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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ConnectiCare VIP Prime 1 (HMO) - H3528-001-0 Benefit Details |
Tolland | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
ConnectiCare VIP Prime 4 (HMO) - H3528-003-0 Benefit Details |
Tolland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 | ||||||
UnitedHealthcare MedicareComplete Essential (HMO) - H0755-032-0 Benefit Details |
Tolland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,200 | ||||||
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 MedicareComplete Plan 2 (HMO) - H0755-031-0 Benefit Details |
Tolland | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,600 Browse Formulary | |||||
Wellcare Value (HMO) - H0712-019-0 Benefit Details |
Tolland | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: $89.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
Anthem MediBlue Preferred Standard (PPO) - H2836-001-0 Benefit Details |
Tolland | $18.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Injectable Drugs: 33% Specialty Tier: 33% | $3,800 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 | |||||||||
AARP MedicareComplete Choice (Regional PPO) - R7444-001-0 Benefit Details |
Tolland | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
ConnectiCare VIP Option 3 (HMO-POS) - H3528-008-0 Benefit Details |
Tolland | $24.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Anthem MediBlue Value (HMO) - H5854-005-0 Benefit Details |
Tolland | $28.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Brand: $80.00 Injectable Drugs: 33% 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 | |||||||||
WellCare Access (HMO SNP) - H0712-005-0 Benefit Details |
Tolland | $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: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $94.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
UnitedHealthcare Nursing Home Plan (PPO SNP) - H0710-001-0 Benefit Details |
Tolland | $31.40 | $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 | |||||
ConnectiCare VIP Prime 2 (HMO) - H3528-009-0 Benefit Details |
Tolland | $40.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,400 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 | |||||||||
WellCare Choice (HMO-POS) - H0712-001-0 Benefit Details |
Tolland | $69.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | $4,900 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Plan 1 (HMO) - H0755-030-0 Benefit Details |
Tolland | $99.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $43.00 Non-Preferred Brand: $91.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
ConnectiCare VIP Prime 3 (HMO) - H3528-002-0 Benefit Details |
Tolland | $134.00 | $0 | All Generics | 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 | |||||||||
ConnectiCare VIP Option 1 (HMO-POS) - H3528-006-0 Benefit Details |
Tolland | $204.00 | $0 | All Generics | Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,500 Browse Formulary | |||||
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