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 Plus Plan 1 (HMO-POS) - H4456-025-0 Benefit Details |
Polk | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $7.00 Tier 3: $45.00 Tier 4: $92.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Advantra Platinum (PPO) - H1608-001-0 Benefit Details |
Polk | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,300 Browse Formulary | |||||
Advantra Silver (HMO) - H1609-001-0 Benefit Details |
Polk | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,300 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 Gold Rx (PPO SNP) - H0084-011-0 Benefit Details |
Polk | $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 H5868-004 (PPO) - H5868-004-0 Benefit Details |
Polk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Today's Options Premier 400 (PFFS) - H6169-011-0 Benefit Details |
Polk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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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 200 (PFFS) - H6169-001-0 Benefit Details |
Polk | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,250 | ||||||
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HumanaChoice H5868-001 (PPO) - H5868-001-0 Benefit Details |
Polk | $21.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $42.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Today's Options Premier Plus 450B (PFFS) - H6169-031-0 Benefit Details |
Polk | $27.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $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 | |||||||||
UnitedHealthcare Dual Complete (HMO-POS SNP) - H2803-012-0 Benefit Details |
Polk | $ 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 | |||||
Care Improvement Plus Dual Advantage (PPO SNP) - H0084-012-0 Benefit Details |
Polk | $ 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 | |||||
Care Improvement Plus Silver Rx (PPO SNP) - H0084-010-0 Benefit Details |
Polk | $36.00 | $195 | 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 | |||||
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) - H0084-013-0 Benefit Details |
Polk | $53.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
Today's Options Premier Plus 250A (PFFS) - H6169-021-0 Benefit Details |
Polk | $72.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
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MedicareBlue PPO (Regional PPO) - R5566-005-0 Benefit Details |
Polk | $84.40 | $155 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $11.00 Tier 3: $33.00 Tier 4: 45% | $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 | |||||||||
AARP MedicareComplete Plan 2 (HMO) - H4456-015-0 Benefit Details |
Polk | $85.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $38.00 Tier 4: $78.00 Tier 5: 33% | $3,500 Browse Formulary | |||||
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