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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Humana Gold Choice H8145-120 (PFFS) - H8145-120-0 Benefit Details |
Park | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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HumanaChoice H0623-009 (PPO) - H0623-009-0 Benefit Details |
Park | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Kaiser Permanente Senior Advantage Core (HMO) - H0630-013-0 Benefit Details |
Park | $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 | |||||||||
AB Basic Plan (Cost) - H0602-026-0 Benefit Details |
Park | $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 |
Park | $8.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Senior Advantage Medicare Medicaid Plan (HMO SNP) - H0630-014-0 Benefit Details |
Park | $ 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 | |||||||||
Rocky Mountain Thrifty Plan (Cost) - H0602-027-0 Benefit Details |
Park | $34.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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HumanaChoice H0623-011 (PPO) - H0623-011-0 Benefit Details |
Park | $35.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $5,000 Browse Formulary | |||||
Rocky Mountain Standard Plan (Cost) - H0602-007-0 Benefit Details |
Park | $42.90 | 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 | |||||||||
Kaiser Permanente Senior Advantage Silver (HMO) - H0630-015-0 Benefit Details |
Park | $48.00 | $0 | All Generics, Few Brands | Tier 1: tbd | $3,400 Browse Formulary | |||||
Rocky Mountain Green Plan + Rx (Cost) - H0602-043-0 Benefit Details |
Park | $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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HumanaChoice H0623-001 (PPO) - H0623-001-0 Benefit Details |
Park | $61.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $42.00 Tier 3: $80.00 Tier 4: 33% | $4,500 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 | |||||||||
Humana Gold Choice H8145-123 (PFFS) - H8145-123-0 Benefit Details |
Park | $68.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $41.00 Tier 3: $80.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
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Rocky Mountain Thrifty Plan + Rx (Cost) - H0602-039-0 Benefit Details |
Park | $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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Kaiser Permanente Senior Advantage Plus Choice (HMO-POS) - H0630-019-0 Benefit Details |
Park | $86.00 | $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 | |||||||||
Rocky Mountain Standard Plan + Rx (Cost) - H0602-020-0 Benefit Details |
Park | $99.10 | $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 |
Park | $156.80 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Kaiser Permanente Senior Advantage Gold (HMO) - H0630-016-0 Benefit Details |
Park | $177.00 | $0 | All Generics, Few Brands | Tier 1: tbd | $2,350 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 | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) - H0602-019-0 Benefit Details |
Park | $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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