2012 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
AARP MedicareComplete SecureHorizons (HMO) - H4590-012-0 Benefit Details |
Tarrant | $0.00 | $0 | Some Generics | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $44.00 Tier 4: $88.00 Tier 5: 33% | $4,900 Browse Formulary | |||||
AARP MedicareComplete SecureHorizons Essential (HMO) - H4590-027-0 Benefit Details |
Tarrant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
Advantra (PPO) - H7306-001-0 Benefit Details |
Tarrant | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $35.00 Tier 3: $70.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Aetna Medicare Premier Plan (HMO) - H4523-005-0 Benefit Details |
Tarrant | $0.00 | $0 | Many Generics | Tier 1: $4.00 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $94.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
-- | |||||||||||
Amerivantage Classic Choice + Rx (HMO-POS) - H5817-010-0 Benefit Details |
Tarrant | $0.00 | $0 | Some Generics | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $30.00 Tier 4: $70.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
Any, Any, Any Gold (PFFS) - H8098-001-0 Benefit Details |
Tarrant | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $85.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
-- | -- | ||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any Gold MA Only (PFFS) - H8098-003-0 Benefit Details |
Tarrant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
-- | -- | ||||||||||
Bravo Achieve (HMO SNP) - H4528-014-0 Benefit Details |
Tarrant | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $8.00 Tier 3: $35.00 Tier 4: $70.00 Tier 5: 33% Tier 6: $5.00 | n/a Browse Formulary | |||||
Bravo Classic Plus (HMO-POS) - H4528-001-0 Benefit Details |
Tarrant | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $8.00 Tier 3: $35.00 Tier 4: $70.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Bravo Freedom (PPO) - H1355-001-0 Benefit Details |
Tarrant | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $8.00 Tier 3: $35.00 Tier 4: $70.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
-- | |||||||||||
Care Improvement Plus Gold Rx (PPO SNP) - H0084-004-0 Benefit Details |
Tarrant | $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 | |||||
Care Improvement Plus Gold Rx (Regional PPO SNP) - R6801-009-0 Benefit Details |
Tarrant | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care N' Care Health Plan II MA-Only (PPO) - H6328-006-0 Benefit Details |
Tarrant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Care N' Care Health Plan III (PPO) - H6328-003-0 Benefit Details |
Tarrant | $0.00 | $0 | Many Generics | Tier 1: $2.00 Tier 2: $40.00 Tier 3: $70.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HealthyAdvantage (PPO) - H7787-002-0 Benefit Details |
Tarrant | $0.00 | 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 |
|||||
Service | Exper. | Cost Info | |||||||||
HealthyAdvantage Preferred DFW (PPO) - H7787-001-0 Benefit Details |
Tarrant | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $4.00 Tier 3: $30.00 Tier 4: $60.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Humana Gold Choice H8145-126 (PFFS) - H8145-126-0 Benefit Details |
Tarrant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
-- | -- | ||||||||||
Humana Reader's Digest Healthy Living Plan (HMO) - H4510-018-0 Benefit Details |
Tarrant | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $40.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-026 (Regional PPO) - R5826-026-0 Benefit Details |
Tarrant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
-- | |||||||||||
TexanPlus Classic (HMO) - H5656-001-0 Benefit Details |
Tarrant | $0.00 | $0 | Many Generics, Some Brands | Tier 1: tbd | $3,000 Browse Formulary | |||||
-- | |||||||||||
TexanPlus Value (HMO) - H5656-003-0 Benefit Details |
Tarrant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Texas Hassle-Free (HMO-POS) - H6642-001-0 Benefit Details |
Tarrant | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $70.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
-- | |||||||||||
Texas Hassle-Free C-SNP (HMO-POS SNP) - H6642-007-0 Benefit Details |
Tarrant | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $70.00 Tier 5: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Texas Hassle-Free MA Only (HMO-POS) - H6642-004-0 Benefit Details |
Tarrant | $0.00 | 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Universal Hassle-Free (PPO) - H5096-001-0 Benefit Details |
Tarrant | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $85.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
Universal Hassle-Free MA Only (PPO) - H5096-002-0 Benefit Details |
Tarrant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
WellCare Dividend (HMO) - H1264-014-0 Benefit Details |
Tarrant | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $60.00 Tier 4: 33% | $5,500 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
WellCare Value (HMO-POS) - H1264-004-0 Benefit Details |
Tarrant | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $60.00 Tier 4: 33% | $5,500 Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (PPO) - H0084-001-0 Benefit Details |
Tarrant | $15.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $43.00 Tier 3: $95.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H4590-020-0 Benefit Details |
Tarrant | $ 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 |
|||||
Service | Exper. | Cost Info | |||||||||
UnitedHealthcare Nursing Home Plan (HMO SNP) - H4590-038-0 Benefit Details |
Tarrant | $28.50 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
WellCare Access (HMO SNP) - H1264-007-0 Benefit Details |
Tarrant | $ 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: $0.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 25% | n/a Browse Formulary | |||||
Care N' Care Health Plan II (PPO) - H6328-002-0 Benefit Details |
Tarrant | $29.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $36.00 Tier 3: $68.00 Tier 4: 33% | $3,100 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Amerivantage Specialty + Rx (HMO SNP) - H5817-009-0 Benefit Details |
Tarrant | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Many Generics | Tier 1: $0.00 Tier 2: $0.00 Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
Fidelis Secure Comfort (HMO SNP) - H5980-005-0 Benefit Details |
Tarrant | $29.90 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
-- | -- | ||||||||||
Fidelis Secure Freedom (HMO SNP) - H5980-011-0 Benefit Details |
Tarrant | $29.90 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
-- | -- | ||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Plus SNP-DE H4510-023 (HMO SNP) - H4510-023-0 Benefit Details |
Tarrant | $ 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: 0% Tier 2: 0% | n/a Browse Formulary | |||||
Texas Hassle-Free D-SNP (HMO-POS SNP) - H6642-008-0 Benefit Details |
Tarrant | $ 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 | |||||
-- | |||||||||||
Bravo Select (HMO SNP) - H4528-002-0 Benefit Details |
Tarrant | $ 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Bravo Traditions (PPO SNP) - H1355-002-0 Benefit Details |
Tarrant | $30.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | n/a Browse Formulary | |||||
-- | |||||||||||
Care Improvement Plus Dual Advantage (PPO SNP) - H0084-005-0 Benefit Details |
Tarrant | $ 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: $45.00 Tier 3: $95.00 Tier 4: 28% | n/a Browse Formulary | |||||
Care Improvement Plus Dual Advantage (Regional PPO SNP) - R6801-011-0 Benefit Details |
Tarrant | $ 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: $45.00 Tier 3: $95.00 Tier 4: 27% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Silver Rx (PPO SNP) - H0084-003-0 Benefit Details |
Tarrant | $30.00 | $210 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 27% | n/a Browse Formulary | |||||
Care Improvement Plus Silver Rx (Regional PPO SNP) - R6801-008-0 Benefit Details |
Tarrant | $30.00 | $165 | 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 | |||||
Care N' Care Health Plan I MA-Only (PPO) - H6328-005-0 Benefit Details |
Tarrant | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Fresenius Health Partners (PPO SNP) - H5162-019-0 Benefit Details |
Tarrant | $30.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
-- | -- | ||||||||||
Aetna Medicare Value Plan (PPO) - H4524-007-0 Benefit Details |
Tarrant | $39.00 | $0 | Many Generics | Tier 1: $6.00 Tier 2: $33.00 Tier 3: $40.00 Tier 4: $85.00 Tier 5: 33% | $5,000 Browse Formulary | |||||
-- | |||||||||||
HumanaChoice H4520-006 (PPO) - H4520-006-0 Benefit Details |
Tarrant | $49.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $40.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-012 (Regional PPO) - R5826-012-0 Benefit Details |
Tarrant | $54.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $42.00 Tier 3: $82.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
-- | |||||||||||
Care Improvement Plus Medicare Advantage (Regional PPO) - R6801-012-0 Benefit Details |
Tarrant | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
Today's Options Advantage Plus 450H (PPO) - H5378-016-0 Benefit Details |
Tarrant | $62.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care N' Care Health Plan I (PPO) - H6328-001-0 Benefit Details |
Tarrant | $75.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $33.00 Tier 3: $65.00 Tier 4: 33% | $2,500 Browse Formulary | |||||
Humana Gold Choice H8145-084 (PFFS) - H8145-084-0 Benefit Details |
Tarrant | $79.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $38.00 Tier 3: $80.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
-- | -- | ||||||||||
Fidelis Secure Comfort Plus (HMO SNP) - H5980-006-0 Benefit Details |
Tarrant | $98.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $65.00 Tier 4: 33% | n/a Browse Formulary | |||||
-- | -- | ||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Today's Options Advantage Plus 250A (PPO) - H5378-010-0 Benefit Details |
Tarrant | $132.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
-- | |||||||||||
Fidelis Secure Independence (HMO SNP) - H5980-007-0 Benefit Details |
Tarrant | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $65.00 Tier 4: 33% | n/a Browse Formulary | |||||
-- | -- |
|