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) - H5253-011-0 Benefit Details |
Shawano | $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: $92.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Advocare Essence (HMO-POS) - H5211-003-0 Benefit Details |
Shawano | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Anthem Medicare Preferred Core (PPO) - H4036-004-0 Benefit Details |
Shawano | $0.00 | $60 | Many Generics | Tier 1: $0.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% Tier 5: 33% Tier 6: $0.00 | $4,500 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 H8145-121 (PFFS) - H8145-121-0 Benefit Details |
Shawano | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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Humana Gold Plus H6622-001 (HMO-POS) - H6622-001-0 Benefit Details |
Shawano | $0.00 | $0 | Few Generics, Few Brands | Tier 1: $4.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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HumanaChoice R5826-023 (Regional PPO) - R5826-023-0 Benefit Details |
Shawano | $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 | |||||||||
Network PlatinumSelect (PPO) - H5215-008-0 Benefit Details |
Shawano | $0.00 | $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% | $2,900 Browse Formulary | |||||
Today's Options Premier 400 (PFFS) - H6169-012-0 Benefit Details |
Shawano | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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UnitedHealthcare Nursing Home Plan (HMO-POS SNP) - H5253-007-0 Benefit Details |
Shawano | $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 | |||||
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 | |||||||||
Anthem Medicare Preferred Select (PPO) - H4036-003-0 Benefit Details |
Shawano | $36.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $43.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 33% Tier 6: $5.00 | $3,400 Browse Formulary | |||||
Network PlatinumPlus (PPO) - H5215-001-0 Benefit Details |
Shawano | $36.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,700 | ||||||
Today's Options Advantage Plus 450B (PPO) - H5378-183-0 Benefit Details |
Shawano | $36.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $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 | |||||||||
UnitedHealthcare Dual Complete LP (HMO SNP) - H5253-024-0 Benefit Details |
Shawano | $ 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 | |||||
Advocare Essence Rx (HMO-POS) - H5211-002-0 Benefit Details |
Shawano | $39.00 | $0 | Few Generics | Tier 1: $6.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H5216-003 (PPO) - H5216-003-0 Benefit Details |
Shawano | $41.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $4,500 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 | |||||||||
Today's Options Premier 200 (PFFS) - H6169-050-0 Benefit Details |
Shawano | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,250 | ||||||
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Today's Options Advantage Plus 250A (PPO) - H5378-199-0 Benefit Details |
Shawano | $52.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
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Today's Options Premier Plus 450B (PFFS) - H6169-032-0 Benefit Details |
Shawano | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $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 | |||||||||
Humana Gold Choice H8145-006 (PFFS) - H8145-006-0 Benefit Details |
Shawano | $61.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $41.00 Tier 3: $80.00 Tier 4: 33% | $6,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) - R5826-009-0 Benefit Details |
Shawano | $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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Network PlatinumPlus Pharmacy (PPO) - H5215-002-0 Benefit Details |
Shawano | $74.00 | $0 | Many Generics | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $65.00 Tier 4: 33% | $2,700 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 | |||||||||
Network PlatinumPremier (PPO) - H5215-006-0 Benefit Details |
Shawano | $77.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,000 | ||||||
Today's Options Premier Plus 250A (PFFS) - H6169-054-0 Benefit Details |
Shawano | $112.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
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Advocare Spirit (HMO-POS) - H5211-001-0 Benefit Details |
Shawano | $118.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $900 | ||||||
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 | |||||||||
Network PlatinumPremier Pharmacy (PPO) - H5215-005-0 Benefit Details |
Shawano | $135.00 | $0 | Many Generics | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $65.00 Tier 4: 33% | $2,000 Browse Formulary | |||||
Advocare Spirit Rx (HMO-POS) - H5211-004-0 Benefit Details |
Shawano | $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 |
Shawano | $192.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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 Vitality Rx (HMO-POS) - H5211-005-0 Benefit Details |
Shawano | $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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