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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AARP MedicareComplete Plus (HMO-POS) - H4604-003-0 Benefit Details |
Salt Lake | $0.00 | $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% | $3,900 Browse Formulary | |||||
AARP MedicareComplete Plus Essential (HMO-POS) - H4604-005-0 Benefit Details |
Salt Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,100 | ||||||
Altius Advantra (HMO-POS) - H8649-003-0 Benefit Details |
Salt Lake | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $45.00 Tier 3: $85.00 Tier 4: 33% | $3,150 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 | |||||||||
Any, Any, Any Gold (PFFS) - H8098-001-0 Benefit Details |
Salt Lake | $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 | |||||
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Any, Any, Any Gold MA Only (PFFS) - H8098-003-0 Benefit Details |
Salt Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Humana Gold Choice H8145-097 (PFFS) - H8145-097-0 Benefit Details |
Salt Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
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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 Plus H2486-003 (HMO-POS) - H2486-003-0 Benefit Details |
Salt Lake | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $38.00 Tier 3: $80.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
HumanaChoice H4606-006 (PPO) - H4606-006-0 Benefit Details |
Salt Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Universal Hassle-Free (PPO) - H5096-001-0 Benefit Details |
Salt Lake | $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 | |||||||||
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 | |||||||||
Universal Hassle-Free MA Only (PPO) - H5096-002-0 Benefit Details |
Salt Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
HumanaChoice H4606-001 (PPO) - H4606-001-0 Benefit Details |
Salt Lake | $26.60 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $42.00 Tier 3: $80.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
WindsorSterling Emerald Connect Plan (PFFS) - H3410-004-18 Benefit Details |
Salt Lake | $28.50 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $33.00 Tier 4: $87.00 Tier 5: 29% | $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 Silver Connect Plan (PFFS) - H3410-002-18 Benefit Details |
Salt Lake | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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Altius Advantra Preference (HMO) - H8649-007-0 Benefit Details |
Salt Lake | $36.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $45.00 Tier 3: $85.00 Tier 4: 33% | $3,950 Browse Formulary | |||||
Healthy Advantage (HMO SNP) - H5628-006-0 Benefit Details |
Salt Lake | $ 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 | |||||
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 | |||||||||
Molina Medicare Options Plus (HMO SNP) - H5628-001-0 Benefit Details |
Salt Lake | $ 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 | |||||
Regence MedAdvantage Basic (PPO) - H4605-001-0 Benefit Details |
Salt Lake | $48.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Humana Gold Choice H8145-107 (PFFS) - H8145-107-0 Benefit Details |
Salt Lake | $57.00 | $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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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) - H3410-003-18 Benefit Details |
Salt Lake | $60.00 | $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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WindsorSterling Gold Plus Plan (PPO) - H8558-004-0 Benefit Details |
Salt Lake | $60.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $16.00 Tier 3: $36.00 Tier 4: $90.00 Tier 5: 30% | $4,000 Browse Formulary | |||||
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Molina Medicare Options (HMO) - H5628-002-0 Benefit Details |
Salt Lake | $68.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $40.00 Tier 3: $75.00 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 | |||||||||
Regence MedAdvantage + Rx Classic (PPO) - H4605-002-0 Benefit Details |
Salt Lake | $93.00 | $190 | 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: 28% Tier 6: 28% | $3,400 Browse Formulary | |||||
Regence MedAdvantage + Rx Enhanced (PPO) - H4605-004-0 Benefit Details |
Salt Lake | $163.00 | $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 | |||||
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