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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Coventry Advantra Platinum (PPO) - H1608-001-0 Benefit Details |
McCook | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $3,300 Browse Formulary | |||||
Coventry Total Care (PPO) - H1608-004-0 Benefit Details |
McCook | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
HumanaChoice H6609-004 (PPO) - H6609-004-0 Benefit Details |
McCook | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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 | |||||||||
HumanaChoice H6609-019 (PPO) - H6609-019-0 Benefit Details |
McCook | $40.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | $5,000 Browse Formulary | |||||
HumanaChoice H6609-001 (PPO) - H6609-001-0 Benefit Details |
McCook | $51.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 28% | $4,000 Browse Formulary | |||||
Medica Prime Solution Thrift with Part D Option 1 (Cost) - H2450-007-0 Benefit Details |
McCook | $51.70 | $325 | 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 | |||||
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 | |||||||||
Medica Prime Solution Value with Part D Option 1 (Cost) - H2450-022-0 Benefit Details |
McCook | $77.70 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Basic with Part D Option 1 (Cost) - H2450-016-0 Benefit Details |
McCook | $95.70 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,000 Browse Formulary | |||||
Medica Clear Solution Essential (PPO) - H3283-003-0 Benefit Details |
McCook | $102.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $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 | |||||||||
Medica Prime Solution Value with Part D Option 2 (Cost) - H2450-023-0 Benefit Details |
McCook | $111.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Basic with Part D Option 2 (Cost) - H2450-001-0 Benefit Details |
McCook | $129.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced w/Part D Option 1 (Cost) - H2450-017-0 Benefit Details |
McCook | $149.70 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $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 | |||||||||
Medica Prime Solution Value with Part D Option 3 (Cost) - H2450-028-0 Benefit Details |
McCook | $171.80 | $0 | Many Generics | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Enhanced w/Part D Option 2 (Cost) - H2450-002-0 Benefit Details |
McCook | $183.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Basic with Part D Option 3 (Cost) - H2450-005-0 Benefit Details |
McCook | $189.80 | $0 | Many Generics | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $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 | |||||||||
Medica Clear Solution Premier (PPO) - H3283-001-0 Benefit Details |
McCook | $206.70 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $2,500 Browse Formulary | |||||
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Medica Prime Solution Enhanced w/Part D Option 3 (Cost) - H2450-006-0 Benefit Details |
McCook | $243.80 | $0 | Many Generics | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,000 Browse Formulary | |||||
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