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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'Ohana Value (HMO-POS) - H2491-002-0 Benefit Details |
Maui | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $4.00 Preferred Brand: $38.00 Non-Preferred Brand: $68.00 Specialty Tier: 33% | $3,900 Browse Formulary | |||||
Akamai Advantage Secure (Regional PPO) - R7439-001-0 Benefit Details |
Maui | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
AlohaCare Advantage (HMO) - H5969-001-0 Benefit Details |
Maui | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 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 | |||||||||
Kaiser Permanente Senior Advantage Basic (HMO) - H1230-003-0 Benefit Details |
Maui | $0.00 | $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 | |||||
UnitedHealthcare MedicareComplete Choice (Regional PPO) - R3175-001-0 Benefit Details |
Maui | $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% | $6,700 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) - R3175-002-0 Benefit Details |
Maui | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 | ||||||
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 | |||||||||
Akamai Advantage Assured (Regional PPO) - R7439-006-0 Benefit Details |
Maui | $21.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
'Ohana Liberty (HMO-POS SNP) - H2491-004-0 Benefit Details |
Maui | $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: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
AlohaCare Advantage Plus (HMO SNP) - H5969-002-0 Benefit Details |
Maui | $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 | |||||||||
UnitedHealthcare Dual Complete RP (Regional PPO SNP) - R3175-003-0 Benefit Details |
Maui | $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 | |||||
Akamai Advantage Preferred (Regional PPO) - R7439-003-0 Benefit Details |
Maui | $65.50 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 25% | $3,400 Browse Formulary | |||||
65C Plus Basic Option (Cost) - H1251-001-0 Benefit Details |
Maui | $90.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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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 | |||||||||
65C Plus High Option (Cost) - H1251-002-0 Benefit Details |
Maui | $94.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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65C Plus Basic Option BRx (Cost) - H1251-003-0 Benefit Details |
Maui | $121.40 | $325 | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $70.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
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65C Plus High Option SRx (Cost) - H1251-004-0 Benefit Details |
Maui | $138.10 | $325 | No additional gap coverage, only the Donut Hole Discount | Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 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 | |||||||||
Kaiser Permanente Senior Advantage Enhanced (HMO) - H1230-001-0 Benefit Details |
Maui | $143.00 | $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 | |||||
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