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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Advantra Elite (PPO) - H8980-003-0 Benefit Details |
Columbiana | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $25.00 Tier 3: $40.00 Tier 4: $85.00 Tier 5: 33% | $6,475 Browse Formulary | |||||
Advantra Silver (PPO) - H8980-002-0 Benefit Details |
Columbiana | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $25.00 Tier 3: $41.00 Tier 4: $80.00 Tier 5: 33% | $4,900 Browse Formulary | |||||
Anthem Senior Advantage Basic (HMO) - H3655-013-0 Benefit Details |
Columbiana | $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 | |||||
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 Value (HMO) - H3655-031-0 Benefit Details |
Columbiana | $0.00 | $60 | Many Generics | Tier 1: $0.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $0.00 | $3,400 Browse Formulary | |||||
Blue Medicare Access Classic (Regional PPO) - R5941-007-0 Benefit Details |
Columbiana | $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 |
Columbiana | $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 | |||||||||
HumanaChoice R5826-021 (Regional PPO) - R5826-021-0 Benefit Details |
Columbiana | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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PrimeTime Health Plan Basic - MA Only (HMO-POS) - H3664-014-0 Benefit Details |
Columbiana | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
SecureCare - Option I (HMO) - H3672-014-0 Benefit Details |
Columbiana | $0.00 | 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 | |||||||||
SummaCare Secure Classic (HMO-POS) - H3660-043-0 Benefit Details |
Columbiana | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
SummaCare Secure Core (HMO) - H3660-044-0 Benefit Details |
Columbiana | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $90.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H3619-014 (PPO) - H3619-014-0 Benefit Details |
Columbiana | $18.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $43.00 Tier 3: $86.00 Tier 4: 33% | $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 | |||||||||
SecureChoice - Option I (PPO) - H8604-002-0 Benefit Details |
Columbiana | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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CareSource Advantage (HMO SNP) - H6178-001-0 Benefit Details |
Columbiana | $ 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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SummaCare Secure Silver (HMO-POS) - H3660-029-0 Benefit Details |
Columbiana | $30.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $8.00 Tier 3: $45.00 Tier 4: $85.00 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 | |||||||||
Anthem Senior Advantage Plus (HMO) - H3655-030-0 Benefit Details |
Columbiana | $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 | |||||
PrimeTime Health Plan Basic-Select (HMO-POS) - H3664-018-0 Benefit Details |
Columbiana | $35.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $45.00 Tier 3: $77.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Anthem Medicare Preferred Standard (PPO) - H5529-001-0 Benefit Details |
Columbiana | $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 | |||||
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 H8145-135 (PFFS) - H8145-135-0 Benefit Details |
Columbiana | $39.00 | 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 |
Columbiana | $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 | |||||
PrimeTime Health Plan Plus (HMO-POS) - H3664-017-0 Benefit Details |
Columbiana | $63.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $75.00 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 | |||||||||
SecureCare - Option II (HMO) - H3672-013-0 Benefit Details |
Columbiana | $71.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $95.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice R5826-007 (Regional PPO) - R5826-007-0 Benefit Details |
Columbiana | $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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Humana Gold Choice H8145-033 (PFFS) - H8145-033-0 Benefit Details |
Columbiana | $89.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $42.00 Tier 3: $86.00 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 | |||||||||
SecureChoice - Option II (PPO) - H8604-001-0 Benefit Details |
Columbiana | $111.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $95.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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SecureCare - Option III (HMO) - H3672-016-0 Benefit Details |
Columbiana | $112.00 | $0 | Many Generics | Tier 1: $3.00 Tier 2: $35.00 Tier 3: $95.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
SummaCare Secure Gold (HMO-POS) - H3660-028-0 Benefit Details |
Columbiana | $120.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $8.00 Tier 3: $45.00 Tier 4: $85.00 Tier 5: 33% | $3,000 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 | |||||||||
PrimeTime Health Plan Prime PPO (PPO) - H3620-001-0 Benefit Details |
Columbiana | $121.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $45.00 Tier 3: $80.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
PrimeTime Health Plan Premier (HMO-POS) - H3664-012-0 Benefit Details |
Columbiana | $130.00 | $0 | All Generics | Tier 1: $6.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
SecureChoice - Option III (PPO) - H8604-005-0 Benefit Details |
Columbiana | $137.00 | $0 | Many Generics | Tier 1: $3.00 Tier 2: $35.00 Tier 3: $95.00 Tier 4: 33% | $3,400 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 | |||||||||
SummaCare Secure Platinum (HMO-POS) - H3660-032-0 Benefit Details |
Columbiana | $278.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $8.00 Tier 3: $45.00 Tier 4: $85.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
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