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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Any, Any, Any Gold (PFFS) - H5820-002-0 Benefit Details |
Jones | $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 | |||||
Any, Any, Any Gold MA Only (PFFS) - H5820-026-0 Benefit Details |
Jones | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Care Improvement Plus Gold Rx (PPO SNP) - H6528-016-0 Benefit Details |
Jones | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | 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 | |||||||||
Care Improvement Plus Gold Rx (Regional PPO SNP) - R9896-009-0 Benefit Details |
Jones | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | n/a Browse Formulary | |||||
HumanaChoice R5826-064 (Regional PPO) - R5826-064-0 Benefit Details |
Jones | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 | ||||||
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Medicare Preferred Core (PPO) - H9947-001-0 Benefit Details |
Jones | $0.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $5.00 | $4,900 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 | |||||||||
Medicare Preferred Online (PPO) - H9947-003-0 Benefit Details |
Jones | $0.00 | $60 | Many Generics | Tier 1: $0.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% Tier 5: 33% Tier 6: $0.00 | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
Presidential (PFFS) - H9720-038-0 Benefit Details |
Jones | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Presidential Plus (PFFS) - H9720-039-0 Benefit Details |
Jones | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $45.00 Tier 3: $80.00 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 | |||||||||
Southeast Community Care - Plus (HMO) - H5578-006-0 Benefit Details |
Jones | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
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Today's Options Premier 400 (PFFS) - H5421-046-0 Benefit Details |
Jones | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Southeast Community Care - Dual Plus (HMO SNP) - H5578-007-0 Benefit Details |
Jones | $ 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: tbd | 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 | |||||||||
WindsorSterling Silver Access Plan (PFFS) - H5006-018-10 Benefit Details |
Jones | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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Care Improvement Plus Dual Advantage (PPO SNP) - H6528-017-0 Benefit Details |
Jones | $ 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: $10.00 Tier 2: $43.00 Tier 3: $95.00 Tier 4: 29% | n/a Browse Formulary | |||||
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Care Improvement Plus Silver Rx (PPO SNP) - H6528-015-0 Benefit Details |
Jones | $31.20 | $185 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 28% | 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 Nursing Home Plan (PPO SNP) - H1108-001-0 Benefit Details |
Jones | $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 | |||||
Care Improvement Plus Silver Rx (Regional PPO SNP) - R9896-008-0 Benefit Details |
Jones | $33.60 | $145 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 29% | n/a Browse Formulary | |||||
Today's Options Premier 200 (PFFS) - H5421-206-0 Benefit Details |
Jones | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,250 | ||||||
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 | |||||||||
Care Improvement Plus Medicare Advantage (PPO) - H6528-006-0 Benefit Details |
Jones | $38.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
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Medicare Preferred Premier (PPO) - H9947-002-0 Benefit Details |
Jones | $40.00 | $60 | Many Generics | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $7.00 | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
Today's Options Premier Plus 450B (PFFS) - H5421-070-0 Benefit Details |
Jones | $41.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $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 | |||||||||
WindsorSterling Gold Access Plan (PFFS) - H5006-017-10 Benefit Details |
Jones | $60.00 | $50 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $15.00 Tier 3: $34.00 Tier 4: $84.00 Tier 5: 30% | $4,000 Browse Formulary | |||||
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Care Improvement Plus Medicare Advantage (Regional PPO) - R9896-012-0 Benefit Details |
Jones | $70.00 | $230 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 27% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-077 (Regional PPO) - R5826-077-0 Benefit Details |
Jones | $76.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 28% | $5,900 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 | |||||||||
Today's Options Premier Plus 250A (PFFS) - H5421-212-0 Benefit Details |
Jones | $98.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
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