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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HumanaChoice R5826-065 (Regional PPO) - R5826-065-0 Benefit Details |
Crenshaw | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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VIVA Medicare Plus Rx (HMO) - H0154-001-0 Benefit Details |
Crenshaw | $0.00 | $125 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $75.00 Tier 5: 29% | $6,700 Browse Formulary | |||||
VIVA Medicare Plus Rx Extra Value (HMO SNP) - H0154-012-0 Benefit Details |
Crenshaw | $ 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 | |||||||||
VIVA Medicare Plus Select (HMO) - H0154-008-0 Benefit Details |
Crenshaw | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
HumanaChoice R5826-001 (Regional PPO) - R5826-001-0 Benefit Details |
Crenshaw | $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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Blue Advantage Complete (PPO) - H0104-011-3 Benefit Details |
Crenshaw | $99.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 29% | $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 | |||||||||
VIVA Medicare Plus Rx Premier (HMO) - H0154-011-0 Benefit Details |
Crenshaw | $99.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $75.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
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