2012 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
Bravo Achieve (HMO SNP) - H7281-005-0 Benefit Details |
Burlington | $0.00 | $250 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 26% Tier 6: $5.00 | n/a Browse Formulary | |||||
Bravo Classic Plus (HMO-POS) - H7281-001-0 Benefit Details |
Burlington | $0.00 | $250 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 26% | $6,700 Browse Formulary | |||||
Horizon Medicare Blue Value (HMO) - H3154-013-0 Benefit Details |
Burlington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Horizon Medicare Blue Value w/ Rx Std (HMO) - H3154-004-0 Benefit Details |
Burlington | $0.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $42.00 Tier 3: $84.00 Tier 4: 25% | $6,700 Browse Formulary | |||||
Bravo Complete (HMO) - H7281-003-0 Benefit Details |
Burlington | $35.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $6,700 Browse Formulary | |||||
Bravo Traditions (HMO SNP) - H7281-004-0 Benefit Details |
Burlington | $36.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Horizon Medicare Blue TotalCare (HMO SNP) - H3154-020-0 Benefit Details |
Burlington | $ 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 | |||||
Horizon Medicare Blue Access (HMO-POS) - H3154-005-0 Benefit Details |
Burlington | $56.80 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Horizon Medicare Blue Value w/ Rx Enhanced (HMO) - H3154-016-0 Benefit Details |
Burlington | $84.70 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $39.00 Tier 3: $78.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Bravo Premier Plus (HMO-POS) - H7281-002-0 Benefit Details |
Burlington | $89.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $8.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
Aetna Medicare Standard Plan (HMO) - H3152-022-0 Benefit Details |
Burlington | $98.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $25.00 Tier 3: $30.00 Tier 4: $75.00 Tier 5: 25% | $6,700 Browse Formulary | |||||
-- | |||||||||||
Horizon Medicare Blue Access w/ Rx Std (HMO-POS) - H3154-012-0 Benefit Details |
Burlington | $114.90 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $42.00 Tier 3: $84.00 Tier 4: 25% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Horizon Medicare Blue Access w/Rx Enhanced (HMO-POS) - H3154-006-0 Benefit Details |
Burlington | $149.50 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $39.00 Tier 3: $78.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
AmeriHealth 65 NJ Medical Only (HMO) - H3156-027-0 Benefit Details |
Burlington | $184.70 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
AmeriHealth 65 NJ Rx (HMO) - H3156-028-0 Benefit Details |
Burlington | $242.10 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $6,700 Browse Formulary | |||||
|