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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BlueSaver MSA (MSA) - H9788-001-0 Benefit Details |
Genesee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
BlueCross BlueShield Senior Blue HMO 601 (HMO) - H3384-022-0 Benefit Details |
Genesee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
BlueCross BlueShield Senior Blue HMO 651 PartD (HMO) - H3384-019-0 Benefit Details |
Genesee | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $5.00 Tier 3: $40.00 Tier 4: 50% Tier 5: 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 | |||||||||
GoldValue Rx (HMO-POS) - H3305-015-0 Benefit Details |
Genesee | $0.00 | $0 | Few Generics | Tier 1: $8.00 Tier 2: $35.00 Tier 3: $90.00 Tier 4: 33% Tier 5: $0.00 | $4,600 Browse Formulary | |||||
Independent Health Encompass 65 (HMO) - H3362-016-0 Benefit Details |
Genesee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Independent Health Encompass 65 Basic (HMO) - H3362-017-0 Benefit Details |
Genesee | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $0.00 Tier 2: $4.00 Tier 3: $45.00 Tier 4: $75.00 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 | |||||||||
Independent Health Medicare Passport Basic (PPO) - H3344-006-0 Benefit Details |
Genesee | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $0.00 Tier 2: $4.00 Tier 3: $45.00 Tier 4: $75.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Preferred Gold (HMO-POS) - H3305-007-0 Benefit Details |
Genesee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,800 | ||||||
SeniorChoice Value (HMO) - H3351-010-0 Benefit Details |
Genesee | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $90.00 Tier 4: 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 300 (PFFS) - H2816-007-0 Benefit Details |
Genesee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,400 | ||||||
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UnitedHealthcare MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Genesee | $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: $95.00 Tier 5: 33% | $4,900 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) - R5342-002-0 Benefit Details |
Genesee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 | ||||||
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 100 (PFFS) - H2816-001-0 Benefit Details |
Genesee | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Today's Options Premier Plus 350B (PFFS) - H2816-019-0 Benefit Details |
Genesee | $21.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $4,400 Browse Formulary | |||||
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UnitedHealthcare Dual Complete RP (Regional PPO SNP) - R5342-003-0 Benefit Details |
Genesee | $ 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 | |||||||||
Independent Health Medicare Family Choice (HMO SNP) - H3362-020-0 Benefit Details |
Genesee | $37.00 | $320 | Few Generics, Few Brands | Tier 1: $0.00 Tier 2: $4.00 Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
Independent Health Encompass 65 (HMO) - H3362-003-0 Benefit Details |
Genesee | $39.80 | $0 | Few Generics, Few Brands | Tier 1: $0.00 Tier 2: $4.00 Tier 3: $45.00 Tier 4: $75.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
UnitedHealthcare Nursing Home Plan (HMO SNP) - H3379-022-0 Benefit Details |
Genesee | $39.80 | $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 | |||||||||
BlueCross BlueShield Forever Blue Medicare PPO 701 (PPO) - H5526-002-0 Benefit Details |
Genesee | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
SeniorChoice Value Plus (HMO) - H3351-012-0 Benefit Details |
Genesee | $40.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $90.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Univera Medicare PPO Plan 102 (PPO) - H3335-002-0 Benefit Details |
Genesee | $40.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $90.00 Tier 4: 33% | $4,000 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 | |||||||||
Independent Health Medicare Passport Advantage (PPO) - H3344-005-0 Benefit Details |
Genesee | $65.00 | $0 | Few Generics, Few Brands | Tier 1: $0.00 Tier 2: $4.00 Tier 3: $42.00 Tier 4: $75.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Today's Options Premier Plus 150A (PFFS) - H2816-013-0 Benefit Details |
Genesee | $72.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
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SeniorChoice Select (HMO-POS) - H3351-001-0 Benefit Details |
Genesee | $80.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | |||||||||
BlueCross BlueShield Senior Blue HMO 653 PartD (HMO) - H3384-041-0 Benefit Details |
Genesee | $95.00 | $0 | Some Generics | Tier 1: $0.00 Tier 2: $5.00 Tier 3: $40.00 Tier 4: 50% Tier 5: 30% | $3,400 Browse Formulary | |||||
Preferred Gold Rx (HMO-POS) - H3305-011-0 Benefit Details |
Genesee | $102.50 | $0 | Few Generics | Tier 1: $8.00 Tier 2: $35.00 Tier 3: $90.00 Tier 4: 33% Tier 5: $0.00 | $3,800 Browse Formulary | |||||
BlueCross BlueShield Forever Blue Medicare PPO 751 (PPO) - H5526-004-0 Benefit Details |
Genesee | $111.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $7.50 Tier 3: $45.00 Tier 4: 50% Tier 5: 30% | $5,100 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 | |||||||||
SeniorChoice Secure (HMO-POS) - H3351-002-0 Benefit Details |
Genesee | $114.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $90.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Independent Health Medicare Passport Premier (PPO) - H3344-003-0 Benefit Details |
Genesee | $173.00 | $0 | Few Generics, Few Brands | Tier 1: $0.00 Tier 2: $4.00 Tier 3: $40.00 Tier 4: $70.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
GoldAnywhere Rx (PPO) - H3346-002-0 Benefit Details |
Genesee | $254.90 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $90.00 Tier 4: 33% Tier 5: $0.00 | $2,000 Browse Formulary | |||||
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