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 R5826-023 (Regional PPO) - R5826-023-0 Benefit Details |
Grant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice R5826-023 (Regional PPO) - R5826-023-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Gundersen Lutheran Sr. Pref. Value (no RX) (HMO) - H5262-004-0 Benefit Details |
Grant | $10.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
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 | |||||||||
Gundersen Lutheran Senior Pref. Value w/RX (HMO) - H5262-003-0 Benefit Details |
Grant | $48.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $9.00 Non-Preferred Generic Drugs: $23.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $92.00 Specialty Tier Drugs: 33% | $2,500 Browse Formulary | |||||
UCare for Seniors Value (HMO-POS) - H4270-001-0 Benefit Details |
Grant | $58.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice R5826-009 (Regional PPO) - R5826-009-0 Benefit Details |
Grant | $61.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $5,000 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 R5826-009 (Regional PPO) - R5826-009-0 Benefit Details |
Statewide | $61.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $5,000 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) - H4270-004-0 Benefit Details |
Grant | $70.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
UCare for Seniors Value Plus (HMO-POS) - H4270-003-0 Benefit Details |
Grant | $82.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $9.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $70.00 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 |
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Service | Exper. | Cost Info | |||||||||
DeanCare Gold Shared Value (Cost) - H5264-005-0 Benefit Details |
Grant | $85.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
Gundersen Lutheran Sr. Pref. Elite (no RX) (HMO) - H5262-005-0 Benefit Details |
Grant | $95.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Medical Associates SmartPlan (Cost) - H5256-001-0 Benefit Details |
Grant | $96.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
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 | |||||||||
DeanCare Gold Basic (Cost) - H5264-003-0 Benefit Details |
Grant | $97.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
DeanCare Gold Enhanced (Cost) - H5264-002-0 Benefit Details |
Grant | $102.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
Medical Associates Community Plan (Cost) - H5256-002-0 Benefit Details |
Grant | $120.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
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 | |||||||||
Medical Associates Freedom Plan (Cost) - H5256-004-0 Benefit Details |
Grant | $120.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
Gundersen Lutheran Senior Pref. Elite w/RX (HMO) - H5262-001-0 Benefit Details |
Grant | $132.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $7.00 Non-Preferred Generic Drugs: $19.00 Preferred Brand Drugs: $39.00 Non-Preferred Brand Drugs: $92.00 Specialty Tier Drugs: 33% | $2,500 Browse Formulary | |||||
UCare for Seniors Classic (HMO-POS) - H4270-002-0 Benefit Details |
Grant | $147.00 | $0 | Many Generics | Generic Drugs: $9.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
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