2011 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
AARP MedicareComplete Plan 3 (HMO) - H5005-019-0 Benefit Details |
Lewis | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $43.00 Non-Preferred Generic and Non-Preferred Brand Drug: $84.00 Specialty Tier Drugs: 33% | $4,700 Browse Formulary | |||||
Ascent (HMO) - H9302-009-0 Benefit Details |
Lewis | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Sound Plus Rx (HMO) - H9302-007-0 Benefit Details |
Lewis | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Brand Drugs: $32.00 Non-Preferred Brand Drugs: $64.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Group Health Cooperative Clear Care Basic (HMO) - H5050-001-0 Benefit Details |
Lewis | $17.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Group Health Cooperative Clear Care Vital (HMO) - H5050-013-0 Benefit Details |
Lewis | $19.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $4.00 Preferred Brand Drugs: $23.00 Non-Preferred Generic and Non-Preferred Brand Drug: 50% | $3,200 Browse Formulary | |||||
AARP MedicareComplete Essential (HMO) - H5005-018-0 Benefit Details |
Lewis | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Community HealthFirst MA Plan with Pharmacy (HMO) - H5826-009-0 Benefit Details |
Lewis | $30.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Brand Drugs: $39.00 Specialty Tier Drugs: 33% | $2,800 Browse Formulary | |||||
Alpine (HMO) - H9302-004-0 Benefit Details |
Lewis | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,250 | ||||||
Kaiser Permanente Senior Advantage Basic (HMO) - H9003-006-0 Benefit Details |
Lewis | $47.00 | $0 | All Generics | Generic Drugs: $10.00 Brand Drugs: $45.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Community HealthFirst MA Plan, Enhanced Pharmacy (HMO) - H5826-012-0 Benefit Details |
Lewis | $66.00 | $0 | Many Generics | Generic Drugs: $7.00 Brand Drugs: $37.00 Specialty Tier Drugs: 33% | $2,300 Browse Formulary | |||||
Charter Plus Rx (HMO) - H9302-003-0 Benefit Details |
Lewis | $79.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $8.00 Brand Drugs: $32.00 Non-Preferred Brand Drugs: $64.00 Specialty Tier Drugs: 33% | $2,250 Browse Formulary | |||||
Regence MedAdvantage (PPO) - H5009-001-0 Benefit Details |
Lewis | $98.00 | 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 |
|||||
Service | Exper. | Cost Info | |||||||||
AARP MedicareComplete Plan 1 (HMO) - H5005-001-0 Benefit Details |
Lewis | $99.00 | $0 | Some Generics | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $79.00 Specialty Tier Drugs: 33% | $4,200 Browse Formulary | |||||
Kaiser Permanente Senior Advantage (HMO) - H9003-001-0 Benefit Details |
Lewis | $107.00 | $0 | All Generics | Generic Drugs: $10.00 Brand Drugs: $45.00 Specialty Tier Drugs: 25% | $2,500 Browse Formulary | |||||
Group Health Cooperative Clear Care Essential (HMO) - H5050-009-0 Benefit Details |
Lewis | $118.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $4.00 Preferred Brand Drugs: $17.00 Non-Preferred Generic and Non-Preferred Brand Drug: 50% | $2,500 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Regence MedAdvantage + Rx Classic (PPO) - H5009-002-0 Benefit Details |
Lewis | $144.00 | $190 | 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: 28% Specialty Tier Drugs: 28% | $3,400 Browse Formulary | |||||
Apex Plus Rx (HMO) - H9302-001-0 Benefit Details |
Lewis | $152.00 | $0 | Many Generics | Generic Drugs: $8.00 Brand Drugs: $32.00 Non-Preferred Brand Drugs: $64.00 Specialty Tier Drugs: 33% | $1,200 Browse Formulary | |||||
Summit Plus Rx (HMO-POS) - H9302-008-0 Benefit Details |
Lewis | $190.00 | $0 | Many Generics | Generic Drugs: $8.00 Brand Drugs: $32.00 Non-Preferred Brand Drugs: $64.00 Specialty Tier Drugs: 33% | $1,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Group Health Cooperative Clear Care Optimal (HMO) - H5050-004-0 Benefit Details |
Lewis | $210.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $4.00 Preferred Brand Drugs: $20.00 Non-Preferred Generic and Non-Preferred Brand Drug: 50% | $1,000 Browse Formulary | |||||
Regence MedAdvantage + Rx Enhanced (PPO) - H5009-004-0 Benefit Details |
Lewis | $212.00 | $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% | $2,800 Browse Formulary | |||||
|