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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BlueValue Basic (HMO) - H5422-006-0 Benefit Details |
Talbot | $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 (Regional PPO SNP) - R9896-009-0 Benefit Details |
Talbot | $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 |
Talbot | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 | ||||||
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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 Core (PPO) - H9947-001-0 Benefit Details |
Talbot | $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 | |||||
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Medicare Preferred Online (PPO) - H9947-003-0 Benefit Details |
Talbot | $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 | |||||
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Southeast Community Care - Plus (HMO) - H5578-013-0 Benefit Details |
Talbot | $0.00 | $0 | Some Generics | Tier 1: tbd | $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 | |||||||||
Humana Gold Choice H8145-117 (PFFS) - H8145-117-0 Benefit Details |
Talbot | $15.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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BlueValue Secure (HMO) - H5422-002-0 Benefit Details |
Talbot | $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 | |||||
HumanaChoice H5214-009 (PPO) - H5214-009-0 Benefit Details |
Talbot | $28.00 | $0 | Few Generics, Few Brands | Tier 1: $5.00 Tier 2: $44.00 Tier 3: $85.00 Tier 4: 33% | $3,900 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 | |||||||||
Southeast Community Care - Dual Plus (HMO SNP) - H5578-007-0 Benefit Details |
Talbot | $ 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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Care Improvement Plus Silver Rx (Regional PPO SNP) - R9896-008-0 Benefit Details |
Talbot | $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 | |||||
Medicare Preferred Premier (PPO) - H9947-002-0 Benefit Details |
Talbot | $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 | |||||||||
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 |
Talbot | $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 |
Talbot | $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 |
Talbot | $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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