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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ATRIO Bronze (PPO) - H6743-006-0 Benefit Details |
Klamath | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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PacificSource Medicare Essentials 2 (HMO) - H3864-002-0 Benefit Details |
Klamath | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
ATRIO Bronze Rx (PPO) - H6743-001-0 Benefit Details |
Klamath | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 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 | |||||||||
ATRIO Special Needs Plan (HMO SNP) - H3814-007-0 Benefit Details |
Klamath | $ 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 | |||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Klamath | $40.60 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
ATRIO Silver (PPO) - H6743-002-0 Benefit Details |
Klamath | $47.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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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 | |||||||||
PacificSource Medicare Essentials Rx 14 (HMO) - H3864-014-0 Benefit Details |
Klamath | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $85.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
ATRIO Silver Rx (PPO) - H6743-003-0 Benefit Details |
Klamath | $89.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $85.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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PacificSource Medicare Essentials Rx 6 (HMO) - H3864-006-0 Benefit Details |
Klamath | $99.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $35.00 Tier 3: $80.00 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 | |||||||||
PacificSource Medicare Premier 1 (HMO-POS) - H3864-001-0 Benefit Details |
Klamath | $100.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
ODS Advantage PPORX Select (PPO) - H3813-003-0 Benefit Details |
Klamath | $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 | |||||
PacificSource Medicare Explorer Rx 1 (PPO) - H4754-001-0 Benefit Details |
Klamath | $142.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $35.00 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 | |||||||||
ATRIO Gold Rx (PPO) - H6743-004-0 Benefit Details |
Klamath | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | $2,000 Browse Formulary | |||||
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PacificSource Medicare Premier Rx 7 (HMO-POS) - H3864-007-0 Benefit Details |
Klamath | $155.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $70.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
ATRIO Platinum Rx (PPO) - H6743-005-0 Benefit Details |
Klamath | $186.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | $1,300 Browse Formulary | |||||
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