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 SecureHorizons Essential (HMO) - H0543-121-0 Benefit Details |
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
AARP MedicareComplete SecureHorizons Plan 2 (HMO) - H0543-138-0 Benefit Details |
Orange | $0.00 | $0 | Some Generics | Tier 1: $3.00 Tier 2: $5.00 Tier 3: $45.00 Tier 4: $92.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
AARP MedicareComplete SecureHorizons Premier (HMO) - H0543-004-0 Benefit Details |
Orange | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $44.00 Tier 4: $92.00 Tier 5: 33% | $5,900 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 | |||||||||
Advantage I MAPD (HMO) - H7731-001-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: $3.00 Tier 2: $25.00 Tier 3: $59.00 Tier 4: 33% | $2,400 Browse Formulary | |||||
Advantage Select MA (HMO) - H7731-007-0 Benefit Details |
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,000 | ||||||
Aetna Medicare Select Plan (HMO) - H0523-002-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $33.00 Tier 3: $40.00 Tier 4: $95.00 Tier 5: 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 | |||||||||
Blue Cross Senior Secure Plan I (HMO) - H0564-006-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $7.00 | $3,400 Browse Formulary | |||||
Blue Shield 65 Plus (HMO) - H0504-015-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% Tier 5: 33% | $3,000 Browse Formulary | |||||
Blue Shield 65 Plus Choice Plan (HMO) - H0504-021-0 Benefit Details |
Orange (Partial) | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 33% Tier 5: 33% | $2,000 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 | |||||||||
Brand New Day (HMO) - H0838-022-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: $2.50 Tier 2: $40.00 | $3,400 Browse Formulary | |||||
Care1st AdvantageOptimum Plan (HMO) - H5928-006-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $5.00 Tier 3: $30.00 Tier 4: $50.00 Tier 5: 30% Tier 6: $40.00 | $3,400 Browse Formulary | |||||
CareMore Breathe (HMO SNP) - H0544-014-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Tier 1: $0.00 Tier 2: $5.00 Tier 3: $25.00 Tier 4: $85.00 Tier 5: 33% Tier 6: $0.00 | 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 | |||||||||
CareMore Connect (HMO SNP) - H0544-003-0 Benefit Details |
Orange | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | All Generics | Tier 1: $0.00 Tier 2: $0.00 Tier 3: 25% Tier 4: 25% Tier 5: 25% Tier 6: $0.00 | n/a Browse Formulary | |||||
CareMore ESRD (HMO SNP) - H0544-015-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Tier 1: $0.00 Tier 2: $5.00 Tier 3: $25.00 Tier 4: $85.00 Tier 5: 33% Tier 6: $0.00 | n/a Browse Formulary | |||||
CareMore Heart (HMO SNP) - H0544-013-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Tier 1: $0.00 Tier 2: $5.00 Tier 3: $25.00 Tier 4: $85.00 Tier 5: 33% Tier 6: $0.00 | 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 | |||||||||
CareMore Reliance (HMO SNP) - H0544-004-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Tier 1: $0.00 Tier 2: $5.00 Tier 3: $25.00 Tier 4: $85.00 Tier 5: 33% Tier 6: $0.00 | n/a Browse Formulary | |||||
CareMore Touch (HMO SNP) - H0544-005-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Tier 1: $0.00 Tier 2: $5.00 Tier 3: $25.00 Tier 4: $50.00 Tier 5: 33% Tier 6: $0.00 | n/a Browse Formulary | |||||
CareMore Value Plus (HMO) - H0544-002-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Tier 1: $0.00 Tier 2: $5.00 Tier 3: $25.00 Tier 4: $85.00 Tier 5: 33% Tier 6: $0.00 | $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 | |||||||||
Central Health Medicare Plan (HMO) - H5649-001-0 Benefit Details |
Orange | $0.00 | $0 | All Generics | Tier 1: $0.00 Tier 2: $5.00 Tier 3: $25.00 Tier 4: $50.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Citizens Choice Healthplan (HMO) - H3815-001-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $15.00 Tier 3: $60.00 Tier 4: 33% Tier 5: 33% | $3,400 Browse Formulary | |||||
Easy Choice Best Plan (HMO) - H5087-005-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $10.00 Tier 3: $30.00 Tier 4: $90.00 Tier 5: 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 | |||||||||
Golden State Medicare Health Plan, Golden (HMO) - H2241-001-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $30.00 Tier 3: $65.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
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Health Net Healthy Heart Plan 1 (HMO) - H0562-082-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: tbd | $3,400 Browse Formulary | |||||
Health Net Seniority Plus Green (HMO) - H0562-044-0 Benefit Details |
Orange | $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 | |||||||||
Health Net Seniority Plus Ruby Plan 1 (HMO) - H0562-083-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: tbd | $3,400 Browse Formulary | |||||
Humana Gold Plus H0108-013 (HMO) - H0108-013-0 Benefit Details |
Orange | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $0.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
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Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) - H0524-003-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, Few Brands | Tier 1: tbd | $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 | |||||||||
Salud con Health Net Medicare Advantage (HMO) - H0562-085-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: tbd | $3,400 Browse Formulary | |||||
SCAN Classic (HMO) - H5425-007-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: $3.00 Tier 2: $8.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 33% | $5,000 Browse Formulary | |||||
SCAN Healthy at Home (HMO SNP) - H9104-007-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: $3.00 Tier 2: $8.00 Tier 3: $39.00 Tier 4: $80.00 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 | |||||||||
SCAN Options (HMO) - H5425-014-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $90.00 Tier 5: 33% | $5,000 Browse Formulary | |||||
StartSmart with CareMore (HMO) - H0544-007-0 Benefit Details |
Orange | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $8.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% Tier 6: $35.00 | $3,400 Browse Formulary | |||||
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP) - H0524-029-0 Benefit Details |
Orange | $ 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: tbd | 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 | |||||||||
Health Net Healthy Heart Plan 2 (HMO) - H0562-086-0 Benefit Details |
Orange | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
Easy Choice Plus Plan (HMO) - H5087-002-0 Benefit Details |
Orange | $23.60 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | $3,400 Browse Formulary | |||||
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Health Net Seniority Plus Amber I (HMO SNP) - H0562-055-0 Benefit Details |
Orange | $ 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: tbd | 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 | |||||||||
Care1st TotalDual Plan (HMO SNP) - H5928-005-0 Benefit Details |
Orange | $ 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: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% Tier 6: $40.00 | n/a Browse Formulary | |||||
OneCare (HMO SNP) - H5433-001-0 Benefit Details |
Orange | $ 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: $0.00 Tier 2: $0.00 | n/a Browse Formulary | |||||
Preferred Dual SNP (HMO SNP) - H7731-008-0 Benefit Details |
Orange | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Many Generics, Some Brands | Tier 1: $0.00 Tier 2: $0.00 Tier 3: 25% Tier 4: 25% | 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 | |||||||||
Brand New Day (HMO SNP) - H0838-020-0 Benefit Details |
Orange | $30.90 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | n/a Browse Formulary | |||||
Brand New Day HMO Extra Care (HMO) - H0838-023-0 Benefit Details |
Orange | $30.90 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $6,700 Browse Formulary | |||||
Health Net Seniority Plus Amber II (HMO SNP) - H0562-070-0 Benefit Details |
Orange | $ 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: tbd | 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 | |||||||||
UnitedHealthcare Dual Complete (HMO SNP) - H0543-079-0 Benefit Details |
Orange | $ 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 | |||||
Humana Gold Plus H0108-014 (HMO-POS) - H0108-014-0 Benefit Details |
Orange | $39.00 | $0 | Few Generics, Few Brands | Tier 1: $0.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $5,000 Browse Formulary | |||||
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Anthem Medicare Preferred Standard (PPO) - H8552-002-0 Benefit Details |
Orange | $40.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $7.00 | $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 | |||||||||
My Choice (HMO-POS) - H5425-026-0 Benefit Details |
Orange | $40.00 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $8.00 Tier 3: $37.00 Tier 4: $65.00 Tier 5: 33% | $3,000 Browse Formulary | |||||
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