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 Platinum (PPO) - H1608-001-0 Benefit Details |
Lake | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,300 Browse Formulary | |||||
HumanaChoice H6609-002 (PPO) - H6609-002-0 Benefit Details |
Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
HumanaChoice H6609-019 (PPO) - H6609-019-0 Benefit Details |
Lake | $25.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $5,000 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 | |||||||||
HumanaChoice H6609-001 (PPO) - H6609-001-0 Benefit Details |
Lake | $45.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $77.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Medica Prime Solution Thrift with Part D Option 1 (Cost) - H2450-007-0 Benefit Details |
Lake | $55.50 | $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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MedicareBlue PPO (Regional PPO) - R5566-005-0 Benefit Details |
Lake | $84.40 | $155 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $11.00 Tier 3: $33.00 Tier 4: 45% | $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 | |||||||||
Medica Prime Solution Value with Part D Option 1 (Cost) - H2450-022-0 Benefit Details |
Lake | $85.50 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,350 Browse Formulary | |||||
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Medica Prime Solution Value with Part D Option 2 (Cost) - H2450-023-0 Benefit Details |
Lake | $102.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $34.00 Tier 3: $74.00 Tier 4: 25% | $3,350 Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 1 (Cost) - H2450-016-0 Benefit Details |
Lake | $105.50 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,000 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) - H2450-001-0 Benefit Details |
Lake | $122.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $34.00 Tier 3: $74.00 Tier 4: 25% | $3,000 Browse Formulary | |||||
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Medica Prime Solution Enhanced w/Part D Option 1 (Cost) - H2450-017-0 Benefit Details |
Lake | $155.50 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,000 Browse Formulary | |||||
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Medica Prime Solution Value with Part D Option 3 (Cost) - H2450-028-0 Benefit Details |
Lake | $161.20 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $34.00 Tier 3: $74.00 Tier 4: 25% | $3,350 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 | |||||||||
Medica Prime Solution Enhanced w/Part D Option 2 (Cost) - H2450-002-0 Benefit Details |
Lake | $172.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $34.00 Tier 3: $74.00 Tier 4: 25% | $3,000 Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 3 (Cost) - H2450-005-0 Benefit Details |
Lake | $181.20 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $34.00 Tier 3: $74.00 Tier 4: 25% | $3,000 Browse Formulary | |||||
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Medica Prime Solution Enhanced w/Part D Option 3 (Cost) - H2450-006-0 Benefit Details |
Lake | $231.20 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $34.00 Tier 3: $74.00 Tier 4: 25% | $3,000 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 | |||||||||
Medica Clear Solution with Part D Option 1 (PPO) - H3283-001-0 Benefit Details |
Lake | $262.70 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $2,500 Browse Formulary | |||||
new | new | new | |||||||||
Medica Clear Solution with Part D Option 3 (PPO) - H3283-002-0 Benefit Details |
Lake | $347.10 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $34.00 Tier 3: $74.00 Tier 4: 25% | $2,500 Browse Formulary | |||||
new | new | new |
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