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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Amerivantage Choice + Rx (HMO-POS) - H5746-012-0 Benefit Details |
Bernalillo | $0.00 | $0 | Some Generics | Tier 1: $0.00 Tier 2: $5.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
Care Improvement Plus Gold Rx (PPO SNP) - H0084-019-0 Benefit Details |
Bernalillo | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | n/a Browse Formulary | |||||
Humana Gold Choice H8145-131 (PFFS) - H8145-131-0 Benefit Details |
Bernalillo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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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 | |||||||||
Humana Gold Plus H3028-001 (HMO) - H3028-001-0 Benefit Details |
Bernalillo | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $4.00 Tier 2: $25.00 Tier 3: $50.00 Tier 4: 33% | $2,900 Browse Formulary | |||||
HumanaChoice H6411-008 (PPO) - H6411-008-0 Benefit Details |
Bernalillo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Lovelace Medicare Plan - Medical Only (HMO) - H3251-023-0 Benefit Details |
Bernalillo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,800 | ||||||
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 | |||||||||
Lovelace Medicare Plan -- Standard Plan (HMO) - H3251-002-0 Benefit Details |
Bernalillo | $0.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $36.00 Tier 3: $70.00 Tier 4: 33% | $2,500 Browse Formulary | |||||
Presbyterian Senior Care Plan 1 (HMO) - H3204-008-0 Benefit Details |
Bernalillo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Presbyterian Senior Care Plan 2 with Rx (HMO) - H3204-001-0 Benefit Details |
Bernalillo | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $75.00 Tier 4: 30% | $3,000 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 | |||||||||
HumanaChoice H6411-007 (PPO) - H6411-007-0 Benefit Details |
Bernalillo | $16.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $75.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Molina Medicare Options (HMO) - H9082-002-0 Benefit Details |
Bernalillo | $16.00 | $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% | $2,800 Browse Formulary | |||||
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UnitedHealthcare Nursing Home Plan (PPO SNP) - H3209-001-0 Benefit Details |
Bernalillo | $20.50 | $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 | |||||
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 | |||||||||
Amerivantage Specialty + Rx (HMO SNP) - H5746-006-0 Benefit Details |
Bernalillo | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Many Generics | Tier 1: $0.00 Tier 2: $0.00 Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
Care Improvement Plus Silver Rx (PPO SNP) - H0084-018-0 Benefit Details |
Bernalillo | $21.30 | $215 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 27% | n/a Browse Formulary | |||||
UnitedHealthcare Dual Complete (PPO SNP) - H3209-002-0 Benefit Details |
Bernalillo | $ 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 Choice H8145-078 (PFFS) - H8145-078-0 Benefit Details |
Bernalillo | $38.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
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Presbyterian MediCare PPO Plan 1 (PPO) - H3206-003-0 Benefit Details |
Bernalillo | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
Care Improvement Plus Medicare Advantage (PPO) - H0084-021-0 Benefit Details |
Bernalillo | $53.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $43.00 Tier 3: $95.00 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 | |||||||||
Lovelace Medicare Plan -- Enhanced Plan (HMO-POS) - H3251-021-0 Benefit Details |
Bernalillo | $55.30 | $0 | Many Generics | Tier 1: $7.00 Tier 2: $36.00 Tier 3: $70.00 Tier 4: 33% | $3,350 Browse Formulary | |||||
Presbyterian Senior Care Plan 3 with Rx (HMO) - H3204-007-0 Benefit Details |
Bernalillo | $59.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $75.00 Tier 4: 30% | $2,500 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) - H3206-001-0 Benefit Details |
Bernalillo | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $75.00 Tier 4: 30% | $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 | |||||||||
Presbyterian MediCare PPO Plan 3 with Rx (PPO) - H3206-002-0 Benefit Details |
Bernalillo | $107.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $75.00 Tier 4: 30% | $3,000 Browse Formulary | |||||
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