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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BlueAdvantage Garnet (PPO) - H7917-032-0 Benefit Details |
Dickson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $80.00 Tier 4: 33% | $4,950 Browse Formulary | |||||
HealthyAdvantage (HMO) - H4454-012-0 Benefit Details |
Dickson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HealthyAdvantage Preferred (HMO) - H4454-002-0 Benefit Details |
Dickson | $0.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $12.00 Tier 3: $45.00 Tier 4: $70.00 Tier 5: 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 | |||||||||
HumanaChoice R5826-065 (Regional PPO) - R5826-065-0 Benefit Details |
Dickson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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HealthyAdvantage Premier (HMO-POS) - H4454-030-0 Benefit Details |
Dickson | $26.00 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $12.00 Tier 3: $45.00 Tier 4: $70.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H0251-002-0 Benefit Details |
Dickson | $ 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 | |||||
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 R5826-001 (Regional PPO) - R5826-001-0 Benefit Details |
Dickson | $59.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $4,900 Browse Formulary | |||||
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BlueAdvantage Ruby (PPO) - H7917-013-0 Benefit Details |
Dickson | $91.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $30.00 Tier 3: $75.00 Tier 4: 33% | $4,800 Browse Formulary | |||||
BlueAdvantage Diamond (PPO) - H7917-009-0 Benefit Details |
Dickson | $153.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $30.00 Tier 3: $75.00 Tier 4: 33% | $4,650 Browse Formulary | |||||
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