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 Plan 3 (HMO) - H4456-025-0 Benefit Details |
Polk | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $7.00 Preferred Brand: $44.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,900 Browse Formulary | |||||
Care Improvement Plus Copper RX (PPO SNP) - H0084-032-0 Benefit Details |
Polk | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx (PPO SNP) - H0084-011-0 Benefit Details |
Polk | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | 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 | |||||||||
Care Improvement Plus Medicare Advantage (PPO) - H0084-013-0 Benefit Details |
Polk | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,900 Browse Formulary | |||||
Coventry Advantra Platinum (PPO) - H1608-001-0 Benefit Details |
Polk | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $3,300 Browse Formulary | |||||
Coventry Advantra Silver (HMO) - H1609-001-0 Benefit Details |
Polk | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $85.00 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 | |||||||||
Coventry Total Care (HMO) - H1609-009-0 Benefit Details |
Polk | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Humana Gold Plus H0028-002 (HMO) - H0028-002-0 Benefit Details |
Polk | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
HumanaChoice H5868-004 (PPO) - H5868-004-0 Benefit Details |
Polk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | |||||||||
Today's Options Premier 600 (PFFS) - H6169-011-0 Benefit Details |
Polk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Today's Options Premier 300 (PFFS) - H6169-001-0 Benefit Details |
Polk | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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UnitedHealthcare Dual Complete (HMO-POS SNP) - H2803-012-0 Benefit Details |
Polk | $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 | |||||||||
HumanaChoice H5868-001 (PPO) - H5868-001-0 Benefit Details |
Polk | $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 | |||||
Today's Options Premier Plus 650B (PFFS) - H6169-031-0 Benefit Details |
Polk | $32.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
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Care Improvement Plus Chrome RX (PPO SNP) - H0084-031-0 Benefit Details |
Polk | $34.60 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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 | |||||||||
Care Improvement Plus Dual Advantage (PPO SNP) - H0084-012-0 Benefit Details |
Polk | $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% | n/a Browse Formulary | |||||
Care Improvement Plus Silver Rx (PPO SNP) - H0084-010-0 Benefit Details |
Polk | $34.60 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Today's Options Premier Plus 350A (PFFS) - H6169-021-0 Benefit Details |
Polk | $77.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | 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 | |||||||||
AARP MedicareComplete Plan 1 (HMO) - H4456-015-0 Benefit Details |
Polk | $85.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $38.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $3,900 Browse Formulary | |||||
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