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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Care1st AdvantageOptimum Plan (HMO) - H5928-016-0 Benefit Details |
Santa Clara | $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 Connect (HMO SNP) - H0544-041-0 Benefit Details |
Santa Clara | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | All Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
CareMore Touch (HMO SNP) - H0544-022-0 Benefit Details |
Santa Clara | $0.00 | $0 | All Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 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 | |||||||||
Easy Choice Best Plan (HMO) - H5087-005-0 Benefit Details |
Santa Clara | $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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StartSmart with CareMore (HMO) - H0544-021-0 Benefit Details |
Santa Clara | $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 North (HMO SNP) - H0524-030-0 Benefit Details |
Santa Clara | $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: $12.00 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 | |||||||||
Care1st TotalDual Plan (HMO SNP) - H5928-031-0 Benefit Details |
Santa Clara | $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 | |||||
Easy Choice Plus Plan (HMO) - H5087-002-0 Benefit Details |
Santa Clara | $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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CareMore Breathe (HMO SNP) - H0544-024-0 Benefit Details |
Santa Clara | $49.00 | $0 | All Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 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 Diabetes (HMO SNP) - H0544-025-0 Benefit Details |
Santa Clara | $49.00 | $0 | All Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
CareMore Heart (HMO SNP) - H0544-037-0 Benefit Details |
Santa Clara | $49.00 | $0 | All Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
CareMore Value Plus (HMO) - H0544-012-0 Benefit Details |
Santa Clara | $49.00 | $0 | All Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $85.00 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 Classic (HMO) - H5425-020-0 Benefit Details |
Santa Clara | $59.00 | $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: $75.00 Specialty Tier: 33% Select Care Drugs: $10.00 | $3,400 Browse Formulary | |||||
Health Net Ruby Select (HMO) - H0562-089-0 Benefit Details |
Santa Clara | $69.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Kaiser Permanente Senior Advantage Santa Clara (HMO) - H0524-039-0 Benefit Details |
Santa Clara | $72.00 | $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 | |||||
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 (HMO) - H0562-037-0 Benefit Details |
Santa Clara | $99.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
Health Net Seniority Plus Green (HMO) - H0562-045-0 Benefit Details |
Santa Clara | $99.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
AARP MedicareComplete SecureHorizons (HMO) - H0543-029-0 Benefit Details |
Santa Clara | $106.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $44.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,900 Browse Formulary | |||||
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