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 Choice (PPO) - H5532-001-0 Benefit Details |
Hillsborough | $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: $92.00 Tier 5: 33% | $5,900 Browse Formulary | |||||
AARP MedicareComplete Choice Essential (Regional PPO) - R5287-002-0 Benefit Details |
Hillsborough | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
AARP MedicareComplete Choice Plan 2 (Regional PPO) - R5287-001-0 Benefit Details |
Hillsborough | $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: $95.00 Tier 5: 33% | $5,900 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 | |||||||||
AARP MedicareComplete Plus Plan 1 (HMO-POS) - H1080-004-0 Benefit Details |
Hillsborough | $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: $92.00 Tier 5: 33% | $4,950 Browse Formulary | |||||
Any, Any, Any Gold (PFFS) - H8098-001-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $85.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
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Any, Any, Any Gold MA Only (PFFS) - H8098-003-0 Benefit Details |
Hillsborough | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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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 | |||||||||
BlueMedicare HMO (HMO) - H1026-038-0 Benefit Details |
Hillsborough | $0.00 | $0 | All Generics | Tier 1: $0.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
BlueMedicare Regional PPO (Regional PPO) - R3332-001-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $45.00 Tier 3: $85.00 Tier 4: 33% | $4,750 Browse Formulary | |||||
CareDirect (HMO SNP) - H1019-059-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics, Few Brands | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $55.00 Tier 5: 33% | 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 | |||||||||
CareFree (HMO) - H1019-060-0 Benefit Details |
Hillsborough | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $25.00 Tier 4: $55.00 Tier 5: 33% | $4,000 Browse Formulary | |||||
CareOne (HMO) - H1019-014-0 Benefit Details |
Hillsborough | $0.00 | $0 | Some Generics, Few Brands | Tier 1: $0.00 Tier 2: $10.00 Tier 3: $25.00 Tier 4: $80.00 Tier 5: 33% | $5,000 Browse Formulary | |||||
CareOne PLUS (HMO) - H1019-054-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics, Few Brands | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $55.00 Tier 5: 33% | $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 | |||||||||
Citrus Total (HMO) - H5407-004-0 Benefit Details |
Hillsborough | $0.00 | $0 | Some Generics | Tier 1: $3.00 Tier 2: $25.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 33% | $3,950 Browse Formulary | |||||
Coventry Advantra Ideal (HMO) - H5850-025-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $25.00 Tier 3: $60.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Coventry Advantra Select Plus (HMO-POS) - H5850-026-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $39.00 Tier 3: $79.00 Tier 4: 33% | $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 | |||||||||
Freedom Medicare Plan Rx (HMO) - H5427-060-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $60.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Freedom Savings Plan (HMO) - H5427-052-0 Benefit Details |
Hillsborough | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Freedom Savings Plan Rx (HMO) - H5427-054-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $25.00 Tier 3: $65.00 Tier 4: 33% | $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 | |||||||||
Freedom VIP Care (HMO SNP) - H5427-070-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $60.00 Tier 4: 33% | n/a Browse Formulary | |||||
Freedom VIP Care COPD (HMO SNP) - H5427-076-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $60.00 Tier 4: 33% | n/a Browse Formulary | |||||
Freedom VIP Savings (HMO SNP) - H5427-072-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $60.00 Tier 4: 33% | 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 | |||||||||
Freedom VIP Savings COPD (HMO SNP) - H5427-077-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $60.00 Tier 4: 33% | n/a Browse Formulary | |||||
Humana Gold Plus H1036-025 (HMO) - H1036-025-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics, Few Brands | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $55.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Humana Gold Plus H1036-119 (HMO) - H1036-119-0 Benefit Details |
Hillsborough | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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 Plus H1036-141 (HMO) - H1036-141-0 Benefit Details |
Hillsborough | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $25.00 Tier 4: $55.00 Tier 5: 33% | $4,000 Browse Formulary | |||||
Humana Gold Plus SNP-DB H1036-160 (HMO SNP) - H1036-160-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics, Few Brands | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $55.00 Tier 5: 33% | n/a Browse Formulary | |||||
Humana Reader's Digest Healthy Living Plan (Regional PPO) - R5826-074-0 Benefit Details |
Hillsborough | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $41.00 Tier 3: $81.00 Tier 4: 33% | $4,950 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-018 (Regional PPO) - R5826-018-0 Benefit Details |
Hillsborough | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | |||||||||||
Medicare Masterpiece (HMO) - H5404-001-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $8.00 Tier 3: $45.00 Tier 4: $75.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Medicare Masterpiece (PPO) - H5429-001-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $79.00 Tier 5: 33% | $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 | |||||||||
Medicare Masterpiece MA Only (HMO) - H5404-116-0 Benefit Details |
Hillsborough | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Medicare Masterpiece Premier - COPD (HMO SNP) - H5404-137-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $20.00 Tier 4: $50.00 Tier 5: 33% | n/a Browse Formulary | |||||
Medicare Masterpiece Premier - Dementia (HMO SNP) - H5404-136-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $20.00 Tier 4: $50.00 Tier 5: 33% | 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 | |||||||||
Medicare Masterpiece Premier - Diabetes, CHF, CVD (HMO SNP) - H5404-135-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $20.00 Tier 4: $50.00 Tier 5: 33% | n/a Browse Formulary | |||||
Medicare Masterpiece Premier (HMO) - H5404-138-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $20.00 Tier 4: $50.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Molina Medicare Options (HMO) - H8130-002-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $50.00 Tier 4: 33% | $3,400 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 | |||||||||
Optimum Diamond Rewards (HMO-POS SNP) - H5594-028-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $50.00 Tier 4: 33% | n/a Browse Formulary | |||||
Optimum Diamond Rewards COPD (HMO-POS SNP) - H5594-029-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $50.00 Tier 4: 33% | n/a Browse Formulary | |||||
Optimum Gold Rewards Plan (HMO-POS) - H5594-001-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $69.00 Tier 4: 33% | $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 | |||||||||
Optimum Platinum Plan (HMO-POS) - H5594-002-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $60.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Preferred Gold Option (HMO) - H1045-019-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics, Few Brands | Tier 1: $0.00 Tier 2: $15.00 Tier 3: $55.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
Preferred Select Care (HMO SNP) - H1045-022-0 Benefit Details |
Hillsborough | $0.00 | $0 | Many Generics, Few Brands | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $50.00 Tier 4: 33% | 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 | |||||||||
PUP PLUS (HMO) - H5696-040-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $4.00 Tier 3: $35.00 Tier 4: $95.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
PUP SIMPLE (HMO) - H5696-039-0 Benefit Details |
Hillsborough | $0.00 | $0 | Some Generics | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $20.00 Tier 4: $80.00 Tier 5: 33% | $4,200 Browse Formulary | |||||
Simply Extra (HMO) - H5471-006-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $10.00 Tier 3: $25.00 Tier 4: $55.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
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 | |||||||||
Simply More (HMO) - H5471-005-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $15.00 Tier 4: $45.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
Universal Hassle-Free (PPO) - H5096-001-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $85.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
Universal Hassle-Free MA Only (PPO) - H5096-002-0 Benefit Details |
Hillsborough | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
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 | |||||||||
WellCare Choice (HMO-POS) - H1032-012-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $35.00 Tier 3: $69.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
WellCare Dividend (HMO) - H1032-032-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $39.00 Tier 3: $75.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
WellCare Value (HMO-POS) - H1032-035-0 Benefit Details |
Hillsborough | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $30.00 Tier 3: $69.00 Tier 4: 33% | $5,500 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 | |||||||||
Molina Medicare Options Plus (HMO SNP) - H8130-001-0 Benefit Details |
Hillsborough | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Many Generics | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $95.00 Tier 4: 25% | n/a Browse Formulary | |||||
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PUP EXTRA (HMO SNP) - H5696-021-0 Benefit Details |
Hillsborough | $ 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: $0.00 Tier 2: $0.00 Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
Optimum Emerald Full (HMO SNP) - H5594-017-0 Benefit Details |
Hillsborough | $ 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: 0% Tier 2: 0% | 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 | |||||||||
Optimum Emerald Partial (HMO SNP) - H5594-016-0 Benefit Details |
Hillsborough | $ 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 | |||||
Coventry Advantra Maximum (HMO SNP) - H5850-021-0 Benefit Details |
Hillsborough | $ 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: $0.00 Tier 2: $45.00 Tier 3: $76.00 Tier 4: 33% | n/a Browse Formulary | |||||
Citrus Plus (HMO SNP) - H5407-011-0 Benefit Details |
Hillsborough | $ 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 | |||||||||
Freedom Medi-Medi Partial (HMO SNP) - H5427-078-0 Benefit Details |
Hillsborough | $ 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 | |||||
WellCare Select (HMO-POS SNP) - H1032-061-0 Benefit Details |
Hillsborough | $ 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: $4.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 25% | n/a Browse Formulary | |||||
Humana Gold Plus SNP-DE H1036-102 (HMO SNP) - H1036-102-0 Benefit Details |
Hillsborough | $ 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: $0.00 Tier 2: $0.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 25% | 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 | |||||||||
WellCare Access (HMO SNP) - H1032-124-0 Benefit Details |
Hillsborough | $ 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: $0.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 25% | n/a Browse Formulary | |||||
Humana Gold Plus SNP-DE H1036-161 (HMO SNP) - H1036-161-0 Benefit Details |
Hillsborough | $ 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: $0.00 Tier 2: $0.00 Tier 3: $44.00 Tier 4: $87.00 Tier 5: 25% | n/a Browse Formulary | |||||
UnitedHealthcare Dual Complete LP (HMO SNP) - H1080-036-0 Benefit Details |
Hillsborough | $ 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 | |||||||||
CareNeeds (HMO SNP) - H1019-026-0 Benefit Details |
Hillsborough | $ 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: $0.00 Tier 2: $0.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 25% | n/a Browse Formulary | |||||
Amerivantage Specialty + Rx (HMO SNP) - H8991-017-0 Benefit Details |
Hillsborough | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Some Generics | Tier 1: $0.00 Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
CareNeeds PLUS (HMO SNP) - H1019-046-0 Benefit Details |
Hillsborough | $ 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: $0.00 Tier 2: $0.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Freedom Medi-Medi Full (HMO SNP) - H5427-087-0 Benefit Details |
Hillsborough | $ 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: 0% Tier 2: 0% | n/a Browse Formulary | |||||
Medicare Masterpiece Premier SNP - Dual (HMO SNP) - H5404-111-0 Benefit Details |
Hillsborough | $ 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 | |||||
Simply Care (HMO SNP) - H5471-010-0 Benefit Details |
Hillsborough | $23.80 | $320 | Some Generics | Tier 1: 0% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
new | new | new | |||||||||
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 | |||||||||
Simply Comfort (HMO SNP) - H5471-011-0 Benefit Details |
Hillsborough | $23.80 | $320 | Some Generics | Tier 1: 0% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
new | new | new | |||||||||
Simply Complete (HMO SNP) - H5471-007-0 Benefit Details |
Hillsborough | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Some Generics | Tier 1: $0.00 Tier 2: $10.00 Tier 3: $25.00 Tier 4: $55.00 Tier 5: 33% | n/a Browse Formulary | |||||
new | new | new | |||||||||
UnitedHealthcare Dual Complete EV (HMO SNP) - H5440-001-0 Benefit Details |
Hillsborough | $ 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 | |||||
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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 | |||||||||
UnitedHealthcare Dual Complete RP (Regional PPO SNP) - R5287-003-0 Benefit Details |
Hillsborough | $ 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 | |||||
Medicare Masterpiece Plus (HMO-POS) - H5404-086-0 Benefit Details |
Hillsborough | $29.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $79.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Aetna Medicare Value Plan (HMO) - H5414-009-0 Benefit Details |
Hillsborough | $38.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $6,700 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 | |||||||||
Aetna Medicare Premier Plan (PPO) - H5521-033-0 Benefit Details |
Hillsborough | $68.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $30.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-005 (Regional PPO) - R5826-005-0 Benefit Details |
Hillsborough | $80.00 | $0 | Few Generics, Few Brands | Tier 1: $2.00 Tier 2: $8.00 Tier 3: $40.00 Tier 4: $85.00 Tier 5: 33% | $4,750 Browse Formulary | |||||
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Humana Gold Choice H8145-061 (PFFS) - H8145-061-0 Benefit Details |
Hillsborough | $99.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $42.00 Tier 3: $81.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
-- | -- | ||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
BlueMedicare PPO (PPO) - H5434-002-0 Benefit Details |
Hillsborough | $150.00 | $105 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 25% | $6,700 Browse Formulary | |||||
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