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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Care Improvement Plus Gold Rx (PPO SNP) - H6528-019-0 Benefit Details |
Abbeville | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | n/a Browse Formulary | |||||
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Care Improvement Plus Gold Rx (Regional PPO SNP) - R9896-009-0 Benefit Details |
Abbeville | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | n/a Browse Formulary | |||||
Humana Gold Choice H8145-150 (PFFS) - H8145-150-0 Benefit Details |
Abbeville | $0.00 | 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 R5826-064 (Regional PPO) - R5826-064-0 Benefit Details |
Abbeville | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 | ||||||
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Medicare Blue (PPO) - H4209-001-0 Benefit Details |
Abbeville | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $85.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
Medicare Blue Saver (PPO) - H4209-007-0 Benefit Details |
Abbeville | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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 | |||||||||
Windsor Medicare Extra Emerald Plan (HMO) - H5698-159-0 Benefit Details |
Abbeville | $0.00 | $0 | Some Generics | Tier 1: $7.00 Tier 2: $12.00 Tier 3: $42.00 Tier 4: $68.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
Windsor Medicare Extra Silver Plan (HMO) - H5698-035-0 Benefit Details |
Abbeville | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Care Improvement Plus Silver Rx (Regional PPO SNP) - R9896-008-0 Benefit Details |
Abbeville | $33.60 | $145 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 29% | 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) - H5698-157-0 Benefit Details |
Abbeville | $35.00 | $0 | Some Generics | Tier 1: $3.00 Tier 2: $10.00 Tier 3: $40.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
WindsorSterling Silver Connect Plan (PFFS) - H3410-002-16 Benefit Details |
Abbeville | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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Windsor Medicare Extra Comp Plus Plan (HMO SNP) - H5698-158-0 Benefit Details |
Abbeville | $ 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 | |||||||||
Care Improvement Plus Dual Advantage (PPO SNP) - H6528-020-0 Benefit Details |
Abbeville | $ 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: $10.00 Tier 2: $42.00 Tier 3: $95.00 Tier 4: 29% | n/a Browse Formulary | |||||
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Care Improvement Plus Silver Rx (PPO SNP) - H6528-018-0 Benefit Details |
Abbeville | $36.20 | $180 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 28% | n/a Browse Formulary | |||||
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Care Improvement Plus Medicare Advantage (PPO) - H6528-007-0 Benefit Details |
Abbeville | $42.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 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 | |||||||||
WindsorSterling Gold Connect Plan (PFFS) - H3410-003-16 Benefit Details |
Abbeville | $65.00 | $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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Care Improvement Plus Medicare Advantage (Regional PPO) - R9896-012-0 Benefit Details |
Abbeville | $70.00 | $230 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 27% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-077 (Regional PPO) - R5826-077-0 Benefit Details |
Abbeville | $76.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 28% | $5,900 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 Choice H8145-071 (PFFS) - H8145-071-0 Benefit Details |
Abbeville | $81.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $42.00 Tier 3: $84.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
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Medicare Blue Plus (PPO) - H4209-004-0 Benefit Details |
Abbeville | $91.00 | $0 | Many Generics | Tier 1: $2.00 Tier 2: $9.00 Tier 3: $35.00 Tier 4: $75.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) - H5698-160-0 Benefit Details |
Abbeville | $160.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
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