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 SecureHorizons (HMO) - H4590-012-0 Benefit Details |
Johnson | $0.00 | $0 | Some Generics | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $44.00 Tier 4: $88.00 Tier 5: 33% | $4,900 Browse Formulary | |||||
AARP MedicareComplete SecureHorizons Essential (HMO) - H4590-027-0 Benefit Details |
Johnson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
Advantra (PPO) - H7306-001-0 Benefit Details |
Johnson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $35.00 Tier 3: $70.00 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 | |||||||||
Bravo Achieve (HMO SNP) - H4528-014-0 Benefit Details |
Johnson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $8.00 Tier 3: $35.00 Tier 4: $70.00 Tier 5: 33% Tier 6: $5.00 | n/a Browse Formulary | |||||
Bravo Classic Plus (HMO-POS) - H4528-001-0 Benefit Details |
Johnson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $8.00 Tier 3: $35.00 Tier 4: $70.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Care Improvement Plus Gold Rx (PPO SNP) - H0084-004-0 Benefit Details |
Johnson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | 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 | |||||||||
Care Improvement Plus Gold Rx (Regional PPO SNP) - R6801-009-0 Benefit Details |
Johnson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | n/a Browse Formulary | |||||
Care N' Care Health Plan II MA-Only (PPO) - H6328-006-0 Benefit Details |
Johnson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Care N' Care Health Plan III (PPO) - H6328-003-0 Benefit Details |
Johnson | $0.00 | $0 | Many Generics | Tier 1: $2.00 Tier 2: $40.00 Tier 3: $70.00 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 | |||||||||
HealthyAdvantage (PPO) - H7787-002-0 Benefit Details |
Johnson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Humana Gold Choice H8145-126 (PFFS) - H8145-126-0 Benefit Details |
Johnson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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Humana Reader's Digest Healthy Living Plan (HMO) - H4510-018-0 Benefit Details |
Johnson | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 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 | |||||||||
HumanaChoice R5826-026 (Regional PPO) - R5826-026-0 Benefit Details |
Johnson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Care Improvement Plus Medicare Advantage (PPO) - H0084-001-0 Benefit Details |
Johnson | $15.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $43.00 Tier 3: $95.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H4590-020-0 Benefit Details |
Johnson | $ 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 | |||||||||
Care N' Care Health Plan II (PPO) - H6328-002-0 Benefit Details |
Johnson | $29.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $36.00 Tier 3: $68.00 Tier 4: 33% | $3,100 Browse Formulary | |||||
Bravo Select (HMO SNP) - H4528-002-0 Benefit Details |
Johnson | $ 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 | |||||
Care Improvement Plus Dual Advantage (PPO SNP) - H0084-005-0 Benefit Details |
Johnson | $ 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: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 28% | 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 | |||||||||
Care Improvement Plus Dual Advantage (Regional PPO SNP) - R6801-011-0 Benefit Details |
Johnson | $ 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: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 27% | n/a Browse Formulary | |||||
Care Improvement Plus Silver Rx (PPO SNP) - H0084-003-0 Benefit Details |
Johnson | $30.00 | $210 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 27% | n/a Browse Formulary | |||||
Care Improvement Plus Silver Rx (Regional PPO SNP) - R6801-008-0 Benefit Details |
Johnson | $30.00 | $165 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 29% | 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 | |||||||||
Care N' Care Health Plan I MA-Only (PPO) - H6328-005-0 Benefit Details |
Johnson | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
HealthyAdvantage Preferred (PPO) - H7787-004-0 Benefit Details |
Johnson | $35.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $4.00 Tier 3: $30.00 Tier 4: $60.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H4520-006 (PPO) - H4520-006-0 Benefit Details |
Johnson | $49.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 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 | |||||||||
HumanaChoice R5826-012 (Regional PPO) - R5826-012-0 Benefit Details |
Johnson | $54.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $42.00 Tier 3: $82.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
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Care Improvement Plus Medicare Advantage (Regional PPO) - R6801-012-0 Benefit Details |
Johnson | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
Care N' Care Health Plan I (PPO) - H6328-001-0 Benefit Details |
Johnson | $75.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $33.00 Tier 3: $65.00 Tier 4: 33% | $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 | |||||||||
Humana Gold Choice H8145-084 (PFFS) - H8145-084-0 Benefit Details |
Johnson | $79.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $38.00 Tier 3: $80.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
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