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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AARP MedicareComplete Plan 3 (HMO) - H5005-019-0 Benefit Details |
Lewis | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $7.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $5,700 Browse Formulary | |||||
Soundpath Health Ascent (HMO) - H9302-009-0 Benefit Details |
Lewis | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Soundpath Health Sound + Rx (HMO) - H9302-007-0 Benefit Details |
Lewis | $0.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $18.00 Tier 3: $36.00 Tier 4: $60.00 Tier 5: 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 | |||||||||
Group Health Cooperative Clear Care Vital (HMO) - H5050-013-0 Benefit Details |
Lewis | $19.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $11.00 Tier 4: 50% | $3,200 Browse Formulary | |||||
WindsorSterling Emerald Connect Plan (PFFS) - H3410-004-19 Benefit Details |
Lewis | $28.50 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $33.00 Tier 4: $87.00 Tier 5: 29% | $6,700 Browse Formulary | |||||
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AARP MedicareComplete Essential (HMO) - H5005-018-0 Benefit Details |
Lewis | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 | ||||||
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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) - H3410-002-19 Benefit Details |
Lewis | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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Group Health Cooperative Clear Care Basic (HMO) - H5050-001-0 Benefit Details |
Lewis | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Community HealthFirst MA Special Needs Plan (HMO SNP) - H5826-005-0 Benefit Details |
Lewis | $ 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 | |||||
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 | |||||||||
Kaiser Permanente Senior Advantage Basic (HMO) - H9003-006-0 Benefit Details |
Lewis | $39.00 | $0 | All Generics, Few Brands | Tier 1: tbd | $3,400 Browse Formulary | |||||
Community HealthFirst MA Pharmacy Plan (HMO) - H5826-009-0 Benefit Details |
Lewis | $49.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: 33% | $2,800 Browse Formulary | |||||
Soundpath Health Alpine (HMO) - H9302-004-0 Benefit Details |
Lewis | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,250 | ||||||
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 | |||||||||
WindsorSterling Gold Connect Plan (PFFS) - H3410-003-19 Benefit Details |
Lewis | $59.00 | $50 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $15.00 Tier 3: $34.00 Tier 4: $84.00 Tier 5: 30% | $4,000 Browse Formulary | |||||
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Community HealthFirst MA Enhanced Pharmacy Plan (HMO) - H5826-012-0 Benefit Details |
Lewis | $79.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $40.00 Tier 3: 33% | $2,300 Browse Formulary | |||||
Regence MedAdvantage Basic (PPO) - H5009-001-0 Benefit Details |
Lewis | $79.00 | 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 | |||||||||
Soundpath Health Charter + Rx (HMO) - H9302-003-0 Benefit Details |
Lewis | $94.00 | $0 | Many Generics | Tier 1: $6.00 Tier 2: $18.00 Tier 3: $36.00 Tier 4: $60.00 Tier 5: 33% | $2,250 Browse Formulary | |||||
Kaiser Permanente Senior Advantage (HMO) - H9003-001-0 Benefit Details |
Lewis | $99.00 | $0 | All Generics, Few Brands | Tier 1: tbd | $2,500 Browse Formulary | |||||
AARP MedicareComplete Plan 1 (HMO) - H5005-001-0 Benefit Details |
Lewis | $101.00 | $0 | Some Generics | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $44.00 Tier 4: $88.00 Tier 5: 33% | $4,200 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 | |||||||||
Group Health Cooperative Clear Care Essential (HMO) - H5050-009-0 Benefit Details |
Lewis | $118.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $2.00 Tier 2: $11.00 Tier 3: $12.00 Tier 4: 50% | $2,500 Browse Formulary | |||||
Regence MedAdvantage + Rx Classic (PPO) - H5009-002-0 Benefit Details |
Lewis | $119.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.50 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $90.00 Tier 5: 28% Tier 6: 28% | $3,400 Browse Formulary | |||||
Soundpath Health Apex + Rx (HMO) - H9302-001-0 Benefit Details |
Lewis | $169.00 | $0 | Many Generics | Tier 1: $6.00 Tier 2: $18.00 Tier 3: $36.00 Tier 4: $60.00 Tier 5: 33% | $1,400 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 | |||||||||
Regence MedAdvantage + Rx Enhanced (PPO) - H5009-004-0 Benefit Details |
Lewis | $211.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $90.00 Tier 5: 33% Tier 6: 33% | $2,800 Browse Formulary | |||||
Group Health Cooperative Clear Care Optimal (HMO) - H5050-004-0 Benefit Details |
Lewis | $212.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $20.00 Tier 3: $25.00 Tier 4: 50% | $1,000 Browse Formulary | |||||
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