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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FreedomBlue PPO HD (PPO) - H5106-026-0 Benefit Details |
Hancock | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
Humana Gold Choice H8145-050 (PFFS) - H8145-050-0 Benefit Details |
Hancock | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Hancock | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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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 | |||||||||
SecureCare - Option I (HMO) - H5151-004-0 Benefit Details |
Hancock | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
SecureChoice - Option I (PPO) - H8604-004-0 Benefit Details |
Hancock | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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UPMC for Life PPO High Deductible with Rx WV (PPO) - H9670-004-0 Benefit Details |
Hancock | $32.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $42.00 Tier 3: $95.00 Tier 4: 33% | $3,400 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 | |||||||||
Humana Gold Choice H8145-051 (PFFS) - H8145-051-0 Benefit Details |
Hancock | $39.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $84.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Hancock | $58.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $6,700 Browse Formulary | |||||
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Humana Gold Choice H8145-049 (PFFS) - H8145-049-0 Benefit Details |
Hancock | $69.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $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 | |||||||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Hancock | $79.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $44.00 Tier 3: $85.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
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FreedomBlue PPO Value (PPO) - H5106-018-0 Benefit Details |
Hancock | $81.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
SecureCare - Option II (HMO) - H5151-002-0 Benefit Details |
Hancock | $91.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $95.00 Tier 4: 33% | $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 | |||||||||
SecureChoice - Option II (PPO) - H8604-003-0 Benefit Details |
Hancock | $111.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $95.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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SecureCare - Option III (HMO) - H5151-006-0 Benefit Details |
Hancock | $117.00 | $0 | Many Generics | Tier 1: $3.00 Tier 2: $35.00 Tier 3: $95.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
SecureChoice - Option III (PPO) - H8604-006-0 Benefit Details |
Hancock | $137.00 | $0 | Many Generics | Tier 1: $3.00 Tier 2: $35.00 Tier 3: $95.00 Tier 4: 33% | $3,400 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 | |||||||||
FreedomBlue PPO Standard (PPO) - H5106-015-0 Benefit Details |
Hancock | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Deluxe (PPO) - H5106-016-0 Benefit Details |
Hancock | $225.00 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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