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 SecureHorizons (HMO) - H3749-001-0 Benefit Details |
Pottawatomie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $44.00 Tier 4: $88.00 Tier 5: 33% | $4,900 Browse Formulary | |||||
Generations Healthcare Classic (HMO) - H3706-001-0 Benefit Details |
Pottawatomie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,000 Browse Formulary | |||||
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Generations Healthcare Value (HMO) - H3706-009-0 Benefit Details |
Pottawatomie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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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 Choice H8145-120 (PFFS) - H8145-120-0 Benefit Details |
Pottawatomie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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HumanaChoice R5826-069 (Regional PPO) - R5826-069-0 Benefit Details |
Pottawatomie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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WindsorSterling Emerald Connect Plan (PFFS) - H3410-004-15 Benefit Details |
Pottawatomie | $28.50 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $33.00 Tier 4: $87.00 Tier 5: 29% | $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 | |||||||||
HumanaChoice H8644-005 (PPO) - H8644-005-0 Benefit Details |
Pottawatomie | $29.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $5,000 Browse Formulary | |||||
WindsorSterling Silver Connect Plan (PFFS) - H3410-002-15 Benefit Details |
Pottawatomie | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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Today's Options Premier 400 (PFFS) - H6169-016-0 Benefit Details |
Pottawatomie | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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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 | |||||||||
HumanaChoice H8644-003 (PPO) - H8644-003-0 Benefit Details |
Pottawatomie | $49.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
WindsorSterling Gold Connect Plan (PFFS) - H3410-003-15 Benefit Details |
Pottawatomie | $60.00 | $50 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $15.00 Tier 3: $34.00 Tier 4: $84.00 Tier 5: 30% | $4,000 Browse Formulary | |||||
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Today's Options Premier 200 (PFFS) - H6169-053-0 Benefit Details |
Pottawatomie | $85.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,250 | ||||||
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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 | |||||||||
Generations Healthcare Premier (HMO) - H3706-017-0 Benefit Details |
Pottawatomie | $86.00 | $0 | Many Generics, Some Brands | Tier 1: tbd | $2,500 Browse Formulary | |||||
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Today's Options Premier Plus 450D (PFFS) - H6169-036-0 Benefit Details |
Pottawatomie | $101.00 | $50 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
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Humana Gold Choice H8145-001 (PFFS) - H8145-001-0 Benefit Details |
Pottawatomie | $156.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $42.00 Tier 3: $80.00 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 | |||||||||
Today's Options Premier Plus 250A (PFFS) - H6169-057-0 Benefit Details |
Pottawatomie | $157.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
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HumanaChoice R5826-013 (Regional PPO) - R5826-013-0 Benefit Details |
Pottawatomie | $161.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,400 Browse Formulary | |||||
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