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 |
Snohomish | $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 |
Snohomish | $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 |
Snohomish | $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 | |||||||||
Humana Gold Plus H2012-037 (HMO) - H2012-037-0 Benefit Details |
Snohomish | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,900 Browse Formulary | |||||
Soundpath Health Ascent (HMO) - H9302-009-0 Benefit Details |
Snohomish | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Soundpath Health Sound + Rx (HMO) - H9302-007-0 Benefit Details |
Snohomish | $0.00 | $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 | |||||
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 | |||||||||
Molina Medicare Options Plus (HMO SNP) - H5823-006-0 Benefit Details |
Snohomish | $ 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: 0% Tier 2: 0% | n/a Browse Formulary | |||||
Group Health Cooperative Clear Care Vital (HMO) - H5050-013-0 Benefit Details |
Snohomish | $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 |
Snohomish | $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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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 | |||||||||
AARP MedicareComplete Essential (HMO) - H5005-018-0 Benefit Details |
Snohomish | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 | ||||||
Humana Gold Plus H2012-038 (HMO-POS) - H2012-038-0 Benefit Details |
Snohomish | $30.00 | $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 Silver Connect Plan (PFFS) - H3410-002-19 Benefit Details |
Snohomish | $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 |
Snohomish | $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 |
Snohomish | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
UnitedHealthcare Nursing Home Plan (HMO SNP) - H5008-001-0 Benefit Details |
Snohomish | $35.10 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | 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 Special Needs Plan (HMO SNP) - H5826-005-0 Benefit Details |
Snohomish | $ 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 | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H5008-002-0 Benefit Details |
Snohomish | $ 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 | |||||
Providence Medicare Choice (HMO-POS) - H9047-035-0 Benefit Details |
Snohomish | $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 | |||||||||
Soundpath Health Alpine (HMO) - H9302-004-0 Benefit Details |
Snohomish | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,250 | ||||||
HumanaChoice H6609-013 (PPO) - H6609-013-0 Benefit Details |
Snohomish | $59.00 | $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 Gold Connect Plan (PFFS) - H3410-003-19 Benefit Details |
Snohomish | $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 | |||||||||
Molina Medicare Options (HMO) - H5823-002-0 Benefit Details |
Snohomish | $66.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $65.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
AARP MedicareComplete Plan 1 (HMO) - H5005-011-0 Benefit Details |
Snohomish | $73.00 | $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 | |||||
WindsorSterling Gold Plus Plan (PPO) - H8558-012-0 Benefit Details |
Snohomish | $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 | |||||||||
Providence Medicare Choice + RX (HMO-POS) - H9047-024-0 Benefit Details |
Snohomish | $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 |
Snohomish | $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 |
Snohomish | $79.00 | 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 | |||||||||
Providence Medicare Extra (HMO) - H9047-033-0 Benefit Details |
Snohomish | $87.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Soundpath Health Charter + Rx (HMO) - H9302-003-0 Benefit Details |
Snohomish | $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 | |||||
Group Health Cooperative Clear Care Essential (HMO) - H5050-009-0 Benefit Details |
Snohomish | $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 |
Snohomish | $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 | |||||
Providence Medicare Extra + RX (HMO) - H9047-001-0 Benefit Details |
Snohomish | $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 | |||||
Soundpath Health Apex + Rx (HMO) - H9302-001-0 Benefit Details |
Snohomish | $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 | |||||
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 |
Snohomish | $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 |
Snohomish | $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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