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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WindsorSterling Emerald Connect Plan (PFFS) - H3410-004-19 Benefit Details |
Benton | $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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WindsorSterling Silver Connect Plan (PFFS) - H3410-002-19 Benefit Details |
Benton | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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Spokane Community Care - Dual Plus (HMO SNP) - H5416-014-0 Benefit Details |
Benton | $ 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: tbd | n/a 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 | |||||||||
Community HealthFirst MA Special Needs Plan (HMO SNP) - H5826-005-0 Benefit Details |
Benton | $ 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 | |||||
Columbia Community Care - Plus (HMO) - H5416-004-0 Benefit Details |
Benton | $49.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
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Community HealthFirst MA Pharmacy Plan (HMO) - H5826-009-0 Benefit Details |
Benton | $49.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: 33% | $2,800 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 | |||||||||
WindsorSterling Gold Connect Plan (PFFS) - H3410-003-19 Benefit Details |
Benton | $59.00 | $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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Group Health Options Clear Care Prestige (PPO) - H2810-001-0 Benefit Details |
Benton | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $15.00 Tier 3: $16.00 Tier 4: 50% | $3,200 Browse Formulary | |||||
Community HealthFirst MA Enhanced Pharmacy Plan (HMO) - H5826-012-0 Benefit Details |
Benton | $79.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $40.00 Tier 3: 33% | $2,300 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 | |||||||||
Asuris TruAdvantage Basic (PPO) - H5010-001-0 Benefit Details |
Benton | $98.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Group Health Options Clear Care Elite (PPO) - H2810-002-0 Benefit Details |
Benton | $121.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $20.00 Tier 3: $25.00 Tier 4: 50% | $2,500 Browse Formulary | |||||
Asuris TruAdvantage + Rx Classic (PPO) - H5010-002-0 Benefit Details |
Benton | $138.00 | $220 | 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: 27% Tier 6: 27% | $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 | |||||||||
Asuris TruAdvantage + Rx Enhanced (PPO) - H5010-004-0 Benefit Details |
Benton | $215.00 | $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% | $2,800 Browse Formulary | |||||
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