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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HealthSpring Advantage SMS (HMO) - H4407-011-0 Benefit Details |
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Humana Gold Plus H1036-171 (HMO) - H1036-171-0 Benefit Details |
Jackson | $0.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Humana Gold Plus SNP-DB H1036-178 (HMO SNP) - H1036-178-0 Benefit Details |
Jackson | $0.00 | $0 | Some Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 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 | |||||||||
HumanaChoice R5826-068 (Regional PPO) - R5826-068-0 Benefit Details |
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Humana Gold Plus SNP-DE H1036-169 (HMO SNP) - H1036-169-0 Benefit Details |
Jackson | $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 Non-Preferred Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 28% | n/a Browse Formulary | |||||
HealthSpring TotalCare SMS (HMO SNP) - H4407-004-0 Benefit Details |
Jackson | $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 | |||||
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 | |||||||||
HealthSpring Preferred SMS (HMO) - H4407-002-0 Benefit Details |
Jackson | $39.50 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
HumanaChoice R5826-078 (Regional PPO) - R5826-078-0 Benefit Details |
Jackson | $42.00 | $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% | $6,700 Browse Formulary | |||||
HumanaChoice H4956-001 (PPO) - H4956-001-0 Benefit Details |
Jackson | $48.00 | $0 | Few Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,250 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 | |||||||||
Today's Options Premier 600 (PFFS) - H6169-013-0 Benefit Details |
Jackson | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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HealthSpring Premier SMS (HMO-POS) - H4407-023-0 Benefit Details |
Jackson | $69.50 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $2,950 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) - R5826-011-0 Benefit Details |
Jackson | $72.00 | $0 | Few Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 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 | |||||||||
Humana Gold Choice H8145-087 (PFFS) - H8145-087-0 Benefit Details |
Jackson | $79.00 | $0 | Few Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Today's Options Premier 300 (PFFS) - H6169-051-0 Benefit Details |
Jackson | $80.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Today's Options Premier Plus 650D (PFFS) - H6169-033-0 Benefit Details |
Jackson | $92.00 | $85 | 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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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 Plus 350A (PFFS) - H6169-024-0 Benefit Details |
Jackson | $152.00 | $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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