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 Sapphire (PPO) - H7917-030-0 Benefit Details |
Grundy | $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 |
Grundy | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HealthyAdvantage Preferred (HMO) - H4454-002-0 Benefit Details |
Grundy | $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 |
Grundy | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Windsor Medicare Extra Emerald Plan (HMO) - H5698-062-0 Benefit Details |
Grundy | $0.00 | $0 | Some Generics | Tier 1: $7.00 Tier 2: $12.00 Tier 3: $42.00 Tier 4: $68.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
Windsor Medicare Extra Silver Plan (HMO) - H5698-035-0 Benefit Details |
Grundy | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | |||||||||
HealthyAdvantage Premier (HMO-POS) - H4454-030-0 Benefit Details |
Grundy | $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 | |||||
HealthyAdvantage Primary Plan (HMO) - H4454-028-0 Benefit Details |
Grundy | $27.10 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H0251-002-0 Benefit Details |
Grundy | $ 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 | |||||||||
Windsor Medicare Extra Comp Plus Plan (HMO SNP) - H5698-140-0 Benefit Details |
Grundy | $ 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: 15% Tier 2: 15% | n/a Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) - H5698-036-0 Benefit Details |
Grundy | $35.00 | $0 | Some Generics | Tier 1: $3.00 Tier 2: $10.00 Tier 3: $40.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H4408-006 (PPO) - H4408-006-0 Benefit Details |
Grundy | $42.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $5,300 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 | |||||||||
BlueAdvantage Ruby (PPO) - H7917-014-0 Benefit Details |
Grundy | $50.00 | $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 | |||||
HumanaChoice R5826-001 (Regional PPO) - R5826-001-0 Benefit Details |
Grundy | $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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Windsor Medicare Extra Diabetes Plan (HMO SNP) - H5698-156-0 Benefit Details |
Grundy | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | 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 | |||||||||
Windsor Medicare Extra Fusion Plan (HMO SNP) - H5698-141-0 Benefit Details |
Grundy | $110.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) - H5698-068-0 Benefit Details |
Grundy | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
BlueAdvantage Diamond (PPO) - H7917-010-0 Benefit Details |
Grundy | $150.00 | $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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