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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Anthem MediBlue Preferred Standard (PPO) - H2836-001-0 Benefit Details |
Windham | $0.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $5.00 Tier 3: $42.00 Tier 4: $80.00 Tier 5: 33% Tier 6: 33% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
Anthem MediBlue Value (HMO) - H5854-005-0 Benefit Details |
Windham | $0.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% Tier 5: 33% Tier 6: $9.00 | $5,400 Browse Formulary | |||||
ConnectiCare VIP Option 3 (HMO-POS) - H3528-008-0 Benefit Details |
Windham | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 25% | $6,700 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 | |||||||||
ConnectiCare VIP Prime 1 (HMO) - H3528-001-0 Benefit Details |
Windham | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 25% | $5,400 Browse Formulary | |||||
ConnectiCare VIP Prime 4 (HMO) - H3528-003-0 Benefit Details |
Windham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 | ||||||
UnitedHealthcare MedicareComplete Essential (HMO) - H0755-032-0 Benefit Details |
Windham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,200 | ||||||
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 MedicareComplete Plan 2 (HMO) - H0755-031-0 Benefit Details |
Windham | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $7.00 Tier 3: $44.00 Tier 4: $92.00 Tier 5: 33% | $5,600 Browse Formulary | |||||
AARP MedicareComplete Choice (Regional PPO) - R7444-001-0 Benefit Details |
Windham | $20.00 | $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% | $6,700 Browse Formulary | |||||
UnitedHealthcare Dual Complete (PPO SNP) - H0710-002-0 Benefit Details |
Windham | $ 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 | |||||||||
ConnectiCare VIP Prime 3 (HMO) - H3528-002-0 Benefit Details |
Windham | $119.00 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Plan 1 (HMO) - H0755-030-0 Benefit Details |
Windham | $121.00 | $0 | Some Generics | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $42.00 Tier 4: $88.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
ConnectiCare VIP Option 1 (HMO-POS) - H3528-006-0 Benefit Details |
Windham | $179.00 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $5,500 Browse Formulary | |||||
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