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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AARP MedicareComplete Plus (HMO-POS) - H3456-001-0 Benefit Details |
Davidson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $45.00 Tier 4: $92.00 Tier 5: 33% | $4,750 Browse Formulary | |||||
AARP MedicareComplete Plus Essential (HMO-POS) - H3456-020-0 Benefit Details |
Davidson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 | ||||||
Any, Any, Any Gold (PFFS) - H8098-001-0 Benefit Details |
Davidson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $85.00 Tier 5: 33% | $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 | |||||||||
Any, Any, Any Gold MA Only (PFFS) - H8098-003-0 Benefit Details |
Davidson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Blue Medicare HMO Medical Only (HMO) - H3449-012-0 Benefit Details |
Davidson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Blue Medicare HMO Standard (HMO) - H3449-013-0 Benefit Details |
Davidson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $25.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 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 | |||||||||
Humana Gold Plus H1036-138 (HMO-POS) - H1036-138-0 Benefit Details |
Davidson | $0.00 | $0 | Many Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $85.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice R5826-063 (Regional PPO) - R5826-063-0 Benefit Details |
Davidson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Universal Hassle-Free (PPO) - H5096-001-0 Benefit Details |
Davidson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $85.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
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 | |||||||||
Universal Hassle-Free MA Only (PPO) - H5096-002-0 Benefit Details |
Davidson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
Humana Gold Choice H8145-114 (PFFS) - H8145-114-0 Benefit Details |
Davidson | $15.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Blue Medicare HMO Enhanced (HMO) - H3449-005-0 Benefit Details |
Davidson | $16.40 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $20.00 Tier 3: $30.00 Tier 4: $70.00 Tier 5: 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 400 (PFFS) - H6169-012-0 Benefit Details |
Davidson | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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HumanaChoice H3405-002 (PPO) - H3405-002-0 Benefit Details |
Davidson | $27.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $42.00 Tier 3: $85.00 Tier 4: 33% | $4,900 Browse Formulary | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H3456-016-0 Benefit Details |
Davidson | $ 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 | |||||
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 | |||||||||
Humana Gold Plus SNP-DE H1036-168 (HMO SNP) - H1036-168-0 Benefit Details |
Davidson | $ 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: $67.00 Tier 4: 25% | n/a Browse Formulary | |||||
Fidelis Secure Comfort (HMO SNP) - H5575-005-0 Benefit Details |
Davidson | $33.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
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Fidelis Secure Freedom (HMO SNP) - H5575-011-0 Benefit Details |
Davidson | $33.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a 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 | |||||||||
UnitedHealthcare Nursing Home Plan (HMO SNP) - H3456-010-0 Benefit Details |
Davidson | $33.00 | $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 | |||||
Today's Options Advantage Plus 450B (PPO) - H5378-183-0 Benefit Details |
Davidson | $36.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
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Humana Gold Choice H8145-063 (PFFS) - H8145-063-0 Benefit Details |
Davidson | $42.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $41.00 Tier 3: $85.00 Tier 4: 33% | $5,500 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 | |||||||||
AARP MedicareComplete Choice (PPO) - H5516-001-0 Benefit Details |
Davidson | $45.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $5.00 Tier 3: $45.00 Tier 4: $92.00 Tier 5: 33% | $4,200 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) - H3404-001-0 Benefit Details |
Davidson | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $25.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Today's Options Premier 200 (PFFS) - H6169-050-0 Benefit Details |
Davidson | $50.00 | 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 | |||||||||
WindsorSterling Gold Plus Plan (PPO) - H9988-004-0 Benefit Details |
Davidson | $50.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $16.00 Tier 3: $36.00 Tier 4: $90.00 Tier 5: 30% | $4,000 Browse Formulary | |||||
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Today's Options Advantage Plus 250A (PPO) - H5378-199-0 Benefit Details |
Davidson | $52.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
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HumanaChoice R5826-079 (Regional PPO) - R5826-079-0 Benefit Details |
Davidson | $58.00 | $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 | |||||||||
Today's Options Premier Plus 450B (PFFS) - H6169-032-0 Benefit Details |
Davidson | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-003 (Regional PPO) - R5826-003-0 Benefit Details |
Davidson | $69.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $80.00 Tier 4: 33% | $5,900 Browse Formulary | |||||
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Fidelis Secure Comfort Plus (HMO SNP) - H5575-006-0 Benefit Details |
Davidson | $98.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $65.00 Tier 4: 33% | n/a 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 | |||||||||
Blue Medicare PPO Enhanced Freedom (PPO) - H3404-002-0 Benefit Details |
Davidson | $99.90 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $20.00 Tier 3: $30.00 Tier 4: $70.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Today's Options Premier Plus 250A (PFFS) - H6169-054-0 Benefit Details |
Davidson | $112.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
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Fidelis Secure Independence (HMO SNP) - H5575-007-0 Benefit Details |
Davidson | $120.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $65.00 Tier 4: 33% | n/a Browse Formulary | |||||
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