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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Fallon Senior Plan Saver (HMO) - H9001-026-0 Benefit Details |
Hampden | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Fallon Senior Plan Super Saver Rx (HMO) - H9001-028-0 Benefit Details |
Hampden | $0.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $20.00 Tier 3: $55.00 Tier 4: 25% | $3,400 Browse Formulary | |||||
Tufts Medicare Preferred HMO Basic (HMO) - H2256-027-2 Benefit Details |
Hampden | $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 | |||||||||
HNE Medicare Basic No Rx (HMO) - H8578-009-0 Benefit Details |
Hampden | $4.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Fallon Senior Plan Saver Rx (HMO) - H9001-020-0 Benefit Details |
Hampden | $6.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $20.00 Tier 3: $55.00 Tier 4: 25% | $3,400 Browse Formulary | |||||
Fallon Senior Plan Saver Enhanced Rx (HMO) - H9001-021-0 Benefit Details |
Hampden | $17.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $20.00 Tier 3: $55.00 | $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 Choice (Regional PPO) - R7444-001-0 Benefit Details |
Hampden | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $8.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
UnitedHealthcare Senior Care Options (HMO SNP) - H2226-001-0 Benefit Details |
Hampden | $ 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: 0% Tier 2: 0% | n/a Browse Formulary | |||||
Tufts Medicare Preferred HMO Value (HMO) - H2256-019-8 Benefit Details |
Hampden | $24.00 | 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 | |||||||||
Fallon Senior Plan Standard (HMO) - H9001-022-0 Benefit Details |
Hampden | $27.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Tufts Medicare Preferred HMO Basic Rx (HMO) - H2256-026-2 Benefit Details |
Hampden | $27.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $43.00 Tier 3: $93.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Senior Care Options Program (HMO SNP) - H2225-001-0 Benefit Details |
Hampden | $ 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: 0% Tier 2: 0% | 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 Nursing Home Plan (PPO SNP) - H2228-001-0 Benefit Details |
Hampden | $32.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
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NaviCare (HMO SNP) - H9001-019-0 Benefit Details |
Hampden | $ 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% | n/a Browse Formulary | |||||
HNE Medicare Basic (HMO) - H8578-007-0 Benefit Details |
Hampden | $50.00 | $0 | All Generics | Tier 1: $10.00 Tier 2: $35.00 Tier 3: $65.00 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 | |||||||||
Tufts Medicare Preferred HMO Value Rx (HMO) - H2256-018-8 Benefit Details |
Hampden | $51.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $43.00 Tier 3: $93.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Tufts Medicare Preferred HMO Prime (HMO) - H2256-016-6 Benefit Details |
Hampden | $54.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HNE Medicare Premium No Rx (HMO) - H8578-003-0 Benefit Details |
Hampden | $68.00 | 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 | |||||||||
Fallon Senior Plan Standard Enhanced Rx (HMO) - H9001-024-0 Benefit Details |
Hampden | $69.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $20.00 Tier 3: $55.00 | $3,400 Browse Formulary | |||||
HNE Medicare Plus (HMO) - H8578-004-0 Benefit Details |
Hampden | $78.00 | $0 | All Generics | Tier 1: $10.00 Tier 2: $35.00 Tier 3: $65.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Tufts Medicare Preferred HMO Prime Rx (HMO) - H2256-015-6 Benefit Details |
Hampden | $81.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 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 | |||||||||
Medicare HMO Blue ValueRx (HMO) - H2261-019-0 Benefit Details |
Hampden | $87.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $14.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 29% | $3,400 Browse Formulary | |||||
Fallon Senior Plan Plus Enhanced Rx (HMO) - H9001-025-0 Benefit Details |
Hampden | $92.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $20.00 Tier 3: $55.00 | $3,400 Browse Formulary | |||||
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) - H2256-001-6 Benefit Details |
Hampden | $112.40 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $35.00 Tier 3: $75.00 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 | |||||||||
HNE Medicare Premium (HMO) - H8578-001-0 Benefit Details |
Hampden | $134.00 | $0 | All Generics | Tier 1: $10.00 Tier 2: $35.00 Tier 3: $65.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Medicare PPO Blue PlusRx (PPO) - H2230-002-0 Benefit Details |
Hampden | $134.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $14.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 29% | $3,400 Browse Formulary | |||||
HNE Medicare Freedom (HMO-POS) - H8578-010-0 Benefit Details |
Hampden | $149.00 | $0 | All Generics | Tier 1: $10.00 Tier 2: $35.00 Tier 3: $65.00 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 | |||||||||
Medicare HMO Blue PlusRx (HMO) - H2261-005-0 Benefit Details |
Hampden | $181.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $14.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 29% | $3,400 Browse Formulary | |||||
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