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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Care Improvement Plus Gold Rx (Regional PPO SNP) - R6801-009-0 Benefit Details |
Bastrop | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | n/a Browse Formulary | |||||
HumanaChoice R5826-026 (Regional PPO) - R5826-026-0 Benefit Details |
Bastrop | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Care Improvement Plus Dual Advantage (Regional PPO SNP) - R6801-011-0 Benefit Details |
Bastrop | $ 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: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 27% | 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 | |||||||||
Care Improvement Plus Silver Rx (Regional PPO SNP) - R6801-008-0 Benefit Details |
Bastrop | $30.00 | $165 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 29% | n/a Browse Formulary | |||||
SeniorCare Sr Select-Medical Only (Cost) - H4564-012-0 Benefit Details |
Bastrop | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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HumanaChoice H4520-006 (PPO) - H4520-006-0 Benefit Details |
Bastrop | $49.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 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 | |||||||||
HumanaChoice R5826-012 (Regional PPO) - R5826-012-0 Benefit Details |
Bastrop | $54.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $42.00 Tier 3: $82.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
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Care Improvement Plus Medicare Advantage (Regional PPO) - R6801-012-0 Benefit Details |
Bastrop | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
SeniorCare Sr Select - Value Rx (Cost) - H4564-015-0 Benefit Details |
Bastrop | $70.60 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $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 | |||||||||
SeniorCare Sr Select - Basic Rx (Cost) - H4564-003-0 Benefit Details |
Bastrop | $77.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $64.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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SeniorCare Sr Preferred-Medical Only (Cost) - H4564-011-0 Benefit Details |
Bastrop | $87.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Humana Reader's Digest Healthy Living Plan (HMO) - H4510-020-0 Benefit Details |
Bastrop | $112.00 | $0 | Few Generics, Few Brands | Tier 1: $4.00 Tier 2: $36.00 Tier 3: $70.00 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 | |||||||||
SeniorCare Sr Preferred - Value Rx (Cost) - H4564-014-0 Benefit Details |
Bastrop | $117.60 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,400 Browse Formulary | |||||
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SeniorCare Sr Preferred - Basic Rx (Cost) - H4564-002-0 Benefit Details |
Bastrop | $124.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $64.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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SeniorCare Sr VIP - Medical Only (Cost) - H4564-016-0 Benefit Details |
Bastrop | $125.00 | 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 | |||||||||
SeniorCare Sr Select - Enhanced Rx (Cost) - H4564-006-0 Benefit Details |
Bastrop | $133.10 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $35.00 Tier 3: $65.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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SeniorCare Sr MedOption - Medical Only (Cost) - H4564-020-0 Benefit Details |
Bastrop | $148.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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SeniorCare Sr VIP - Value Rx (Cost) - H4564-019-0 Benefit Details |
Bastrop | $155.60 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) - H4564-017-0 Benefit Details |
Bastrop | $162.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $64.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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SeniorCare Sr Premium-Medical Only (Cost) - H4564-010-0 Benefit Details |
Bastrop | $167.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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SeniorCare Sr MedOption - Value Rx (Cost) - H4564-023-0 Benefit Details |
Bastrop | $178.60 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $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 | |||||||||
SeniorCare Sr Preferred - Enhanced Rx (Cost) - H4564-005-0 Benefit Details |
Bastrop | $180.10 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $35.00 Tier 3: $65.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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SeniorCare Sr MedOption - Basic Rx (Cost) - H4564-021-0 Benefit Details |
Bastrop | $185.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $64.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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SeniorCare Sr Premium - Value Rx (Cost) - H4564-013-0 Benefit Details |
Bastrop | $197.60 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) - H4564-001-0 Benefit Details |
Bastrop | $204.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $64.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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SeniorCare Sr VIP - Enhanced Rx (Cost) - H4564-018-0 Benefit Details |
Bastrop | $218.10 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $35.00 Tier 3: $65.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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SeniorCare Sr MedOption - Enhanced Rx (Cost) - H4564-022-0 Benefit Details |
Bastrop | $241.10 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $35.00 Tier 3: $65.00 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 | |||||||||
SeniorCare Sr Premium - Enhanced Rx (Cost) - H4564-004-0 Benefit Details |
Bastrop | $260.10 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $35.00 Tier 3: $65.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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