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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AARP MedicareComplete Essential (HMO) - H3659-054-0 Benefit Details |
Clermont | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,650 | ||||||
AARP MedicareComplete Plan 2 (HMO) - H3659-031-0 Benefit Details |
Clermont | $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% | $4,300 Browse Formulary | |||||
AARP MedicareComplete Plus (HMO-POS) - H3659-001-0 Benefit Details |
Clermont | $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% | $5,500 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 | |||||||||
Anthem Senior Advantage Basic (HMO) - H3655-013-0 Benefit Details |
Clermont | $0.00 | $60 | Many Generics | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $7.00 | $3,400 Browse Formulary | |||||
Blue Medicare Access Classic (Regional PPO) - R5941-007-0 Benefit Details |
Clermont | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
Blue Medicare Access Value (Regional PPO) - R5941-008-0 Benefit Details |
Clermont | $0.00 | $60 | Many Generics | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $7.00 | $4,800 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 Plus H8953-001 (HMO) - H8953-001-0 Benefit Details |
Clermont | $0.00 | $0 | Many Generics, Few Brands | Tier 1: $6.00 Tier 2: $43.00 Tier 3: $86.00 Tier 4: 33% | $3,750 Browse Formulary | |||||
HumanaChoice R5826-021 (Regional PPO) - R5826-021-0 Benefit Details |
Clermont | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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WellCare Value (HMO) - H0117-005-0 Benefit Details |
Clermont | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | $3,600 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 | |||||||||
Advantage by Buckeye Community Health Plan (HMO SNP) - H0908-001-0 Benefit Details |
Clermont | $ 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: tbd | n/a Browse Formulary | |||||
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Molina Medicare Options (HMO) - H0490-001-0 Benefit Details |
Clermont | $18.00 | $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% | $3,400 Browse Formulary | |||||
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Molina Medicare Options Plus (HMO SNP) - H0490-004-0 Benefit Details |
Clermont | $ 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 | |||||
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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 SNP-DE H8953-007 (HMO SNP) - H8953-007-0 Benefit Details |
Clermont | $ 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: $36.00 Tier 3: $71.00 Tier 4: 25% | n/a Browse Formulary | |||||
WellCare Access (HMO SNP) - H0117-007-0 Benefit Details |
Clermont | $ 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 | |||||
CareSource Advantage (HMO SNP) - H6178-001-0 Benefit Details |
Clermont | $ 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 | |||||
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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 | |||||||||
Anthem Senior Advantage Plus (HMO) - H3655-030-0 Benefit Details |
Clermont | $35.00 | $60 | Many Generics | Tier 1: $4.00 Tier 2: $40.00 Tier 3: $83.00 Tier 4: 33% Tier 5: 33% Tier 6: $4.00 | $3,000 Browse Formulary | |||||
Anthem Medicare Preferred Standard (PPO) - H5529-001-0 Benefit Details |
Clermont | $39.00 | $60 | Many Generics | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $7.00 | $4,500 Browse Formulary | |||||
HumanaChoice H3619-001 (PPO) - H3619-001-0 Benefit Details |
Clermont | $42.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $86.00 Tier 4: 33% | $4,700 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 400 (PFFS) - H6169-013-0 Benefit Details |
Clermont | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Anthem Medicare Preferred Select (PPO) - H5529-004-0 Benefit Details |
Clermont | $59.00 | $60 | Many Generics | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $7.00 | $3,400 Browse Formulary | |||||
HumanaChoice R5826-007 (Regional PPO) - R5826-007-0 Benefit Details |
Clermont | $74.00 | $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 | |||||
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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 | |||||||||
Today's Options Premier 200 (PFFS) - H6169-051-0 Benefit Details |
Clermont | $80.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,250 | ||||||
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Today's Options Premier Plus 450C (PFFS) - H6169-033-0 Benefit Details |
Clermont | $87.00 | $35 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
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Humana Gold Choice H8145-032 (PFFS) - H8145-032-0 Benefit Details |
Clermont | $89.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
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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 | |||||||||
Today's Options Premier Plus 250A (PFFS) - H6169-024-0 Benefit Details |
Clermont | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
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