2013 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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Humana Prime Choice H6609-012 (PPO) - H6609-012-0 Benefit Details |
Boise | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,600 | ||||||
PacificSource Medicare Explorer 6 (PPO) - H4754-006-0 Benefit Details |
Boise | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
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Regence MedAdvantage Basic (PPO) - H1304-008-0 Benefit Details |
Boise | $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 | |||||||||
SelectHealth Advantage (HMO-POS) - H1994-003-0 Benefit Details |
Boise | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $3,600 Browse Formulary | |||||
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Windsor Medicare Extra Emerald Plan (HMO) - H5698-182-0 Benefit Details |
Boise | $0.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $44.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Windsor Medicare Extra Silver Plan (HMO) - H5698-188-0 Benefit Details |
Boise | $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 | |||||||||
PacificSource Medicare Essentials Rx 16 (HMO) - H3864-016-0 Benefit Details |
Boise | $10.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,000 Browse Formulary | |||||
Regence MedAdvantage + Rx Classic (PPO) - H1304-009-0 Benefit Details |
Boise | $20.00 | $165 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.50 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% Injectable Drugs: 29% | $3,400 Browse Formulary | |||||
True Blue (HMO) - H1350-006-0 Benefit Details |
Boise | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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 | |||||||||
PacificSource Medicare Explorer Rx 2 (PPO) - H4754-002-0 Benefit Details |
Boise | $36.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $2,500 Browse Formulary | |||||
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Secure Blue (PPO) - H1302-004-0 Benefit Details |
Boise | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Windsor Medicare Extra Gold Plan (HMO) - H5698-183-0 Benefit Details |
Boise | $40.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 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 | |||||||||
Humana Prime Choice H6609-009 (PPO) - H6609-009-0 Benefit Details |
Boise | $42.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Preferred Brand: $39.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,000 Browse Formulary | |||||
Secure Blue (PPO) - H1302-006-0 Benefit Details |
Boise | $63.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $43.00 Non-Preferred Brand: $93.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) - H5698-184-0 Benefit Details |
Boise | $103.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $65.00 Specialty Tier: 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 | |||||||||
True Blue Rx Option II (HMO) - H1350-010-0 Benefit Details |
Boise | $121.00 | $300 | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $31.00 Non-Preferred Brand: $70.00 Specialty Tier: 25% | $3,000 Browse Formulary | |||||
Regence MedAdvantage + Rx Enhanced (PPO) - H1304-010-0 Benefit Details |
Boise | $135.00 | $0 | Many Generics | Preferred Generic: $5.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Injectable Drugs: 33% | $2,500 Browse Formulary | |||||
True Blue Rx Option I (HMO) - H1350-001-0 Benefit Details |
Boise | $142.00 | $0 | Many Generics | Generic: $6.00 Preferred Brand: $31.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,000 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 | |||||||||
True Blue Special Needs Plan (HMO SNP) - H1350-009-0 Benefit Details |
Boise | $0.00 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: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
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