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 |
Steuben | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
GoldValue Rx (HMO-POS) - H3305-015-0 Benefit Details |
Steuben | $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 | |||||
Humana Gold Choice H1291-003 (PFFS) - H1291-003-0 Benefit Details |
Steuben | $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 | |||||||||
Medicare Blue PPO Plan ONE (PPO) - H3335-037-0 Benefit Details |
Steuben | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Preferred Gold (HMO-POS) - H3305-007-0 Benefit Details |
Steuben | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,800 | ||||||
Today's Options Premier 400 (PFFS) - H2816-008-0 Benefit Details |
Steuben | $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 | |||||||||
UnitedHealthcare MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Steuben | $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 |
Steuben | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 | ||||||
HumanaChoice H5970-001 (PPO) - H5970-001-0 Benefit Details |
Steuben | $19.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $43.00 Tier 3: $85.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
UnitedHealthcare Dual Complete RP (Regional PPO SNP) - R5342-003-0 Benefit Details |
Steuben | $ 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 | |||||
Humana Gold Choice H1291-007 (PFFS) - H1291-007-0 Benefit Details |
Steuben | $31.00 | $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 | |||||
-- | -- | ||||||||||
Today's Options Premier Plus 450B (PFFS) - H2816-020-0 Benefit Details |
Steuben | $35.00 | $0 | 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 PPO Plan FOUR (PPO) - H3335-042-0 Benefit Details |
Steuben | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Humana Gold Choice H1291-001 (PFFS) - H1291-001-0 Benefit Details |
Steuben | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
-- | -- | ||||||||||
Today's Options Premier 100 (PFFS) - H2816-002-0 Benefit Details |
Steuben | $47.00 | 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 PPO Plan TWO (PPO) - H3335-008-0 Benefit Details |
Steuben | $65.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,500 Browse Formulary | |||||
Today's Options Premier Plus 150A (PFFS) - H2816-014-0 Benefit Details |
Steuben | $100.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
-- | -- | -- | |||||||||
Preferred Gold Rx (HMO-POS) - H3305-011-0 Benefit Details |
Steuben | $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 | |||||
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 THREE (PPO) - H3335-009-0 Benefit Details |
Steuben | $105.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,500 Browse Formulary | |||||
Humana Reader's Digest Healthy Living Plan (PPO) - H5970-004-0 Benefit Details |
Steuben | $119.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $86.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
GoldAnywhere Rx (PPO) - H3346-002-0 Benefit Details |
Steuben | $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 | |||||
|