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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Group Health Cooperative Clear Care Vital (HMO) - H5050-013-0 Benefit Details |
San Juan | $19.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $11.00 Tier 4: 50% | $3,200 Browse Formulary | |||||
Group Health Cooperative Clear Care Basic (HMO) - H5050-001-0 Benefit Details |
San Juan | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
WindsorSterling Gold Plus Plan (PPO) - H8558-012-0 Benefit Details |
San Juan | $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 | |||||||||
Regence MedAdvantage Basic (PPO) - H5009-001-0 Benefit Details |
San Juan | $79.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Group Health Cooperative Clear Care Essential (HMO) - H5050-009-0 Benefit Details |
San Juan | $118.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $2.00 Tier 2: $11.00 Tier 3: $12.00 Tier 4: 50% | $2,500 Browse Formulary | |||||
Regence MedAdvantage + Rx Classic (PPO) - H5009-002-0 Benefit Details |
San Juan | $119.00 | $200 | 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 | |||||
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) - H5009-004-0 Benefit Details |
San Juan | $211.00 | $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 | |||||
Group Health Cooperative Clear Care Optimal (HMO) - H5050-004-0 Benefit Details |
San Juan | $212.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $20.00 Tier 3: $25.00 Tier 4: 50% | $1,000 Browse Formulary | |||||
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