2013 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
PacificSource Medicare Explorer 10 (PPO) - H4754-010-0 Benefit Details |
Bingham | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
-- | |||||||||||
PacificSource Medicare Essentials Rx 21 (HMO) - H3864-021-0 Benefit Details |
Bingham | $29.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $44.00 Non-Preferred Brand: $88.00 Specialty Tier: 33% | $3,000 Browse Formulary | |||||
True Blue (HMO) - H1350-006-0 Benefit Details |
Bingham | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Secure Blue (PPO) - H1302-004-0 Benefit Details |
Bingham | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
PacificSource Medicare Explorer Rx 9 (PPO) - H4754-009-0 Benefit Details |
Bingham | $50.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $44.00 Non-Preferred Brand: $88.00 Specialty Tier: 33% | $3,000 Browse Formulary | |||||
-- | |||||||||||
Windsor Medicare Extra Emerald Plan (HMO) - H5698-178-0 Benefit Details |
Bingham | $60.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $44.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Regence MedAdvantage Basic (PPO) - H1304-001-0 Benefit Details |
Bingham | $64.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Windsor Medicare Extra Silver Plan (HMO) - H5698-187-0 Benefit Details |
Bingham | $65.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Windsor Medicare Extra Gold Plan (HMO) - H5698-179-0 Benefit Details |
Bingham | $90.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Secure Blue (PPO) - H1302-001-0 Benefit Details |
Bingham | $93.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $43.00 Non-Preferred Brand: $93.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Regence MedAdvantage + Rx Classic (PPO) - H1304-002-0 Benefit Details |
Bingham | $98.00 | $165 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.50 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% Injectable Drugs: 29% | $3,400 Browse Formulary | |||||
True Blue Rx Option II (HMO) - H1350-010-0 Benefit Details |
Bingham | $121.00 | $300 | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $31.00 Non-Preferred Brand: $70.00 Specialty Tier: 25% | $3,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
True Blue Rx Option I (HMO) - H1350-001-0 Benefit Details |
Bingham | $142.00 | $0 | Many Generics | Generic: $6.00 Preferred Brand: $31.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,000 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) - H5698-180-0 Benefit Details |
Bingham | $143.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $4,500 Browse Formulary | |||||
True Blue Special Needs Plan (HMO SNP) - H1350-009-0 Benefit Details |
Bingham | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Regence MedAdvantage + Rx Enhanced (PPO) - H1304-004-0 Benefit Details |
Bingham | $188.00 | $0 | Many Generics | Preferred Generic: $5.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Injectable Drugs: 33% | $2,500 Browse Formulary | |||||
|