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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BCN Advantage HMO-POS Basic (HMO-POS) - H5883-004-3 Benefit Details |
Livingston | $0.00 | $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% | $5,200 Browse Formulary | |||||
HumanaChoice R5826-053 (Regional PPO) - R5826-053-0 Benefit Details |
Livingston | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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PriorityMedicare Value (HMO-POS) - H2320-012-0 Benefit Details |
Livingston | $28.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $40.00 Tier 3: $81.00 Tier 4: 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 | |||||||||
BCN Advantage HMO-POS Elements (HMO-POS) - H5883-001-3 Benefit Details |
Livingston | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,600 | ||||||
Medicare Plus Blue PPO Vitality (PPO) - H9572-002-4 Benefit Details |
Livingston | $63.00 | $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% | $5,500 Browse Formulary | |||||
HumanaChoice R5826-072 (Regional PPO) - R5826-072-0 Benefit Details |
Livingston | $65.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $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 | |||||||||
BCN Advantage HMO-POS Classic (HMO-POS) - H5883-002-3 Benefit Details |
Livingston | $83.00 | $0 | Many Generics | Tier 1: $3.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 25% Tier 5: 30% | $4,400 Browse Formulary | |||||
HAP Senior Plus - Expanded Network (HMO-POS) - H2312-008-0 Benefit Details |
Livingston | $95.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice R5826-006 (Regional PPO) - R5826-006-0 Benefit Details |
Livingston | $96.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 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 | |||||||||
PriorityMedicare (HMO-POS) - H2320-008-0 Benefit Details |
Livingston | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
PriorityMedicare Select (PPO) - H4875-013-0 Benefit Details |
Livingston | $99.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HAP Senior Plus - Expanded Network (HMO-POS) - H2312-007-0 Benefit Details |
Livingston | $105.00 | $25 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: 32% Tier 5: 32% | $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 | |||||||||
Medicare Plus Blue PPO Signature (PPO) - H9572-001-4 Benefit Details |
Livingston | $143.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 25% Tier 5: 30% | $5,000 Browse Formulary | |||||
Alliance Medicare PPO (PPO) - H2322-001-0 Benefit Details |
Livingston | $152.80 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: 33% Tier 5: 33% | $6,700 Browse Formulary | |||||
HAP Senior Plus - Expanded Network (HMO-POS) - H2312-010-0 Benefit Details |
Livingston | $158.00 | $50 | All Generics | Tier 1: $4.00 Tier 2: $10.00 Tier 3: $40.00 Tier 4: 31% Tier 5: 31% | $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 | |||||||||
Alliance Medicare PPO (PPO) - H2322-004-0 Benefit Details |
Livingston | $177.00 | $0 | All Generics | Tier 1: $4.00 Tier 2: $8.00 Tier 3: $40.00 Tier 4: 33% Tier 5: 33% | $6,700 Browse Formulary | |||||
Medicare Plus Blue PPO Assure (PPO) - H9572-003-4 Benefit Details |
Livingston | $204.00 | $0 | Many Generics | Tier 1: $3.00 Tier 2: $40.00 Tier 3: $95.00 Tier 4: 25% Tier 5: 30% | $4,000 Browse Formulary | |||||
BCN Advantage HMO-POS Prestige (HMO-POS) - H5883-003-3 Benefit Details |
Livingston | $212.00 | $0 | Many Generics | Tier 1: $3.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 25% Tier 5: 30% | $4,200 Browse Formulary | |||||
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