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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AARP MedicareComplete SecureHorizons Essential (HMO) - H0543-121-0 Benefit Details |
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 | ||||||
AARP MedicareComplete SecureHorizons Plan 2 (HMO) - H0543-138-0 Benefit Details |
Orange | $0.00 | $0 | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: $92.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
AARP MedicareComplete SecureHorizons Premier (HMO) - H0543-004-0 Benefit Details |
Orange | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,900 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 | |||||||||
Aetna Medicare Select Plan (HMO) - H0523-002-0 Benefit Details |
Orange | $0.00 | $0 | Some Generics | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Cross Senior Secure Plan I (HMO) - H0564-006-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $4.00 Non-Preferred Generic: $13.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Injectable Drugs: 33% Specialty Tier: 33% | $4,000 Browse Formulary | |||||
Blue Cross Senior Secure Plan II (HMO) - H0564-049-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $7.00 Non-Preferred Generic: $13.00 Preferred Brand: $36.00 Non-Preferred Brand: $80.00 Injectable Drugs: 33% 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 | |||||||||
Blue Shield 65 Plus (HMO) - H0504-015-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Injectable Drugs: 25% Specialty Tier: 33% | $3,000 Browse Formulary | |||||
Blue Shield 65 Plus Choice Plan (HMO) - H0504-021-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Injectable Drugs: 25% Specialty Tier: 33% | $2,000 Browse Formulary | |||||
Brand New Day (HMO) - H0838-022-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Generic: $5.00 Brand: $40.00 | $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 | |||||||||
Care1st AdvantageOptimum Plan (HMO) - H5928-006-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $50.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
CareMore Breathe (HMO SNP) - H0544-014-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
CareMore ESRD (HMO SNP) - H0544-015-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | 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 | |||||||||
CareMore Heart (HMO SNP) - H0544-013-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
CareMore Reliance (HMO SNP) - H0544-004-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
CareMore Touch (HMO SNP) - H0544-005-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | 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 | |||||||||
CareMore Value Plus (HMO) - H0544-002-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, All Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $3,400 Browse Formulary | |||||
Central Health Medicare Plan (HMO) - H5649-001-0 Benefit Details |
Orange | $0.00 | $0 | All Generics | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Central Health Premier Plan (HMO) - H5649-004-0 Benefit Details |
Orange | $0.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 25% Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 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 | |||||||||
Citizens Choice Healthplan (HMO) - H3815-001-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Brand: $60.00 Injectable Drugs: 25% Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Easy Choice Best Plan (HMO) - H5087-005-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
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Freedom VIP Care (HMO SNP) - H5087-007-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% | n/a 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 | |||||||||
Freedom VIP Care COPD (HMO SNP) - H5087-008-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
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Golden (HMO) - H2241-001-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Health Net Gold Select (HMO) - H0562-085-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 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 | |||||||||
Health Net Healthy Heart Plan 1 (HMO) - H0562-082-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Health Net Jade (HMO SNP) - H0562-092-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Health Net Seniority Plus Green (HMO) - H0562-044-0 Benefit Details |
Orange | $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 | |||||||||
Health Net Seniority Plus Ruby Plan 1 (HMO) - H0562-083-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Heart First (HMO SNP) - H5425-028-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
Humana Gold Plus H0108-013 (HMO) - H0108-013-0 Benefit Details |
Orange | $0.00 | $0 | Some Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 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 | |||||||||
Humana Gold Plus H0108-030 (HMO) - H0108-030-0 Benefit Details |
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,000 | ||||||
Kaiser Permanente Senior Advantage B Only South (HMO) - H0524-002-0 Benefit Details |
ORANGE | $0.00 | $0 | n/a | Preferred Generic: $5.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $65.00 Specialty Tier: 25% Vaccines: $0.00 | n/a Browse Formulary | |||||
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) - H0524-003-0 Benefit Details |
Orange | $0.00 | $0 | All Generics, Few Brands | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 25% Vaccines: $0.00 | $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 | |||||||||
SCAN Balance (HMO SNP) - H5425-034-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
SCAN Classic (HMO) - H5425-007-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% Select Care Drugs: $10.00 | $3,400 Browse Formulary | |||||
SCAN Healthy at Home (HMO SNP) - H9104-007-0 Benefit Details |
Orange | $0.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $39.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% Select Care Drugs: $10.00 | 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 | |||||||||
StartSmart with CareMore (HMO) - H0544-007-0 Benefit Details |
Orange | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $10.00 | $6,700 Browse Formulary | |||||
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP) - H0524-029-0 Benefit Details |
Orange | $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 | Preferred Generic: $10.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Vaccines: $0.00 | n/a Browse Formulary | |||||
Humana Gold Plus SNP-DE H0108-016 (HMO SNP) - H0108-016-0 Benefit Details |
Orange | $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% 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 | |||||||||
SCAN Plus (HMO) - H5425-037-0 Benefit Details |
Orange | $27.50 | $325 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Care Drugs: $10.00 | $3,000 Browse Formulary | |||||
Brand New Day (HMO SNP) - H0838-020-0 Benefit Details |
Orange | $29.80 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | n/a Browse Formulary | |||||
Brand New Day D SNP (HMO SNP) - H0838-024-0 Benefit Details |
Orange | $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% | 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 | |||||||||
Brand New Day HMO Extra Care (HMO) - H0838-023-0 Benefit Details |
Orange | $29.80 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $6,700 Browse Formulary | |||||
Care1st TotalDual Plan (HMO SNP) - H5928-005-0 Benefit Details |
Orange | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | n/a Browse Formulary | |||||
Health Net Seniority Plus Amber I (HMO SNP) - H0562-055-0 Benefit Details |
Orange | $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% 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 | |||||||||
Health Net Seniority Plus Amber II (HMO SNP) - H0562-070-0 Benefit Details |
Orange | $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% Tier 5: 25% | n/a Browse Formulary | |||||
Easy Choice Plus Plan (HMO) - H5087-002-0 Benefit Details |
Orange | $29.90 | $325 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 25% Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $6,700 Browse Formulary | |||||
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OneCare (HMO SNP) - H5433-001-0 Benefit Details |
Orange | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Few Generics | Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 | 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 | |||||||||
UnitedHealthcare Dual Complete (HMO SNP) - H0543-079-0 Benefit Details |
Orange | $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% Tier 5: 25% | n/a Browse Formulary | |||||
Health Net Healthy Heart Plan 2 (HMO) - H0562-086-0 Benefit Details |
Orange | $39.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Humana Gold Plus H0108-014 (HMO-POS) - H0108-014-0 Benefit Details |
Orange | $39.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $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 | |||||||||
Anthem Medicare Preferred Standard (PPO) - H8552-002-0 Benefit Details |
Orange | $66.00 | $90 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $17.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Injectable Drugs: 33% Specialty Tier: 33% | $4,500 Browse Formulary | |||||
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