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 |
|||||||||
ActiveSaver MSA (MSA) - H9788-003-0 Benefit Details |
Monroe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
GoldValue Rx (HMO-POS) - H3305-015-0 Benefit Details |
Monroe | $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 | |||||
Preferred Gold (HMO-POS) - H3305-007-0 Benefit Details |
Monroe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,800 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UnitedHealthcare MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Monroe | $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 |
Monroe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 | ||||||
WellCare Advance (HMO) - H3361-059-0 Benefit Details |
Monroe | $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 | |||||||||
WellCare Choice (HMO-POS) - H3361-129-0 Benefit Details |
Monroe | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $39.00 Tier 3: $79.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
-- | |||||||||||
WellCare Value (HMO-POS) - H3361-099-0 Benefit Details |
Monroe | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $39.00 Tier 3: $79.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
-- | |||||||||||
Medicare Blue Choice Value (HMO) - H3351-011-0 Benefit Details |
Monroe | $20.00 | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
UnitedHealthcare Dual Complete RP (Regional PPO SNP) - R5342-003-0 Benefit Details |
Monroe | $ 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 Liberty (HMO SNP) - H3361-098-0 Benefit Details |
Monroe | $ 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 | |||||
-- | |||||||||||
WellCare Access (HMO SNP) - H3361-065-0 Benefit Details |
Monroe | $ 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: $45.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
UnitedHealthcare Nursing Home Plan (HMO SNP) - H3379-022-0 Benefit Details |
Monroe | $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 | |||||
Today's Options Premier 400 (PFFS) - H2816-010-0 Benefit Details |
Monroe | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
-- | -- | -- | |||||||||
Medicare Blue Choice Value Plus (HMO) - H3351-013-0 Benefit Details |
Monroe | $74.00 | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Medicare Blue PPO Plan 201 (PPO) - H3335-032-0 Benefit Details |
Monroe | $74.00 | $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 | |||||
Blue Choice Senior (Cost) - H3356-001-0 Benefit Details |
Monroe | $85.60 | $275 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $75.00 Tier 4: 25% | n/a Browse Formulary | |||||
-- | |||||||||||
Today's Options Premier Plus 450G (PFFS) - H2816-022-0 Benefit Details |
Monroe | $95.00 | $90 | 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Medicare Blue Choice Platinum (HMO-POS) - H3351-007-0 Benefit Details |
Monroe | $96.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Preferred Gold Rx (HMO-POS) - H3305-011-0 Benefit Details |
Monroe | $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 | |||||
Today's Options Premier 100 (PFFS) - H2816-026-0 Benefit Details |
Monroe | $110.00 | 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Medicare Blue Choice Optimum (HMO-POS) - H3351-006-0 Benefit Details |
Monroe | $137.00 | $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 | |||||
Today's Options Premier Plus 150A (PFFS) - H2816-028-0 Benefit Details |
Monroe | $152.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
-- | -- | -- | |||||||||
GoldAnywhere Rx (PPO) - H3346-002-0 Benefit Details |
Monroe | $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 | |||||
|