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) - H3107-004-0 Benefit Details |
Passaic | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $44.00 Tier 4: $88.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
AARP MedicareComplete Plus Essential (HMO-POS) - H3107-008-0 Benefit Details |
Passaic | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Aetna Medicare Basic Plan (HMO) - H3152-045-0 Benefit Details |
Passaic | $0.00 | 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 | |||||||||
Aetna Medicare Value Plan (HMO) - H3152-046-0 Benefit Details |
Passaic | $0.00 | $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 | |||||
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Healthfirst NJ Coordinated Benefits Plan (HMO) - H7015-003-0 Benefit Details |
Passaic | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Healthfirst NJ Medicare Plus Plan (HMO) - H7015-001-0 Benefit Details |
Passaic | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $60.00 Tier 4: 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 | |||||||||
Horizon Medicare Blue Value (HMO) - H3154-013-0 Benefit Details |
Passaic | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Horizon Medicare Blue Value w/ Rx Std (HMO) - H3154-004-0 Benefit Details |
Passaic | $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 | |||||
WellCare Value (HMO) - H0913-002-0 Benefit Details |
Passaic | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $35.00 Tier 3: $65.00 Tier 4: 33% | $5,000 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 (HMO SNP) - H3113-001-0 Benefit Details |
Passaic | $35.00 | $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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Healthfirst NJ Increased Benefits Plan (HMO) - H7015-002-0 Benefit Details |
Passaic | $36.00 | $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 | |||||
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Healthfirst NJ Maximum Plan (HMO SNP) - H7015-004-0 Benefit Details |
Passaic | $ 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 | |||||
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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 | |||||||||
Horizon Medicare Blue TotalCare (HMO SNP) - H3154-020-0 Benefit Details |
Passaic | $ 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 | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H3164-003-0 Benefit Details |
Passaic | $ 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 | |||||
WellCare Access (HMO SNP) - H0913-003-0 Benefit Details |
Passaic | $ 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: $44.00 Tier 3: $95.00 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 | |||||||||
Horizon Medicare Blue Access (HMO-POS) - H3154-005-0 Benefit Details |
Passaic | $56.80 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Aetna Medicare Standard Plan (PPO) - H5521-037-0 Benefit Details |
Passaic | $75.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $28.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
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Horizon Medicare Blue Value w/ Rx Enhanced (HMO) - H3154-016-0 Benefit Details |
Passaic | $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 |
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Service | Exper. | Cost Info | |||||||||
Horizon Medicare Blue Access w/ Rx Std (HMO-POS) - H3154-012-0 Benefit Details |
Passaic | $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 | |||||
Aetna Medicare Premier Plan (HMO) - H3152-048-0 Benefit Details |
Passaic | $125.00 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
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Horizon Medicare Blue Access w/Rx Enhanced (HMO-POS) - H3154-006-0 Benefit Details |
Passaic | $149.50 | $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 |
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Service | Exper. | Cost Info | |||||||||
Aetna Medicare Premier Plan (PPO) - H5521-038-0 Benefit Details |
Passaic | $156.00 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
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