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) - H5883-004-1 Benefit Details |
Ottawa | $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 | |||||
Humana Gold Choice H8145-121 (PFFS) - H8145-121-0 Benefit Details |
Ottawa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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HumanaChoice R5826-053 (Regional PPO) - R5826-053-0 Benefit Details |
Ottawa | $0.00 | 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 | |||||||||
PriorityMedicare Value (HMO-POS) - H2320-015-0 Benefit Details |
Ottawa | $0.00 | $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 | |||||
UnitedHealthcare MedicareComplete Plus (HMO-POS) - H4971-001-0 Benefit Details |
Ottawa | $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: $95.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
BCN Advantage HMO-POS Elements (HMO-POS) - H5883-001-1 Benefit Details |
Ottawa | $15.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,600 | ||||||
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 Vitality (PPO) - H9572-002-1 Benefit Details |
Ottawa | $38.00 | $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 H5470-005 (PPO) - H5470-005-0 Benefit Details |
Ottawa | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $80.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
Humana Gold Choice H8145-005 (PFFS) - H8145-005-0 Benefit Details |
Ottawa | $57.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $42.00 Tier 3: $80.00 Tier 4: 33% | $5,000 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) - H5883-002-1 Benefit Details |
Ottawa | $60.00 | $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 | |||||
PriorityMedicare (HMO-POS) - H2320-013-0 Benefit Details |
Ottawa | $64.00 | $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 | |||||
HumanaChoice R5826-072 (Regional PPO) - R5826-072-0 Benefit Details |
Ottawa | $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 | |||||||||
PriorityMedicare Select (PPO) - H4875-011-0 Benefit Details |
Ottawa | $68.00 | $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 | |||||
Medicare Plus Blue PPO Signature (PPO) - H9572-001-1 Benefit Details |
Ottawa | $83.00 | $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 | |||||
HumanaChoice R5826-006 (Regional PPO) - R5826-006-0 Benefit Details |
Ottawa | $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 | |||||||||
Medicare Plus Blue PPO Assure (PPO) - H9572-003-1 Benefit Details |
Ottawa | $139.00 | $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) - H5883-003-1 Benefit Details |
Ottawa | $213.00 | $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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