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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UnitedHealthcare MedicareDirect Essential (PFFS) - H5435-001-0 Benefit Details |
Rosebud | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
New West Medicare Value (PPO) - H2701-003-0 Benefit Details |
Rosebud | $17.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: 25% Specialty Tier: 33% | $3,400 Browse Formulary | |||||
UnitedHealthcare MedicareDirect Rx (PFFS) - H5435-014-0 Benefit Details |
Rosebud | $28.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $44.00 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 | |||||||||
New West Medicare Preferred (PPO) - H2701-005-0 Benefit Details |
Rosebud | $54.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: 20% Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Today's Options Premier 600 (PFFS) - H5421-049-0 Benefit Details |
Rosebud | $60.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Humana Gold Choice H2944-052 (PFFS) - H2944-052-0 Benefit Details |
Rosebud | $75.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 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 | |||||||||
Today's Options Premier Plus 650H (PFFS) - H5421-073-0 Benefit Details |
Rosebud | $87.00 | $87 | 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: $90.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Today's Options Premier 300 (PFFS) - H5421-209-0 Benefit Details |
Rosebud | $95.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
New West Medicare Enhanced (PPO) - H2701-001-0 Benefit Details |
Rosebud | $120.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: 15% 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 | |||||||||
Today's Options Premier Plus 350A (PFFS) - H5421-067-0 Benefit Details |
Rosebud | $144.00 | $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 | |||||
Humana Gold Choice H2944-222 (PFFS) - H2944-222-0 Benefit Details |
Rosebud | $202.00 | $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% | $3,400 Browse Formulary | |||||
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