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 Essential (Regional PPO) - R5287-002-0 Benefit Details |
Sumter | $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 |
Sumter | $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 | |||||
Any, Any, Any Gold (PFFS) - H8098-001-0 Benefit Details |
Sumter | $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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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 | |||||||||
Any, Any, Any Gold MA Only (PFFS) - H8098-003-0 Benefit Details |
Sumter | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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BlueMedicare Regional PPO (Regional PPO) - R3332-001-0 Benefit Details |
Sumter | $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 | |||||
CareOne (HMO) - H1019-027-0 Benefit Details |
Sumter | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $0.00 Tier 2: $4.00 Tier 3: $40.00 Tier 4: $80.00 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 | |||||||||
Citrus Total (HMO) - H5407-001-0 Benefit Details |
Sumter | $0.00 | $0 | Some Generics | Tier 1: $3.00 Tier 2: $25.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 33% | $3,800 Browse Formulary | |||||
Freedom Medicare Plan Rx (HMO) - H5427-059-0 Benefit Details |
Sumter | $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 |
Sumter | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 Savings Plan Rx (HMO) - H5427-053-0 Benefit Details |
Sumter | $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 | |||||
Freedom VIP Care (HMO SNP) - H5427-070-0 Benefit Details |
Sumter | $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 |
Sumter | $0.00 | $0 | Many Generics | 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 (HMO SNP) - H5427-072-0 Benefit Details |
Sumter | $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 | |||||
Freedom VIP Savings COPD (HMO SNP) - H5427-077-0 Benefit Details |
Sumter | $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 H5426-008 (HMO) - H5426-008-0 Benefit Details |
Sumter | $0.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 35% | $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 | |||||||||
Humana Gold Plus H5426-019 (HMO) - H5426-019-0 Benefit Details |
Sumter | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $0.00 Tier 2: $10.00 Tier 3: $42.00 Tier 4: $80.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
Humana Reader's Digest Healthy Living Plan (Regional PPO) - R5826-074-0 Benefit Details |
Sumter | $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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HumanaChoice R5826-018 (Regional PPO) - R5826-018-0 Benefit Details |
Sumter | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
Medicare Masterpiece (HMO) - H5404-001-0 Benefit Details |
Sumter | $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 MA Only (HMO) - H5404-116-0 Benefit Details |
Sumter | $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 |
Sumter | $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 - Dementia (HMO SNP) - H5404-136-0 Benefit Details |
Sumter | $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 - Diabetes, CHF, CVD (HMO SNP) - H5404-135-0 Benefit Details |
Sumter | $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 |
Sumter | $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 | |||||
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) - H5594-030-0 Benefit Details |
Sumter | $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) - H5594-031-0 Benefit Details |
Sumter | $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) - H5594-026-0 Benefit Details |
Sumter | $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% | $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) - H5594-027-0 Benefit Details |
Sumter | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $30.00 Tier 3: $65.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Preferred Gold Option (HMO) - H1045-019-0 Benefit Details |
Sumter | $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 |
Sumter | $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 EASY (HMO) - H5696-023-0 Benefit Details |
Sumter | $0.00 | $0 | Some Generics | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $30.00 Tier 4: $80.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
PUP REWARDS (HMO) - H5696-024-0 Benefit Details |
Sumter | $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) - H5696-035-0 Benefit Details |
Sumter | $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 | |||||
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 | |||||||||
Universal Hassle-Free (PPO) - H5096-001-0 Benefit Details |
Sumter | $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 |
Sumter | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
WellCare Advance (HMO) - H1032-037-0 Benefit Details |
Sumter | $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 | |||||||||
WellCare Value (HMO-POS) - H1032-091-0 Benefit Details |
Sumter | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Optimum Emerald Full (HMO SNP) - H5594-017-0 Benefit Details |
Sumter | $ 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 | |||||
Optimum Emerald Partial (HMO SNP) - H5594-016-0 Benefit Details |
Sumter | $ 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 | |||||||||
Citrus Plus (HMO SNP) - H5407-011-0 Benefit Details |
Sumter | $ 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 | |||||
Freedom Medi-Medi Partial (HMO SNP) - H5427-078-0 Benefit Details |
Sumter | $ 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 |
Sumter | $ 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 | |||||
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 |
Sumter | $ 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 | |||||
CareNeeds PLUS (HMO SNP) - H1019-061-0 Benefit Details |
Sumter | $ 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: $38.00 Tier 4: $74.00 Tier 5: 25% | n/a Browse Formulary | |||||
Freedom Medi-Medi Full (HMO SNP) - H5427-087-0 Benefit Details |
Sumter | $ 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 | |||||||||
UnitedHealthcare Dual Complete RP (Regional PPO SNP) - R5287-003-0 Benefit Details |
Sumter | $ 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 |
Sumter | $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 | |||||
HumanaChoice R5826-005 (Regional PPO) - R5826-005-0 Benefit Details |
Sumter | $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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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 H8145-061 (PFFS) - H8145-061-0 Benefit Details |
Sumter | $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 | |||||
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