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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Aetna Medicare Value Plan (HMO) - H3597-001-0 Benefit Details |
Penobscot | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
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Martin's Point Generations Advantage Value (HMO) - H5591-003-0 Benefit Details |
Penobscot | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Today's Options Advantage 400 (PPO) - H2775-096-0 Benefit Details |
Penobscot | $10.00 | 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 | |||||||||
Northeast Community Care - Dual Plus (HMO SNP) - H5619-003-0 Benefit Details |
Penobscot | $ 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: tbd | n/a Browse Formulary | |||||
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Today's Options Advantage Plus 450G (PPO) - H2775-084-0 Benefit Details |
Penobscot | $36.00 | $90 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
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Northeast Community Care - Plus (HMO) - H5619-004-0 Benefit Details |
Penobscot | $45.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $4,950 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 | |||||||||
Martin's Point Generations Advantage Prime (HMO-POS) - H5591-001-0 Benefit Details |
Penobscot | $49.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $70.00 Tier 4: 30% | $2,800 Browse Formulary | |||||
Aetna Medicare Standard Plan (HMO) - H3597-002-0 Benefit Details |
Penobscot | $56.00 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
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Martin's Point Generations Advantage Select (PPO) - H1365-002-0 Benefit Details |
Penobscot | $65.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $70.00 Tier 4: 30% | $3,400 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 Advantage Plus 150A (PPO) - H2775-098-0 Benefit Details |
Penobscot | $101.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
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