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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PacificSource Medicare Explorer 6 (PPO) - H4754-006-0 Benefit Details |
Jerome | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
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UnitedHealthcare MedicareDirect Essential (PFFS) - H5435-001-0 Benefit Details |
Jerome | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,200 | ||||||
Today's Options Premier 400 (PFFS) - H5421-047-0 Benefit Details |
Jerome | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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 (HMO) - H1350-006-0 Benefit Details |
Jerome | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
UnitedHealthcare MedicareDirect Rx (PFFS) - H5435-014-0 Benefit Details |
Jerome | $28.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $93.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
PacificSource Medicare Explorer Rx 2 (PPO) - H4754-002-0 Benefit Details |
Jerome | $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 | |||||||||
Secure Blue (PPO) - H1302-004-0 Benefit Details |
Jerome | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
WindsorSterling Silver Access Plan (PFFS) - H5006-018-11 Benefit Details |
Jerome | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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Secure Blue (PPO) - H1302-001-0 Benefit Details |
Jerome | $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 | |||||
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) - H5421-207-0 Benefit Details |
Jerome | $60.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,250 | ||||||
Today's Options Premier Plus 450B (PFFS) - H5421-065-0 Benefit Details |
Jerome | $60.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
WindsorSterling Gold Access Plan (PFFS) - H5006-017-11 Benefit Details |
Jerome | $75.00 | $50 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $15.00 Tier 3: $34.00 Tier 4: $84.00 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 | |||||||||
True Blue Rx Option II (HMO) - H1350-010-0 Benefit Details |
Jerome | $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 | |||||
Today's Options Premier Plus 250A (PFFS) - H5421-213-0 Benefit Details |
Jerome | $119.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
True Blue Rx Option I (HMO) - H1350-001-0 Benefit Details |
Jerome | $135.00 | $0 | Many Generics | Tier 1: $6.00 Tier 2: $31.00 Tier 3: $41.00 Tier 4: 25% | $3,000 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 |
Jerome | $ 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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