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 Plan 3 (HMO) - H5005-019-0 Benefit Details |
Clark | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $7.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $5,700 Browse Formulary | |||||
Community HealthFirst MA Extra Plan (HMO) - H5826-010-0 Benefit Details |
Clark | $0.00 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $45.00 Tier 3: 33% | $3,400 Browse Formulary | |||||
Community HealthFirst MA Plan (HMO) - H5826-006-0 Benefit Details |
Clark | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,800 | ||||||
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 | |||||||||
Health Net Violet Option 2 (PPO) - H5520-005-0 Benefit Details |
Clark | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
Humana Gold Choice H8145-097 (PFFS) - H8145-097-0 Benefit Details |
Clark | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
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Humana Gold Plus H2012-031 (HMO) - H2012-031-0 Benefit Details |
Clark | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 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 | |||||||||
Humana Gold Plus H2012-032 (HMO-POS) - H2012-032-0 Benefit Details |
Clark | $25.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $2,900 Browse Formulary | |||||
WindsorSterling Emerald Connect Plan (PFFS) - H3410-004-19 Benefit Details |
Clark | $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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AARP MedicareComplete Essential (HMO) - H5005-018-0 Benefit Details |
Clark | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 | ||||||
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) - H3410-002-19 Benefit Details |
Clark | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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Community HealthFirst MA Pharmacy Plan (HMO) - H5826-008-0 Benefit Details |
Clark | $33.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $45.00 Tier 3: 33% | $2,800 Browse Formulary | |||||
Regence MedAdvantage Basic (PPO) - H3817-001-0 Benefit Details |
Clark | $35.00 | 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 |
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Service | Exper. | Cost Info | |||||||||
Community HealthFirst MA Special Needs Plan (HMO SNP) - H5826-005-0 Benefit Details |
Clark | $ 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 | |||||
Kaiser Permanente Senior Advantage Basic (HMO) - H9003-006-0 Benefit Details |
Clark | $39.00 | $0 | All Generics, Few Brands | Tier 1: tbd | $3,400 Browse Formulary | |||||
Providence Medicare Choice (HMO-POS) - H9047-035-0 Benefit Details |
Clark | $40.00 | 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 |
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Service | Exper. | Cost Info | |||||||||
Health Net Aqua (PPO) - H5520-001-0 Benefit Details |
Clark | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
HumanaChoice H6609-015 (PPO) - H6609-015-0 Benefit Details |
Clark | $52.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
WindsorSterling Gold Connect Plan (PFFS) - H3410-003-19 Benefit Details |
Clark | $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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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) - H3817-002-0 Benefit Details |
Clark | $67.00 | $160 | 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: 29% Tier 6: 29% | $3,400 Browse Formulary | |||||
Providence Medicare Choice + RX (HMO-POS) - H9047-024-0 Benefit Details |
Clark | $76.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $50.00 Tier 3: 33% | $3,400 Browse Formulary | |||||
Community HealthFirst MA Premium Plan (HMO-POS) - H5826-011-0 Benefit Details |
Clark | $79.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $60.00 Tier 4: 33% | $1,500 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 | |||||||||
Providence Medicare Extra (HMO) - H9047-033-0 Benefit Details |
Clark | $87.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
AARP MedicareComplete Plan 1 (HMO) - H5005-010-0 Benefit Details |
Clark | $89.00 | $0 | Some Generics | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $44.00 Tier 4: $88.00 Tier 5: 33% | $4,200 Browse Formulary | |||||
Humana Gold Choice H8145-109 (PFFS) - H8145-109-0 Benefit Details |
Clark | $92.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,400 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 | |||||||||
Health Net Violet Option 1 (PPO) - H5520-002-0 Benefit Details |
Clark | $99.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $2,500 Browse Formulary | |||||
Kaiser Permanente Senior Advantage (HMO) - H9003-001-0 Benefit Details |
Clark | $99.00 | $0 | All Generics, Few Brands | Tier 1: tbd | $2,500 Browse Formulary | |||||
Providence Medicare Extra + RX (HMO) - H9047-001-0 Benefit Details |
Clark | $130.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $50.00 Tier 3: 33% | $2,500 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 Enhanced (PPO) - H3817-003-0 Benefit Details |
Clark | $135.00 | $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 | |||||
Health Net Healthy Heart (PPO) - H5520-009-0 Benefit Details |
Clark | $149.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $1,750 Browse Formulary | |||||
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