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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Soundpath Health Ascent (HMO) - H9302-009-0 Benefit Details |
Douglas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Soundpath Health Pinnacle + Rx (HMO) - H9302-010-0 Benefit Details |
Douglas | $21.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $18.00 Tier 3: $36.00 Tier 4: $60.00 Tier 5: 25% | $3,400 Browse Formulary | |||||
Community HealthFirst MA Special Needs Plan (HMO SNP) - H5826-005-0 Benefit Details |
Douglas | $ 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 |
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Service | Exper. | Cost Info | |||||||||
Community HealthFirst MA Pharmacy Plan (HMO) - H5826-009-0 Benefit Details |
Douglas | $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 | |||||
Soundpath Health Alpine (HMO) - H9302-004-0 Benefit Details |
Douglas | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,250 | ||||||
Community HealthFirst MA Enhanced Pharmacy Plan (HMO) - H5826-012-0 Benefit Details |
Douglas | $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 | |||||||||
Community HealthFirst MA Premium Plan (HMO-POS) - H5826-011-0 Benefit Details |
Douglas | $79.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $60.00 Tier 4: 33% | $1,500 Browse Formulary | |||||
Soundpath Health Charter + Rx (HMO) - H9302-003-0 Benefit Details |
Douglas | $94.00 | $0 | Many Generics | Tier 1: $6.00 Tier 2: $18.00 Tier 3: $36.00 Tier 4: $60.00 Tier 5: 33% | $2,250 Browse Formulary | |||||
Soundpath Health Apex + Rx (HMO) - H9302-001-0 Benefit Details |
Douglas | $169.00 | $0 | Many Generics | Tier 1: $6.00 Tier 2: $18.00 Tier 3: $36.00 Tier 4: $60.00 Tier 5: 33% | $1,400 Browse Formulary | |||||
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