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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Blue Medicare Access Value (Regional PPO) - R5941-009-0 Benefit Details |
Blackford | $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 | $4,200 Browse Formulary | |||||
HumanaChoice R5826-066 (Regional PPO) - R5826-066-0 Benefit Details |
Blackford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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IU Health Plans Medicare Select (HMO) - H7220-002-0 Benefit Details |
Blackford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
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 | |||||||||
Blue Medicare Access Standard (Regional PPO) - R5941-003-0 Benefit Details |
Blackford | $43.00 | $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 | $3,400 Browse Formulary | |||||
IU Health Plans Medicare Select Plus (HMO) - H7220-003-0 Benefit Details |
Blackford | $63.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.50 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $5,000 Browse Formulary | |||||
HumanaChoice R5826-008 (Regional PPO) - R5826-008-0 Benefit Details |
Blackford | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $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 | |||||||||
Today's Options Premier 400 (PFFS) - H6169-015-0 Benefit Details |
Blackford | $84.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Today's Options Premier 200 (PFFS) - H6169-052-0 Benefit Details |
Blackford | $120.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,250 | ||||||
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Today's Options Premier Plus 450C (PFFS) - H6169-035-0 Benefit Details |
Blackford | $121.00 | $35 | 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 | |||||||||
IU Health Plans Medicare Choice (HMO-POS) - H7220-004-0 Benefit Details |
Blackford | $122.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $85.00 Tier 4: 30% | $4,500 Browse Formulary | |||||
Humana Gold Choice H8145-012 (PFFS) - H8145-012-0 Benefit Details |
Blackford | $169.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $40.00 Tier 3: $82.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
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Today's Options Premier Plus 250A (PFFS) - H6169-056-0 Benefit Details |
Blackford | $187.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
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