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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Akamai Advantage Secure (Regional PPO) - R7439-001-0 Benefit Details |
Kalawao | $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% | $3,400 Browse Formulary | |||||
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AlohaCare Advantage (HMO) - H5969-001-0 Benefit Details |
Kalawao | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $7.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Choice (Regional PPO) - R3175-001-0 Benefit Details |
Kalawao | $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% | $4,900 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 | |||||||||
UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) - R3175-002-0 Benefit Details |
Kalawao | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 | ||||||
Akamai Advantage Assured (Regional PPO) - R7439-006-0 Benefit Details |
Kalawao | $8.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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AlohaCare Advantage Plus (HMO SNP) - H5969-002-0 Benefit Details |
Kalawao | $ 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 | |||||||||
UnitedHealthcare Dual Complete RP (Regional PPO SNP) - R3175-003-0 Benefit Details |
Kalawao | $ 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 | |||||
Akamai Advantage Preferred (Regional PPO) - R7439-003-0 Benefit Details |
Kalawao | $54.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $30.00 Tier 3: $65.00 Tier 4: 25% | $3,400 Browse Formulary | |||||
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65C Plus Basic Option (Cost) - H1251-001-0 Benefit Details |
Kalawao | $90.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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 | |||||||||
65C Plus High Option (Cost) - H1251-002-0 Benefit Details |
Kalawao | $94.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
65C Plus Basic Option BRx (Cost) - H1251-003-0 Benefit Details |
Kalawao | $121.30 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $65.00 Tier 4: 25% | n/a Browse Formulary | |||||
65C Plus High Option SRx (Cost) - H1251-004-0 Benefit Details |
Kalawao | $132.90 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $30.00 Tier 3: $65.00 Tier 4: 25% | n/a Browse Formulary | |||||
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