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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Bravo Achieve (HMO SNP) - H2108-030-0 Benefit Details |
Kent | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $80.00 Tier 5: 33% Tier 6: $10.00 | n/a Browse Formulary | |||||
Bravo Achieve Plus (HMO-POS SNP) - H2108-029-0 Benefit Details |
Kent | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $10.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 33% Tier 6: $5.00 | n/a Browse Formulary | |||||
Bravo Classic (HMO) - H2108-022-0 Benefit Details |
Kent | $0.00 | $50 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $80.00 Tier 5: 31% | $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 | |||||||||
Bravo Classic Plus (HMO-POS) - H2108-028-0 Benefit Details |
Kent | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $10.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
UnitedHealthcare Nursing Home Plan (PPO SNP) - H2111-001-0 Benefit Details |
Kent | $31.20 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
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Bravo Select (HMO SNP) - H2108-001-0 Benefit Details |
Kent | $ 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 | |||||||||
Bravo Traditions (HMO SNP) - H2108-020-0 Benefit Details |
Kent | $34.60 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | n/a Browse Formulary | |||||
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