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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Any, Any, Any Gold (PFFS) - H5820-002-0 Benefit Details |
Storey | $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 | |||||
Any, Any, Any Gold MA Only (PFFS) - H5820-026-0 Benefit Details |
Storey | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Sierra Nevada Spectrum (Regional PPO) - R5674-001-0 Benefit Details |
Storey | $0.00 | $0 | Many Generics, Few Brands | Tier 1: tbd | $4,500 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 | |||||||||
Senior Care Plus: Freedom Rx Plan (PPO) - H2906-006-0 Benefit Details |
Storey | $37.00 | $0 | All Generics | Tier 1: $4.00 Tier 2: $10.00 Tier 3: $40.00 Tier 4: $70.00 Tier 5: 33% Tier 6: $20.00 | $3,400 Browse Formulary | |||||
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Today's Options Premier 400 (PFFS) - H5421-056-0 Benefit Details |
Storey | $75.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Today's Options Premier Plus 450E (PFFS) - H5421-074-0 Benefit Details |
Storey | $108.00 | $65 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $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 | |||||||||
Today's Options Premier 200 (PFFS) - H5421-210-0 Benefit Details |
Storey | $110.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,250 | ||||||
Senior Care Plus: Freedom Rx Select Plan (PPO) - H2906-005-0 Benefit Details |
Storey | $137.00 | $0 | All Generics | Tier 1: $2.00 Tier 2: $6.00 Tier 3: $40.00 Tier 4: $70.00 Tier 5: 33% Tier 6: $15.00 | $3,000 Browse Formulary | |||||
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Today's Options Premier Plus 250A (PFFS) - H5421-068-0 Benefit Details |
Storey | $165.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 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 H2944-053 (PFFS) - H2944-053-0 Benefit Details |
Storey | $171.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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