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 Choice (PPO) - H1303-001-0 Benefit Details |
Ada | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $44.00 Tier 4: $88.00 Tier 5: 33% | $3,600 Browse Formulary | |||||
Humana Gold Choice H8145-097 (PFFS) - H8145-097-0 Benefit Details |
Ada | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
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HumanaChoice H6609-012 (PPO) - H6609-012-0 Benefit Details |
Ada | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | |||||||||
PacificSource Medicare Explorer 6 (PPO) - H4754-006-0 Benefit Details |
Ada | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
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True Blue Freedom (HMO) - H1350-011-0 Benefit Details |
Ada | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $43.00 Tier 3: $93.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
PacificSource Medicare Essentials Rx 16 (HMO) - H3864-016-0 Benefit Details |
Ada | $10.00 | $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% | $2,500 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 | |||||||||
Humana Gold Plus H2012-022 (HMO) - H2012-022-0 Benefit Details |
Ada | $17.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $80.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
True Blue (HMO) - H1350-006-0 Benefit Details |
Ada | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
PacificSource Medicare Explorer Rx 2 (PPO) - H4754-002-0 Benefit Details |
Ada | $33.00 | $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% | $2,500 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 | |||||||||
HumanaChoice H6609-009 (PPO) - H6609-009-0 Benefit Details |
Ada | $38.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $80.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Secure Blue (PPO) - H1302-004-0 Benefit Details |
Ada | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Regence MedAdvantage Basic (PPO) - H1304-001-0 Benefit Details |
Ada | $54.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | |||||||||
Secure Blue (PPO) - H1302-001-0 Benefit Details |
Ada | $60.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $43.00 Tier 3: $93.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Humana Gold Choice H8145-104 (PFFS) - H8145-104-0 Benefit Details |
Ada | $62.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $80.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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Regence MedAdvantage + Rx Classic (PPO) - H1304-002-0 Benefit Details |
Ada | $99.00 | $160 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.50 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $90.00 Tier 5: 29% Tier 6: 29% | $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 | |||||||||
True Blue Rx Option II (HMO) - H1350-010-0 Benefit Details |
Ada | $116.00 | $260 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $31.00 Tier 3: $41.00 Tier 4: 25% | $3,000 Browse Formulary | |||||
True Blue Rx Option I (HMO) - H1350-001-0 Benefit Details |
Ada | $135.00 | $0 | Many Generics | Tier 1: $6.00 Tier 2: $31.00 Tier 3: $41.00 Tier 4: 25% | $3,000 Browse Formulary | |||||
Regence MedAdvantage + Rx Enhanced (PPO) - H1304-004-0 Benefit Details |
Ada | $173.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $90.00 Tier 5: 33% Tier 6: 33% | $2,500 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 | |||||||||
True Blue Special Needs Plan (HMO SNP) - H1350-009-0 Benefit Details |
Ada | $ 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: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 0% | n/a Browse Formulary | |||||
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