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 Plus (HMO-POS) - H1286-008-0 Benefit Details |
Skagit | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $45.00 Tier 4: $92.00 Tier 5: 33% | $4,250 Browse Formulary | |||||
Community HealthFirst MA Extra Plan (HMO) - H5826-010-0 Benefit Details |
Skagit | $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 |
Skagit | $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 | |||||||||
Group Health Cooperative Clear Care Vital (HMO) - H5050-013-0 Benefit Details |
Skagit | $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 | |||||
WindsorSterling Emerald Connect Plan (PFFS) - H3410-004-19 Benefit Details |
Skagit | $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 |
Skagit | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 Pharmacy Plan (HMO) - H5826-008-0 Benefit Details |
Skagit | $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 | |||||
Group Health Cooperative Clear Care Basic (HMO) - H5050-001-0 Benefit Details |
Skagit | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Community HealthFirst MA Special Needs Plan (HMO SNP) - H5826-005-0 Benefit Details |
Skagit | $ 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 | |||||||||
Essence Advantage (HMO) - H1837-002-0 Benefit Details |
Skagit | $49.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $39.00 Tier 3: $80.00 Tier 4: 25% | $3,400 Browse Formulary | |||||
WindsorSterling Gold Connect Plan (PFFS) - H3410-003-19 Benefit Details |
Skagit | $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 |
Skagit | $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 Premium Plan (HMO-POS) - H5826-011-0 Benefit Details |
Skagit | $79.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $60.00 Tier 4: 33% | $1,500 Browse Formulary | |||||
Regence MedAdvantage Basic (PPO) - H5009-001-0 Benefit Details |
Skagit | $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 |
Skagit | $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 | |||||
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) - H5009-002-0 Benefit Details |
Skagit | $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 | |||||
Regence MedAdvantage + Rx Enhanced (PPO) - H5009-004-0 Benefit Details |
Skagit | $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 |
Skagit | $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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