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 |
San Bernardino | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 | ||||||
AARP MedicareComplete SecureHorizons Plan 1 (HMO) - H0543-007-0 Benefit Details |
San Bernardino | $0.00 | $0 | Some Generics | 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 | |||||
AARP MedicareComplete SecureHorizons Plan 2 (HMO) - H0543-144-0 Benefit Details |
San Bernardino | $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 | |||||
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) - H0523-022-0 Benefit Details |
San Bernardino | $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) - H0564-047-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Injectable Drugs: $95.00 Specialty Tier: 33% | $4,000 Browse Formulary | |||||
Blue Shield 65 Plus (HMO) - H0504-017-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Injectable Drugs: 25% 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 | |||||||||
Brand New Day (HMO) - H0838-022-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Generic: $5.00 Brand: $40.00 | $3,400 Browse Formulary | |||||
Care1st AdvantageOptimum Plan (HMO) - H5928-012-0 Benefit Details |
San Bernardino | $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) - H0544-019-0 Benefit Details |
San Bernardino | $0.00 | $0 | All Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $29.00 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 ESRD (HMO SNP) - H0544-020-0 Benefit Details |
San Bernardino | $0.00 | $0 | All Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
CareMore Heart (HMO SNP) - H0544-038-0 Benefit Details |
San Bernardino | $0.00 | $0 | All Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $29.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
CareMore Reliance (HMO SNP) - H0544-010-0 Benefit Details |
San Bernardino | $0.00 | $0 | All Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $29.00 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) - H0544-008-0 Benefit Details |
San Bernardino | $0.00 | $0 | All Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $29.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $10.00 | $3,400 Browse Formulary | |||||
Central Health Medicare Plan (HMO) - H5649-001-0 Benefit Details |
San Bernardino | $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 |
San Bernardino | $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 |
San Bernardino | $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 |
San Bernardino | $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 |
San Bernardino | $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 |
San Bernardino | $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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Health Net Gold Select (HMO) - H0562-085-0 Benefit Details |
San Bernardino | $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 | |||||
Health Net Healthy Heart Plan 1 (HMO) - H0562-082-0 Benefit Details |
San Bernardino | $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 | |||||
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 Jade (HMO SNP) - H0562-092-0 Benefit Details |
San Bernardino | $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 |
San Bernardino | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Health Net Seniority Plus Ruby Plan 1 (HMO) - H0562-083-0 Benefit Details |
San Bernardino | $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 | |||||
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 | |||||||||
Heart First (HMO SNP) - H5425-033-0 Benefit Details |
San Bernardino | $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 H0108-005 (HMO) - H0108-005-0 Benefit Details |
San Bernardino | $0.00 | $0 | Some Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $41.00 Non-Preferred Brand: $92.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Humana Gold Plus H0108-032 (HMO) - H0108-032-0 Benefit Details |
San Bernardino | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,000 | ||||||
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 | |||||||||
Inter Valley Health Plan Service To Seniors (HMO) - H0545-001-0 Benefit Details |
San Bernardino | $0.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $29.00 Non-Preferred Brand: $67.00 Specialty Tier: 25% | $3,400 Browse Formulary | |||||
Inter Valley Health Plan Total Fit (HMO) - H0545-011-0 Benefit Details |
San Bernardino | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Kaiser Permanente Senior Advantage B Only South (HMO) - H0524-002-0 Benefit Details |
SAN BERNARDINO | $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 | |||||
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 | |||||||||
Kaiser Permanente Senior Advantage Inland Empire (HMO) - H0524-015-0 Benefit Details |
San Bernardino | $0.00 | $0 | All Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $65.00 Specialty Tier: 25% Vaccines: $0.00 | $3,400 Browse Formulary | |||||
SCAN Balance (HMO SNP) - H5425-035-0 Benefit Details |
San Bernardino | $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) - H5425-009-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% Select Care Drugs: $10.00 | $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 Healthy at Home (HMO SNP) - H9104-009-0 Benefit Details |
San Bernardino | $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 | |||||
StartSmart with CareMore (HMO) - H0544-039-0 Benefit Details |
San Bernardino | $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 |
San Bernardino | $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 | |||||
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) - H0543-081-0 Benefit Details |
San Bernardino | $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 | |||||
Humana Gold Plus SNP-DE H0108-017 (HMO SNP) - H0108-017-0 Benefit Details |
San Bernardino | $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 | |||||
Care1st TotalDual Plan (HMO SNP) - H5928-007-0 Benefit Details |
San Bernardino | $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 | |||||
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 H0108-006 (HMO-POS) - H0108-006-0 Benefit Details |
San Bernardino | $29.00 | $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% | $3,400 Browse Formulary | |||||
Brand New Day (HMO SNP) - H0838-020-0 Benefit Details |
San Bernardino | $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 |
San Bernardino | $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 |
San Bernardino | $29.80 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $6,700 Browse Formulary | |||||
Health Net Seniority Plus Amber I (HMO SNP) - H0562-055-0 Benefit Details |
San Bernardino | $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 Seniority Plus Amber II (HMO SNP) - H0562-070-0 Benefit Details |
San Bernardino | $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 | |||||||||
Molina Medicare Options Plus (HMO SNP) - H5810-001-0 Benefit Details |
San Bernardino | $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 | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Central Health Medi-Medi Plan (HMO SNP) - H5649-002-0 Benefit Details |
San Bernardino | $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: 25% Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | n/a Browse Formulary | |||||
Easy Choice Plus Plan (HMO) - H5087-002-0 Benefit Details |
San Bernardino | $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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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 | |||||||||
IEHP Medicare DualChoice (HMO SNP) - H5640-001-0 Benefit Details |
San Bernardino | $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 | |||||
SCAN Connections (HMO SNP) - H5425-012-0 Benefit Details |
San Bernardino | $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% Tier 6: 25% | n/a Browse Formulary | |||||
SCAN Connections at Home (HMO SNP) - H5425-031-0 Benefit Details |
San Bernardino | $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% Tier 6: 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 | |||||||||
VillageHealth (HMO-POS SNP) - H5943-001-0 Benefit Details |
San Bernardino | $29.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $65.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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Health Net Healthy Heart Plan 2 (HMO) - H0562-086-0 Benefit Details |
San Bernardino | $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 | |||||
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