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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Health Net Violet Option 2 (PPO) - H5520-005-0 Benefit Details |
Benton | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
Regence MedAdvantage Basic (PPO) - H3817-001-0 Benefit Details |
Benton | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Samaritan Advantage Special Needs Plan (HMO SNP) - H3811-003-0 Benefit Details |
Benton | $ 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 | |||||
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 | |||||||||
Kaiser Permanente Senior Advantage Basic (HMO) - H9003-006-0 Benefit Details |
Benton | $39.00 | $0 | All Generics, Few Brands | Tier 1: tbd | $3,400 Browse Formulary | |||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Benton | $40.60 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Health Net Aqua (PPO) - H5520-001-0 Benefit Details |
Benton | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
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 | |||||||||
AARP MedicareComplete (HMO) - H3805-007-0 Benefit Details |
Benton | $49.00 | $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% | $6,700 Browse Formulary | |||||
Regence MedAdvantage + Rx Classic (PPO) - H3817-002-0 Benefit Details |
Benton | $67.00 | $160 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.50 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $90.00 Tier 5: 29% Tier 6: 29% | $3,400 Browse Formulary | |||||
Samaritan Advantage Conventional Plan (HMO) - H3811-001-0 Benefit Details |
Benton | $67.00 | 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 | |||||||||
Health Net Violet Option 1 (PPO) - H5520-002-0 Benefit Details |
Benton | $99.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $2,500 Browse Formulary | |||||
Kaiser Permanente Senior Advantage (HMO) - H9003-001-0 Benefit Details |
Benton | $99.00 | $0 | All Generics, Few Brands | Tier 1: tbd | $2,500 Browse Formulary | |||||
Samaritan Advantage Premier Plan (HMO) - H3811-002-0 Benefit Details |
Benton | $99.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $9.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 30% | $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 | |||||||||
Samaritan Advantage Premier Plan Plus (HMO) - H3811-009-0 Benefit Details |
Benton | $121.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $9.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 30% | $3,400 Browse Formulary | |||||
ODS Advantage PPORX Select (PPO) - H3813-003-0 Benefit Details |
Benton | $128.30 | $120 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $33.00 Tier 3: $40.00 Tier 4: 50% Tier 5: 30% | $3,400 Browse Formulary | |||||
Regence MedAdvantage + Rx Enhanced (PPO) - H3817-003-0 Benefit Details |
Benton | $135.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $90.00 Tier 5: 33% Tier 6: 33% | $2,500 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 | |||||||||
Health Net Healthy Heart (PPO) - H5520-009-0 Benefit Details |
Benton | $149.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $1,750 Browse Formulary | |||||
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