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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HealthyAdvantage SMS (HMO) - H4407-011-0 Benefit Details |
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Humana Gold Choice H8145-112 (PFFS) - H8145-112-0 Benefit Details |
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Humana Gold Plus H1036-171 (HMO) - H1036-171-0 Benefit Details |
Jackson | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 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 | |||||||||
HumanaChoice R5826-068 (Regional PPO) - R5826-068-0 Benefit Details |
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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HealthyAdvantage Preferred SMS (HMO) - H4407-002-0 Benefit Details |
Jackson | $32.50 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $12.00 Tier 3: $45.00 Tier 4: $70.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Humana Gold Plus SNP-DE H1036-169 (HMO SNP) - H1036-169-0 Benefit Details |
Jackson | $ 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: $0.00 Tier 2: $36.00 Tier 3: $73.00 Tier 4: 25% | 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 | |||||||||
TotalCare SMS (HMO SNP) - H4407-004-0 Benefit Details |
Jackson | $ 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: 15% Tier 2: 15% | n/a Browse Formulary | |||||
Humana Gold Plus H1036-173 (HMO-POS) - H1036-173-0 Benefit Details |
Jackson | $35.00 | $0 | Few Generics, Few Brands | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,900 Browse Formulary | |||||
HumanaChoice R5826-078 (Regional PPO) - R5826-078-0 Benefit Details |
Jackson | $40.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,900 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 H4956-001 (PPO) - H4956-001-0 Benefit Details |
Jackson | $46.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,900 Browse Formulary | |||||
HealthyAdvantage Premier SMS (HMO-POS) - H4407-023-0 Benefit Details |
Jackson | $50.00 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $12.00 Tier 3: $45.00 Tier 4: $70.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Today's Options Premier 400 (PFFS) - H6169-013-0 Benefit Details |
Jackson | $50.00 | 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 | |||||||||
HumanaChoice R5826-011 (Regional PPO) - R5826-011-0 Benefit Details |
Jackson | $67.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
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Humana Gold Choice H8145-087 (PFFS) - H8145-087-0 Benefit Details |
Jackson | $71.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $38.00 Tier 3: $78.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
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Today's Options Premier 200 (PFFS) - H6169-051-0 Benefit Details |
Jackson | $80.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,250 | ||||||
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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 Plus 450C (PFFS) - H6169-033-0 Benefit Details |
Jackson | $87.00 | $35 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
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Today's Options Premier Plus 250A (PFFS) - H6169-024-0 Benefit Details |
Jackson | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
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