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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Akamai Advantage Secure (Regional PPO) - R7439-001-0 Benefit Details |
Kalawao | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
Akamai Advantage Secure (Regional PPO) - R7439-001-0 Benefit Details |
Statewide | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
AlohaCare Advantage (HMO) - H5969-001-0 Benefit Details |
Kalawao | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $4.00 Non-Preferred Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $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 | |||||||||
SecureHorizons MedicareComplete Choice (Regional PPO) - R3175-001-0 Benefit Details |
Kalawao | $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: $85.00 Specialty Tier Drugs: 33% | $4,200 Browse Formulary | |||||
SecureHorizons MedicareComplete Choice (Regional PPO) - R3175-001-0 Benefit Details |
Statewide | $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: $85.00 Specialty Tier Drugs: 33% | $4,200 Browse Formulary | |||||
SecureHorizons MedicareComplete Choice Essential (Regional PPO) - R3175-002-0 Benefit Details |
Kalawao | $0.00 | 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 |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareComplete Choice Essential (Regional PPO) - R3175-002-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 | ||||||
Akamai Advantage Assured (Regional PPO) - R7439-006-0 Benefit Details |
Kalawao | $15.20 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
new | new | new | |||||||||
Akamai Advantage Assured (Regional PPO) - R7439-006-0 Benefit Details |
Statewide | $15.20 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | |||||||||
Evercare Plan RDP (Regional PPO SNP) - R3175-003-0 Benefit Details |
Kalawao | $ 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 | |||||
Evercare Plan RDP (Regional PPO SNP) - R3175-003-0 Benefit Details |
Statewide | $ 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 | |||||
AlohaCare Advantage Plus (HMO SNP) - H5969-002-0 Benefit Details |
Kalawao | $ 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 | |||||||||
Akamai Advantage Preferred (Regional PPO) - R7439-003-0 Benefit Details |
Kalawao | $50.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $4.00 Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
Akamai Advantage Preferred (Regional PPO) - R7439-003-0 Benefit Details |
Statewide | $50.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $4.00 Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 25% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
65C Plus Basic Option (Cost) - H1251-001-0 Benefit Details |
Kalawao | $80.00 | 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 | |||||||||
65C Plus High Option (Cost) - H1251-002-0 Benefit Details |
Kalawao | $87.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
65C Plus Basic Option BRx (Cost) - H1251-003-0 Benefit Details |
Kalawao | $105.50 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 25% | N/A Browse Formulary | |||||
65C Plus High Option SRx (Cost) - H1251-004-0 Benefit Details |
Kalawao | $122.50 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $4.00 Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 25% | N/A Browse Formulary | |||||
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