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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Platinum Blue Core Plan (Cost) - H2461-005-0 Benefit Details |
Nobles | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
SecureBlue (HMO SNP) - H2425-001-0 Benefit Details |
Nobles | $ 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% Tier 2: 0% | n/a Browse Formulary | |||||
UCare's Minnesota Senior Health Options (HMO SNP) - H2456-002-0 Benefit Details |
Nobles | $ 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% Tier 2: 0% | n/a 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 | |||||||||
UCare for Seniors Value (HMO-POS) - H2459-001-0 Benefit Details |
Nobles | $43.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HealthPartners Freedom Basic (Cost) - H2462-004-0 Benefit Details |
Nobles | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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HealthPartners Freedom Vital (Cost) - H2462-018-0 Benefit Details |
Nobles | $53.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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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 | |||||||||
UCare for Seniors Standard D (HMO-POS) - H2459-018-0 Benefit Details |
Nobles | $54.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
HumanaChoice H6609-021 (PPO) - H6609-021-0 Benefit Details |
Nobles | $55.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $38.00 Tier 3: $76.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Medica Prime Solution Thrift with Part D Option 1 (Cost) - H2450-007-0 Benefit Details |
Nobles | $55.50 | $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 | |||||||||
HealthPartners Freedom Vital with Rx (Cost) - H2462-019-0 Benefit Details |
Nobles | $60.20 | $175 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | $3,000 Browse Formulary | |||||
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Platinum Blue Choice Plan (Cost) - H2461-006-0 Benefit Details |
Nobles | $79.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
UCare for Seniors Value Plus (HMO-POS) - H2459-013-0 Benefit Details |
Nobles | $84.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 25% | $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 | |||||||||
MedicareBlue PPO (Regional PPO) - R5566-005-0 Benefit Details |
Nobles | $84.40 | $155 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $11.00 Tier 3: $33.00 Tier 4: 45% | $3,400 Browse Formulary | |||||
Medica Prime Solution Value with Part D Option 1 (Cost) - H2450-022-0 Benefit Details |
Nobles | $85.50 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,350 Browse Formulary | |||||
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HealthPartners Freedom Balance (Cost) - H2462-007-0 Benefit Details |
Nobles | $93.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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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 | |||||||||
Medica Prime Solution Value with Part D Option 2 (Cost) - H2450-023-0 Benefit Details |
Nobles | $102.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $34.00 Tier 3: $74.00 Tier 4: 25% | $3,350 Browse Formulary | |||||
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HealthPartners Freedom Balance with Rx (Cost) - H2462-008-0 Benefit Details |
Nobles | $102.80 | $125 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | $3,000 Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 1 (Cost) - H2450-016-0 Benefit Details |
Nobles | $105.50 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,000 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 | |||||||||
HumanaChoice H6609-028 (PPO) - H6609-028-0 Benefit Details |
Nobles | $110.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $43.00 Tier 3: $84.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Platinum Blue Complete Plan (Cost) - H2461-007-0 Benefit Details |
Nobles | $119.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) - H2450-001-0 Benefit Details |
Nobles | $122.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $34.00 Tier 3: $74.00 Tier 4: 25% | $3,000 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 | |||||||||
UCare for Seniors Classic (HMO-POS) - H2459-002-0 Benefit Details |
Nobles | $137.00 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 25% | $3,400 Browse Formulary | |||||
HealthPartners Freedom Ultimate (Cost) - H2462-010-0 Benefit Details |
Nobles | $138.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Medica Prime Solution Enhanced w/Part D Option 1 (Cost) - H2450-017-0 Benefit Details |
Nobles | $155.50 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,000 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 | |||||||||
Medica Prime Solution Value with Part D Option 3 (Cost) - H2450-028-0 Benefit Details |
Nobles | $161.20 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $34.00 Tier 3: $74.00 Tier 4: 25% | $3,350 Browse Formulary | |||||
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HealthPartners Freedom Ultimate with Rx (Cost) - H2462-011-0 Benefit Details |
Nobles | $162.90 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | $3,000 Browse Formulary | |||||
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Medica Prime Solution Enhanced w/Part D Option 2 (Cost) - H2450-002-0 Benefit Details |
Nobles | $172.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $34.00 Tier 3: $74.00 Tier 4: 25% | $3,000 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 | |||||||||
Medica Prime Solution Basic with Part D Option 3 (Cost) - H2450-005-0 Benefit Details |
Nobles | $181.20 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $34.00 Tier 3: $74.00 Tier 4: 25% | $3,000 Browse Formulary | |||||
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Medica Prime Solution Enhanced w/Part D Option 3 (Cost) - H2450-006-0 Benefit Details |
Nobles | $231.20 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $34.00 Tier 3: $74.00 Tier 4: 25% | $3,000 Browse Formulary | |||||
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HealthPartners Freedom Ultimate with Enhanced Rx (Cost) - H2462-012-0 Benefit Details |
Nobles | $347.00 | $100 | Many Generics, Some Brands | Tier 1: $10.00 Tier 2: $40.00 Tier 3: $65.00 Tier 4: 33% | $3,000 Browse Formulary | |||||
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