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 |
Lincoln | $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 |
Lincoln | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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Community HealthFirst MA Special Needs Plan (HMO SNP) - H5826-005-0 Benefit Details |
Lincoln | $ 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 |
Lincoln | $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 | |||||
WindsorSterling Gold Connect Plan (PFFS) - H3410-003-19 Benefit Details |
Lincoln | $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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WindsorSterling Gold Plus Plan (PPO) - H8558-012-0 Benefit Details |
Lincoln | $75.00 | $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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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 Enhanced Pharmacy Plan (HMO) - H5826-012-0 Benefit Details |
Lincoln | $79.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $40.00 Tier 3: 33% | $2,300 Browse Formulary | |||||
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