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 |
|||||||||
Advocare Essence (HMO-POS) - H5211-003-0 Benefit Details |
Douglas | $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 |
Douglas | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Advocare Essence Rx (HMO-POS) - H5211-002-0 Benefit Details |
Douglas | $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 | |||||
UCare for Seniors Value (HMO-POS) - H4270-001-0 Benefit Details |
Douglas | $58.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HealthPartners Wisconsin Freedom Plan I (Cost) - H2462-015-0 Benefit Details |
Douglas | $61.00 | 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 |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-009 (Regional PPO) - R5826-009-0 Benefit Details |
Douglas | $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 |
Statewide | $61.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) - H2450-007-0 Benefit Details |
Douglas | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) - H4270-004-0 Benefit Details |
Douglas | $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 |
Douglas | $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 | |||||
Medica Prime Solution Value Plus w/Thrift Rx - WI (Cost) - H2450-024-0 Benefit Details |
Douglas | $89.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value Plus with Std Rx - WI (Cost) - H2450-025-0 Benefit Details |
Douglas | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Basic with Thrift Rx - WI (Cost) - H2450-018-0 Benefit Details |
Douglas | $113.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Advocare Spirit (HMO-POS) - H5211-001-0 Benefit Details |
Douglas | $118.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $900 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Standard Rx - WI (Cost) - H2450-008-0 Benefit Details |
Douglas | $122.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
UCare for Seniors Classic (HMO-POS) - H4270-002-0 Benefit Details |
Douglas | $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 | |||||
Medica Prime Solution Enhanced with Thrift Rx - WI (Cost) - H2450-019-0 Benefit Details |
Douglas | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Advocare Spirit Rx (HMO-POS) - H5211-004-0 Benefit Details |
Douglas | $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 | |||||
Medica Prime Solution Enhanced w/Standard Rx - WI (Cost) - H2450-011-0 Benefit Details |
Douglas | $170.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Basic with Enhanced Rx - WI (Cost) - H2450-010-0 Benefit Details |
Douglas | $175.30 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Advocare Vitality (HMO-POS) - H5211-006-0 Benefit Details |
Douglas | $176.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Medica Prime Solution Enhanced w/Enhanced Rx - WI (Cost) - H2450-009-0 Benefit Details |
Douglas | $223.30 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
HealthPartners Wisconsin Freedom Plan II (Cost) - H2462-016-0 Benefit Details |
Douglas | $229.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Advocare Vitality Rx (HMO-POS) - H5211-005-0 Benefit Details |
Douglas | $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 | |||||
HealthPartners Wisconsin Freedom Plan II Std Rx (Cost) - H2462-017-0 Benefit Details |
Douglas | $259.80 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,000 Browse Formulary | |||||
|