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) - H5253-028-0 Benefit Details |
Monroe | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $44.00 Tier 4: $88.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Advocare Essence (HMO-POS) - H5211-003-0 Benefit Details |
Monroe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Gundersen Lutheran Sr. Pref. Value (no RX) (HMO) - H5262-004-0 Benefit Details |
Monroe | $0.00 | 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 | |||||||||
HumanaChoice R5826-023 (Regional PPO) - R5826-023-0 Benefit Details |
Monroe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Humana Gold Plus H6622-003 (HMO) - H6622-003-0 Benefit Details |
Monroe | $17.00 | $0 | Few Generics, Few Brands | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) - H5262-003-0 Benefit Details |
Monroe | $22.60 | $80 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $33.00 Tier 3: $44.00 Tier 4: $95.00 Tier 5: 31% | $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 | |||||||||
UnitedHealthcare Nursing Home Plan (HMO-POS SNP) - H5253-007-0 Benefit Details |
Monroe | $35.30 | $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 | |||||
HumanaChoice H5216-007 (PPO) - H5216-007-0 Benefit Details |
Monroe | $36.00 | $0 | Few Generics, Few Brands | Tier 1: $5.00 Tier 2: $34.00 Tier 3: $75.00 Tier 4: 33% | $4,500 Browse Formulary | |||||
UnitedHealthcare Dual Complete LP (HMO SNP) - H5253-024-0 Benefit Details |
Monroe | $ 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 | |||||||||
Advocare Essence Rx (HMO-POS) - H5211-002-0 Benefit Details |
Monroe | $39.00 | $0 | Few Generics | Tier 1: $6.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
UCare for Seniors Value (HMO-POS) - H4270-001-0 Benefit Details |
Monroe | $61.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice R5826-009 (Regional PPO) - R5826-009-0 Benefit Details |
Monroe | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 | |||||||||
UCare for Seniors Standard D (HMO-POS) - H4270-004-0 Benefit Details |
Monroe | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Value Plus (HMO-POS) - H4270-003-0 Benefit Details |
Monroe | $89.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 25% | $3,400 Browse Formulary | |||||
Gundersen Lutheran Sr. Pref. Elite (no RX) (HMO) - H5262-005-0 Benefit Details |
Monroe | $100.00 | 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 | |||||||||
Advocare Spirit (HMO-POS) - H5211-001-0 Benefit Details |
Monroe | $118.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $900 | ||||||
Gundersen Lutheran Senior Pref. Elite (w/RX) (HMO) - H5262-001-0 Benefit Details |
Monroe | $139.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $33.00 Tier 3: $44.00 Tier 4: $95.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
UCare for Seniors Classic (HMO-POS) - H4270-002-0 Benefit Details |
Monroe | $159.00 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 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 | |||||||||
Advocare Spirit Rx (HMO-POS) - H5211-004-0 Benefit Details |
Monroe | $167.00 | $0 | Few Generics | Tier 1: $6.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 33% | $900 Browse Formulary | |||||
Advocare Vitality (HMO-POS) - H5211-006-0 Benefit Details |
Monroe | $192.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Advocare Vitality Rx (HMO-POS) - H5211-005-0 Benefit Details |
Monroe | $254.00 | $0 | Few Generics | Tier 1: $6.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 33% | n/a Browse Formulary | |||||
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