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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AARP MedicareComplete Plus (HMO-POS) - H5253-011-0 Benefit Details |
Waushara | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $79.00 Specialty Tier Drugs: 33% | $2,900 Browse Formulary | |||||
Advocare Essence (HMO-POS) - H5211-003-0 Benefit Details |
Waushara | $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 | ||||||
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 R5826-023 (Regional PPO) - R5826-023-0 Benefit Details |
Waushara | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Network PlatinumSelect (PPO) - H5215-008-0 Benefit Details |
Waushara | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $2,900 Browse Formulary | |||||
Evercare Plan DH (HMO SNP) - H5253-024-0 Benefit Details |
Waushara | $ 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 | |||||||||
Network PlatinumPlus (PPO) - H5215-001-0 Benefit Details |
Waushara | $31.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Advocare Essence Rx (HMO-POS) - H5211-002-0 Benefit Details |
Waushara | $33.00 | $0 | Few Generics | Generic and Brand Drugs: $6.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Network Cares (PPO SNP) - H5215-007-0 Benefit Details |
Waushara | $ 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 | |||||||||
Humana Gold Choice H8145-121 (PFFS) - H8145-121-0 Benefit Details |
Waushara | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
new | new | new | |||||||||
HumanaChoice H5216-003 (PPO) - H5216-003-0 Benefit Details |
Waushara | $41.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $6.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $4,500 Browse Formulary | |||||
Today's Options Premier 800 (PFFS) - H6169-014-0 Sanctioned Plan |
Waushara | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
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 | |||||||||
Humana Gold Choice H8145-006 (PFFS) - H8145-006-0 Benefit Details |
Waushara | $61.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $7.00 Non-Preferred Generic and Preferred Brand Drugs: $41.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $6,000 Browse Formulary | |||||
new | new | new | |||||||||
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 | |||||
HumanaChoice R5826-009 (Regional PPO) - R5826-009-0 Benefit Details |
Waushara | $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 | |||||||||
Network PlatinumPlus Pharmacy (PPO) - H5215-002-0 Benefit Details |
Waushara | $68.00 | $0 | Many Generics | Tier 1: tbd | $2,500 Browse Formulary | |||||
Network PlatinumPremier (PPO) - H5215-006-0 Benefit Details |
Waushara | $72.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,250 | ||||||
Today's Options Premier 850E powered by CCRx (PFFS) - H6169-034-0 Sanctioned Plan |
Waushara | $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 | |||||
new | new | new | |||||||||
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 | |||||||||
Advocare Spirit (HMO-POS) - H5211-001-0 Benefit Details |
Waushara | $118.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $900 | ||||||
Network PlatinumPremier Pharmacy (PPO) - H5215-005-0 Benefit Details |
Waushara | $124.00 | $0 | Many Generics | Tier 1: tbd | $1,250 Browse Formulary | |||||
Today's Options Premier 450A powered by CCRx (PFFS) - H6169-024-0 Sanctioned Plan |
Waushara | $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 | |||||
new | new | new | |||||||||
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 | |||||||||
Advocare Spirit Rx (HMO-POS) - H5211-004-0 Benefit Details |
Waushara | $163.00 | $0 | Few Generics | Generic and Brand Drugs: $6.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 33% | $900 Browse Formulary | |||||
Advocare Vitality (HMO-POS) - H5211-006-0 Benefit Details |
Waushara | $176.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Advocare Vitality Rx (HMO-POS) - H5211-005-0 Benefit Details |
Waushara | $232.00 | $0 | Few Generics | Generic and Brand Drugs: $6.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
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