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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AB Basic Plan (Cost) - H0602-026-0 Benefit Details |
Archuleta | $5.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Rocky Mountain Green Plan (Cost) - H0602-042-0 Benefit Details |
Archuleta | $8.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Rocky Mountain Thrifty Plan (Cost) - H0602-027-0 Benefit Details |
Archuleta | $34.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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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 | |||||||||
Rocky Mountain Green Plan + Rx (Cost) - H0602-043-0 Benefit Details |
Archuleta | $48.10 | $125 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $2.00 Tier 2: $13.00 Tier 3: $45.00 Tier 4: $87.00 Tier 5: 30% | $6,700 Browse Formulary | |||||
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Rocky Mountain Standard Plan (Cost) - H0602-001-0 Benefit Details |
Archuleta | $73.40 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Rocky Mountain Thrifty Plan + Rx (Cost) - H0602-039-0 Benefit Details |
Archuleta | $74.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $12.00 Tier 3: $45.00 Tier 4: $90.00 Tier 5: 33% | n/a 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 | |||||||||
Rocky Mountain Standard Plan + Rx (Cost) - H0602-017-0 Benefit Details |
Archuleta | $120.80 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $10.00 Tier 3: $40.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
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Rocky Mountain Plus Plan (Cost) - H0602-003-0 Benefit Details |
Archuleta | $156.80 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Rocky Mountain Plus Plan + Rx (Cost) - H0602-019-0 Benefit Details |
Archuleta | $246.20 | $0 | All Generics | Tier 1: $8.50 Tier 2: $8.50 Tier 3: $38.00 Tier 4: $58.00 Tier 5: 33% | n/a Browse Formulary | |||||
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