2012 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 (HMO) - H1111-006-0 Benefit Details |
Forsyth | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $5.00 Tier 3: $42.00 Tier 4: $92.00 Tier 5: 33% | $3,900 Browse Formulary | |||||
AARP MedicareComplete Plus (HMO-POS) - H2182-001-0 Benefit Details |
Forsyth | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $45.00 Tier 4: $92.00 Tier 5: 33% | $4,250 Browse Formulary | |||||
Advantra Elite (HMO) - H5302-008-0 Benefit Details |
Forsyth | $0.00 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $40.00 Tier 3: $78.00 Tier 4: 33% | $3,300 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 | |||||||||
Advantra Silver (HMO-POS) - H5302-003-0 Benefit Details |
Forsyth | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $45.00 Tier 3: $80.00 Tier 4: 33% | $4,375 Browse Formulary | |||||
Aetna Medicare Value Plan (HMO) - H1109-001-0 Benefit Details |
Forsyth | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
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BlueValue Basic (HMO) - H5422-006-0 Benefit Details |
Forsyth | $0.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $7.00 | $4,500 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 | |||||||||
Care Improvement Plus Gold Rx (Regional PPO SNP) - R9896-009-0 Benefit Details |
Forsyth | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | n/a Browse Formulary | |||||
Humana Gold Plus H4141-001 (HMO) - H4141-001-0 Benefit Details |
Forsyth | $0.00 | $0 | Some Generics, Few Brands | Tier 1: $7.00 Tier 2: $45.00 Tier 3: $85.00 Tier 4: 33% | $3,900 Browse Formulary | |||||
HumanaChoice R5826-064 (Regional PPO) - R5826-064-0 Benefit Details |
Forsyth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 | ||||||
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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 | |||||||||
Kaiser Permanente Senior Advantage Basic (HMO) - H1170-009-0 Benefit Details |
Forsyth | $0.00 | $0 | All Generics, Few Brands | Tier 1: tbd | $3,400 Browse Formulary | |||||
Medicare Preferred Core (PPO) - H9947-001-0 Benefit Details |
Forsyth | $0.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $5.00 | $4,900 Browse Formulary | |||||
new | new | new | |||||||||
Medicare Preferred Online (PPO) - H9947-003-0 Benefit Details |
Forsyth | $0.00 | $60 | Many Generics | Tier 1: $0.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% Tier 5: 33% Tier 6: $0.00 | $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 | |||||||||
WellCare Value (HMO-POS) - H1112-027-0 Benefit Details |
Forsyth | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $39.00 Tier 3: $75.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Humana Gold Choice H8145-117 (PFFS) - H8145-117-0 Benefit Details |
Forsyth | $15.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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WellCare Access (HMO SNP) - H1112-006-0 Benefit Details |
Forsyth | $ 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: $0.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 25% | 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 | |||||||||
BlueValue Secure (HMO) - H5422-002-0 Benefit Details |
Forsyth | $25.00 | $60 | Many Generics | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $7.00 | $3,300 Browse Formulary | |||||
Humana Gold Plus SNP-DE H4141-003 (HMO SNP) - H4141-003-0 Benefit Details |
Forsyth | $ 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: $0.00 Tier 2: $36.00 Tier 3: $71.00 Tier 4: 25% | n/a Browse Formulary | |||||
Senior Advantage Medicare Medicaid Plan (HMO SNP) - H1170-008-0 Benefit Details |
Forsyth | $ 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 | |||||||||
Silver Advantage (HMO) - H5302-007-0 Benefit Details |
Forsyth | $29.60 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $45.00 Tier 3: $85.00 Tier 4: 33% | $6,500 Browse Formulary | |||||
Fresenius Health Partners (PPO SNP) - H9988-017-0 Benefit Details |
Forsyth | $30.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
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Care Improvement Plus Silver Rx (Regional PPO SNP) - R9896-008-0 Benefit Details |
Forsyth | $33.60 | $145 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 29% | 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 | |||||||||
Advantra Silver Plus (HMO-POS) - H5302-006-0 Benefit Details |
Forsyth | $38.00 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $40.00 Tier 3: $75.00 Tier 4: 33% | $4,200 Browse Formulary | |||||
Medicare Preferred Premier (PPO) - H9947-002-0 Benefit Details |
Forsyth | $40.00 | $60 | Many Generics | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $7.00 | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
HumanaChoice H5214-003 (PPO) - H5214-003-0 Benefit Details |
Forsyth | $42.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $42.00 Tier 3: $85.00 Tier 4: 33% | $4,900 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 | |||||||||
Today's Options Premier 400 (PFFS) - H6169-013-0 Benefit Details |
Forsyth | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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WindsorSterling Gold Plus Plan (PPO) - H9988-002-0 Benefit Details |
Forsyth | $55.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $16.00 Tier 3: $36.00 Tier 4: $90.00 Tier 5: 30% | $4,000 Browse Formulary | |||||
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Kaiser Permanente Senior Advantage Enhanced (HMO) - H1170-002-0 Benefit Details |
Forsyth | $61.00 | $0 | All Generics, Few Brands | Tier 1: tbd | $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 | |||||||||
Aetna Medicare Standard Plan (PPO) - H1110-001-0 Benefit Details |
Forsyth | $63.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $30.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
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Care Improvement Plus Medicare Advantage (Regional PPO) - R9896-012-0 Benefit Details |
Forsyth | $70.00 | $230 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 27% | $6,700 Browse Formulary | |||||
Humana Gold Choice H8145-079 (PFFS) - H8145-079-0 Benefit Details |
Forsyth | $70.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $42.00 Tier 3: $85.00 Tier 4: 33% | $5,900 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 | |||||||||
HumanaChoice R5826-077 (Regional PPO) - R5826-077-0 Benefit Details |
Forsyth | $76.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 28% | $5,900 Browse Formulary | |||||
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Today's Options Premier 200 (PFFS) - H6169-051-0 Benefit Details |
Forsyth | $80.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,250 | ||||||
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Today's Options Premier Plus 450C (PFFS) - H6169-033-0 Benefit Details |
Forsyth | $87.00 | $35 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 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 | |||||||||
Aetna Medicare Premier Plan (HMO) - H1109-003-0 Benefit Details |
Forsyth | $98.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $33.00 Tier 3: $40.00 Tier 4: $90.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
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Today's Options Premier Plus 250A (PFFS) - H6169-024-0 Benefit Details |
Forsyth | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
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