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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HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Wirt | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
SecureCare - Option I (HMO) - H5151-004-0 Benefit Details |
Wirt | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Freedom Blue PPO HD (PPO) - H5106-025-0 Benefit Details |
Wirt | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 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 | |||||||||
SecureChoice - Option I (PPO) - H8604-004-0 Benefit Details |
Wirt | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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HumanaChoice H3619-016 (PPO) - H3619-016-0 Benefit Details |
Wirt | $37.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,900 Browse Formulary | |||||
Freedom Blue PPO Value (PPO) - H5106-017-0 Benefit Details |
Wirt | $58.00 | 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 R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Wirt | $75.00 | $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 | |||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Wirt | $85.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,300 Browse Formulary | |||||
SecureCare - Option II (HMO) - H5151-002-0 Benefit Details |
Wirt | $94.50 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 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 | |||||||||
SecureChoice - Option II (PPO) - H8604-003-0 Benefit Details |
Wirt | $114.50 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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SecureCare - Option III (HMO) - H5151-006-0 Benefit Details |
Wirt | $130.50 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Freedom Blue PPO Standard (PPO) - H5106-013-0 Benefit Details |
Wirt | $143.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $4,000 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 | |||||||||
SecureChoice - Option III (PPO) - H8604-006-0 Benefit Details |
Wirt | $150.50 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Freedom Blue PPO Deluxe (PPO) - H5106-014-0 Benefit Details |
Wirt | $180.00 | $0 | Many Generics | Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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