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) - H0609-015-0 Benefit Details |
Teller | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 | ||||||
AARP MedicareComplete SecureHorizons Plan 2 (HMO) - H0609-020-0 Benefit Details |
Teller | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $45.00 Tier 4: $88.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
Humana Gold Plus H5291-002 (HMO) - H5291-002-0 Benefit Details |
Teller | $0.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $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 | |||||||||
HumanaChoice H0623-009 (PPO) - H0623-009-0 Benefit Details |
Teller | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Kaiser Permanente Senior Advantage Core (HMO) - H0630-017-0 Benefit Details |
Teller | $0.00 | $0 | All Generics, Few Brands | Tier 1: tbd | $3,350 Browse Formulary | |||||
AB Basic Plan (Cost) - H0602-026-0 Benefit Details |
Teller | $5.00 | 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 (Cost) - H0602-042-0 Benefit Details |
Teller | $8.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Humana Gold Plus H5291-001 (HMO) - H5291-001-0 Benefit Details |
Teller | $20.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $42.00 Tier 3: $75.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Rocky Mountain Thrifty Plan (Cost) - H0602-027-0 Benefit Details |
Teller | $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 | |||||||||
HumanaChoice H0623-011 (PPO) - H0623-011-0 Benefit Details |
Teller | $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 | |||||
AARP MedicareComplete SecureHorizons Plan 1 (HMO) - H0609-002-0 Benefit Details |
Teller | $40.00 | $0 | Some Generics | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $42.00 Tier 4: $84.00 Tier 5: 33% | $5,900 Browse Formulary | |||||
Kaiser Permanente Senior Advantage Silver (HMO) - H0630-018-0 Benefit Details |
Teller | $42.00 | $0 | All Generics, Few Brands | Tier 1: tbd | $2,850 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 (Cost) - H0602-007-0 Benefit Details |
Teller | $42.90 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Rocky Mountain Green Plan + Rx (Cost) - H0602-043-0 Benefit Details |
Teller | $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 |
Teller | $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 | |||||||||
Rocky Mountain Thrifty Plan + Rx (Cost) - H0602-039-0 Benefit Details |
Teller | $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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Rocky Mountain Standard Plan + Rx (Cost) - H0602-020-0 Benefit Details |
Teller | $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 |
Teller | $156.80 | 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 Plus Plan + Rx (Cost) - H0602-019-0 Benefit Details |
Teller | $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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