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) - H0609-018-0 Benefit Details |
Boulder | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 | ||||||
AARP MedicareComplete SecureHorizons Plan 2 (HMO) - H0609-012-0 Benefit Details |
Boulder | $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% | $4,200 Browse Formulary | |||||
Aetna Medicare Select Plan (HMO) - H6923-001-0 Benefit Details |
Boulder | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,400 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 | |||||||||
Humana Gold Choice H8145-120 (PFFS) - H8145-120-0 Benefit Details |
Boulder | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Humana Gold Plus H5291-002 (HMO) - H5291-002-0 Benefit Details |
Boulder | $0.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 15% Non-Preferred Brand: 30% Specialty Tier: 25% | $5,500 Browse Formulary | |||||
HumanaChoice H0623-009 (PPO) - H0623-009-0 Benefit Details |
Boulder | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 | ||||||
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 Core (HMO) - H0630-013-0 Benefit Details |
Boulder | $0.00 | $0 | All Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Vaccines: $0.00 | $3,400 Browse Formulary | |||||
AB Basic Plan (Cost) - H0602-026-0 Benefit Details |
Boulder | $3.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Rocky Mountain Green Plan (Cost) - H0602-042-0 Benefit Details |
Boulder | $5.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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 | |||||||||
Rocky Mountain Thrifty Plan (Cost) - H0602-027-0 Benefit Details |
Boulder | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,000 | ||||||
Humana Gold Plus H5291-001 (HMO) - H5291-001-0 Benefit Details |
Boulder | $27.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $89.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H0624-001-0 Benefit Details |
Boulder | $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 | |||||||||
UnitedHealthcare Nursing Home Plan (PPO SNP) - H0620-002-0 Benefit Details |
Boulder | $29.20 | $325 | 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 | |||||
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Colorado Access Advantage Peak Plan (HMO) - H0621-006-0 Benefit Details |
Boulder | $31.90 | $325 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Colorado Access Advantage Summit Plan (HMO SNP) - H0621-010-0 Benefit Details |
Boulder | $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: $7.50 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 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 | |||||||||
Senior Advantage Medicare Medicaid Plan (HMO SNP) - H0630-014-0 Benefit Details |
Boulder | $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 | |||||
HumanaChoice H0623-011 (PPO) - H0623-011-0 Benefit Details |
Boulder | $39.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 18% Non-Preferred Brand: 30% Specialty Tier: 25% | $5,500 Browse Formulary | |||||
AARP MedicareComplete SecureHorizons Plan 1 (HMO) - H0609-007-0 Benefit Details |
Boulder | $45.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $42.00 Non-Preferred Brand: $91.00 Specialty Tier: 33% | $3,900 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 | |||||||||
Kaiser Permanente Senior Advantage Silver (HMO) - H0630-015-0 Benefit Details |
Boulder | $48.00 | $0 | All Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Vaccines: $0.00 | $3,400 Browse Formulary | |||||
Rocky Mountain Green Plan + Rx (Cost) - H0602-043-0 Benefit Details |
Boulder | $56.00 | $125 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $13.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Rocky Mountain Standard Plan (Cost) - H0602-009-0 Benefit Details |
Boulder | $61.50 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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 | |||||||||
Aetna Medicare Select Plan (PPO) - H5521-028-0 Benefit Details |
Boulder | $68.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
HumanaChoice H0623-001 (PPO) - H0623-001-0 Benefit Details |
Boulder | $70.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Brand: $84.00 Specialty Tier: 33% | $5,500 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) - H0602-039-0 Benefit Details |
Boulder | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 | |||||||||
Humana Gold Choice H8145-123 (PFFS) - H8145-123-0 Benefit Details |
Boulder | $81.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $89.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Kaiser Permanente Senior Advantage Plus Choice (HMO-POS) - H0630-019-0 Benefit Details |
Boulder | $91.00 | $0 | All Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Vaccines: $0.00 | $3,400 Browse Formulary | |||||
Rocky Mountain Standard Plan + Rx (Cost) - H0602-022-0 Benefit Details |
Boulder | $139.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $65.00 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 | |||||||||
Rocky Mountain Plus Plan (Cost) - H0602-003-0 Benefit Details |
Boulder | $147.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Kaiser Permanente Senior Advantage Gold (HMO) - H0630-016-0 Benefit Details |
Boulder | $185.00 | $0 | All Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Vaccines: $0.00 | $2,350 Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) - H0602-019-0 Benefit Details |
Boulder | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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