-Preferred Brand Drugs: $80.00 Tier 5: Specialty Tier Drugs: 33% | 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 | |||||||||
HumanaChoice R5826-079 (Regional PPO) - R5826-079-0 Benefit Details |
Falls Church City | $58.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $5,900 Browse Formulary | |||||
HumanaChoice R5826-079 (Regional PPO) - R5826-079-0 Benefit Details |
Statewide | $58.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $5,900 Browse Formulary | |||||
Kaiser Permanente Medicare Plus High w/o D AB (Cost) - H2150-021-0 Benefit Details |
Falls Church City | $59.00 | 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 | |||||||||
Aetna Medicare Standard Plan (PPO) - H5521-027-0 Sanctioned Plan |
Falls Church City | $59.20 | $100 | n/a | Tier 1: Preferred Generic Drugs: $6.00 Tier 2: Non-Preferred Generic Drugs: $24.00 Tier 3: Preferred Brand Drugs: $37.00 Tier 4: Non-Preferred Brand Drugs: $70.00 Tier 5: Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H8145-004 (PFFS) - H8145-004-0 Benefit Details |
Falls Church City | $61.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $7.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-003 (Regional PPO) - R5826-003-0 Benefit Details |
Falls Church City | $64.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,900 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 R5826-003 (Regional PPO) - R5826-003-0 Benefit Details |
Statewide | $64.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,900 Browse Formulary | |||||
Kaiser Permanente Medicare Plus High w/D AB (Cost) - H2150-002-0 Benefit Details |
Falls Church City | $96.00 | $0 | All Generics | Tier 1: tbd | $3,400 Browse Formulary | |||||
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