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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Gundersen Lutheran Sr. Pref. Value (no RX) (HMO) - H5262-004-0 Benefit Details |
Howard | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice H5868-004 (PPO) - H5868-004-0 Benefit Details |
Howard | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) - H5262-003-0 Benefit Details |
Howard | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $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 | |||||||||
HumanaChoice H5868-001 (PPO) - H5868-001-0 Benefit Details |
Howard | $30.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,000 Browse Formulary | |||||
Gundersen Lutheran Sr. Pref. Elite (no RX) (HMO) - H5262-005-0 Benefit Details |
Howard | $100.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Gundersen Lutheran Senior Pref. Elite (w/RX) (HMO) - H5262-001-0 Benefit Details |
Howard | $142.20 | $50 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 31% | $3,400 Browse Formulary | |||||
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