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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Advantra Elite (HMO) - H5302-008-0 Benefit Details |
Rockdale | $0.00 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $40.00 Tier 3: $78.00 Tier 4: 33% | $3,300 Browse Formulary | |||||
Advantra Silver (HMO-POS) - H5302-003-0 Benefit Details |
Rockdale | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $45.00 Tier 3: $80.00 Tier 4: 33% | $4,375 Browse Formulary | |||||
Any, Any, Any Gold (PFFS) - H8098-001-0 Benefit Details |
Rockdale | $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 |
Rockdale | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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BlueValue Basic (HMO) - H5422-006-0 Benefit Details |
Rockdale | $0.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $7.00 | $4,500 Browse Formulary | |||||
Care Improvement Plus Gold Rx (PPO SNP) - H6528-016-0 Benefit Details |
Rockdale | $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 |
Rockdale | $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 |
Rockdale | $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 |
Rockdale | $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 |
Rockdale | $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 | |||||||||
Universal Hassle-Free (PPO) - H5096-001-0 Benefit Details |
Rockdale | $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 |
Rockdale | $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 Value (HMO-POS) - H1112-027-0 Benefit Details |
Rockdale | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $39.00 Tier 3: $75.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Humana Gold Choice H8145-117 (PFFS) - H8145-117-0 Benefit Details |
Rockdale | $15.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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WellCare Access (HMO SNP) - H1112-006-0 Benefit Details |
Rockdale | $ 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 | |||||
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 | |||||||||
BlueValue Secure (HMO) - H5422-002-0 Benefit Details |
Rockdale | $25.00 | $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 | $3,300 Browse Formulary | |||||
Silver Advantage (HMO) - H5302-007-0 Benefit Details |
Rockdale | $29.60 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $45.00 Tier 3: $85.00 Tier 4: 33% | $6,500 Browse Formulary | |||||
Fresenius Health Partners (PPO SNP) - H9988-017-0 Benefit Details |
Rockdale | $30.00 | $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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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 Dual Advantage (PPO SNP) - H6528-017-0 Benefit Details |
Rockdale | $ 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 |
Rockdale | $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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UnitedHealthcare Nursing Home Plan (PPO SNP) - H1108-001-0 Benefit Details |
Rockdale | $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 | |||||
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 Silver Rx (Regional PPO SNP) - R9896-008-0 Benefit Details |
Rockdale | $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 | |||||
Advantra Silver Plus (HMO-POS) - H5302-006-0 Benefit Details |
Rockdale | $38.00 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $40.00 Tier 3: $75.00 Tier 4: 33% | $4,200 Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (PPO) - H6528-006-0 Benefit Details |
Rockdale | $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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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 Premier (PPO) - H9947-002-0 Benefit Details |
Rockdale | $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 | |||||||||
HumanaChoice H5214-003 (PPO) - H5214-003-0 Benefit Details |
Rockdale | $42.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $42.00 Tier 3: $85.00 Tier 4: 33% | $4,900 Browse Formulary | |||||
WindsorSterling Gold Plus Plan (PPO) - H9988-002-0 Benefit Details |
Rockdale | $55.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $16.00 Tier 3: $36.00 Tier 4: $90.00 Tier 5: 30% | $4,000 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 Medicare Advantage (Regional PPO) - R9896-012-0 Benefit Details |
Rockdale | $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 | |||||
Humana Gold Choice H8145-079 (PFFS) - H8145-079-0 Benefit Details |
Rockdale | $70.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $42.00 Tier 3: $85.00 Tier 4: 33% | $5,900 Browse Formulary | |||||
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HumanaChoice R5826-077 (Regional PPO) - R5826-077-0 Benefit Details |
Rockdale | $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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