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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Bravo-HealthSpring Achieve (HMO SNP) - H2108-029-0 Benefit Details |
Prince George's | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% Select Diabetic Drugs: $5.00 | n/a Browse Formulary | |||||
Bravo-HealthSpring Classic (HMO) - H2108-028-0 Benefit Details |
Prince George's | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Kaiser Permanente Medicare Plus Basic w/o D (AB) (Cost) - H2150-017-0 Benefit Details |
Prince George's | $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 | |||||||||
Kaiser Permanente Medicare Plus Std w/o D (AB) (Cost) - H2150-022-0 Benefit Details |
Prince George's | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Kaiser Permanente Medicare Plus Std w/Part D (AB) (Cost) - H2150-009-0 Benefit Details |
Prince George's | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% Vaccines: $0.00 | $3,400 Browse Formulary | |||||
Aetna Medicare Basic Plan (HMO) - H2112-001-0 Benefit Details |
Prince George's | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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 Medicare Plus Std w/Part D (B) (Cost) - H2150-029-0 Benefit Details |
PRINCE GEORGES | $23.10 | $0 | n/a | Preferred Generic: $7.00 Non-Preferred Generic: $19.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% Vaccines: $0.00 | n/a Browse Formulary | |||||
Bravo-HealthSpring Achieve Essential (HMO SNP) - H2108-030-0 Benefit Details |
Prince George's | $24.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% Select Diabetic Drugs: $10.00 | n/a Browse Formulary | |||||
Bravo-HealthSpring Essential (HMO) - H2108-022-0 Benefit Details |
Prince George's | $25.00 | $45 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 31% | $6,700 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 | |||||||||
Erickson Advantage Guardian (HMO-POS SNP) - H5652-003-0 Benefit Details |
Prince George's | $28.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Bravo-HealthSpring Select (HMO SNP) - H2108-001-0 Benefit Details |
Prince George's | $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% | n/a Browse Formulary | |||||
Aetna Medicare Standard Plan (HMO) - H2112-007-0 Benefit Details |
Prince George's | $33.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 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 |
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Service | Exper. | Cost Info | |||||||||
UnitedHealthcare Nursing Home Plan (PPO SNP) - H2111-001-0 Benefit Details |
Prince George's | $34.80 | $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 | |||||
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Amerivantage Specialty + Rx (HMO SNP) - H5896-007-0 Benefit Details |
Prince George's | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | n/a Browse Formulary | |||||
Bravo-HealthSpring Traditions (HMO SNP) - H2108-020-0 Benefit Details |
Prince George's | $35.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 | |||||||||
Erickson Advantage Freedom (HMO-POS) - H5652-006-0 Benefit Details |
Prince George's | $48.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Kaiser Permanente Medicare Plus High w/o D (AB) (Cost) - H2150-021-0 Benefit Details |
Prince George's | $64.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Aetna Medicare Premier Plan (HMO) - H2112-014-0 Benefit Details |
Prince George's | $83.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 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 |
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Service | Exper. | Cost Info | |||||||||
Aetna Medicare Standard Plan (PPO) - H5521-036-0 Benefit Details |
Prince George's | $93.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Kaiser Permanente Medicare Plus High w/Part D (AB) (Cost) - H2150-002-0 Benefit Details |
Prince George's | $103.00 | $0 | All Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Vaccines: $0.00 | $3,400 Browse Formulary | |||||
Erickson Advantage Signature without Drugs (HMO-POS) - H5652-002-0 Benefit Details |
Prince George's | $136.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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 | |||||||||
Erickson Advantage Champion (HMO-POS SNP) - H5652-004-0 Benefit Details |
Prince George's | $176.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Erickson Advantage Signature with Drugs (HMO-POS) - H5652-001-0 Benefit Details |
Prince George's | $176.00 | $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% | $5,000 Browse Formulary | |||||
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