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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Blue Medicare Access Classic (Regional PPO) - R5941-007-0 Benefit Details |
Holmes | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
Blue Medicare Access Classic (Regional PPO) - R5941-007-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
Blue Medicare Access Value (Regional PPO) - R5941-008-0 Benefit Details |
Holmes | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $4,800 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 | |||||||||
Blue Medicare Access Value (Regional PPO) - R5941-008-0 Benefit Details |
Statewide | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $4,800 Browse Formulary | |||||
HumanaChoice R5826-021 (Regional PPO) - R5826-021-0 Benefit Details |
Holmes | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
HumanaChoice R5826-021 (Regional PPO) - R5826-021-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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 | |||||||||
PrimeTime Health Plan Basic - MA Only (HMO-POS) - H3664-014-0 Benefit Details |
Holmes | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
SecureCare - Option I (HMO) - H3672-014-0 Benefit Details |
Holmes | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
SecureChoice - Option I (PPO) - H8604-002-0 Benefit Details |
Holmes | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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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 | |||||||||
Basic-Select (HMO-POS) - H3664-018-0 Benefit Details |
Holmes | $35.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $77.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
HumanaChoice R5826-080 (Regional PPO) - R5826-080-0 Benefit Details |
Holmes | $61.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $8,500 Browse Formulary | |||||
HumanaChoice R5826-080 (Regional PPO) - R5826-080-0 Benefit Details |
Statewide | $61.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $8,500 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 | |||||||||
PrimeTime Health Plan Plus (HMO-POS) - H3664-017-0 Benefit Details |
Holmes | $63.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $6.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $75.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
HumanaChoice R5826-007 (Regional PPO) - R5826-007-0 Benefit Details |
Holmes | $71.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $7.00 Non-Preferred Generic and Preferred Brand Drugs: $39.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,000 Browse Formulary | |||||
HumanaChoice R5826-007 (Regional PPO) - R5826-007-0 Benefit Details |
Statewide | $71.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $7.00 Non-Preferred Generic and Preferred Brand Drugs: $39.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $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 | |||||||||
SecureCare - Option II (HMO) - H3672-013-0 Benefit Details |
Holmes | $71.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: 50% Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Humana Gold Choice H8145-033 (PFFS) - H8145-033-0 Benefit Details |
Holmes | $91.00 | $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 | |||||
new | new | new | |||||||||
SecureChoice - Option II (PPO) - H8604-001-0 Benefit Details |
Holmes | $91.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: 50% Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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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 | |||||||||
PrimeTime Health Plan Prime PPO (PPO) - H3620-001-0 Benefit Details |
Holmes | $109.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
SecureCare - Option III (HMO) - H3672-016-0 Benefit Details |
Holmes | $112.00 | $0 | Many Generics | Generic Drugs: $3.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: 50% Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
PrimeTime Health Plan Premier (HMO-POS) - H3664-012-0 Benefit Details |
Holmes | $128.00 | $0 | All Generics | Generic Drugs: $6.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $60.00 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 | |||||||||
SecureChoice - Option III (PPO) - H8604-005-0 Benefit Details |
Holmes | $132.00 | $0 | Many Generics | Generic Drugs: $3.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: 50% Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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