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 |
|||||||||
HumanaChoice H6609-004 (PPO) - H6609-004-0 Benefit Details |
Grand Forks | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Medica Prime Solution Thrift with Part D Option 1 (Cost) - H2450-007-0 Benefit Details |
Grand Forks | $51.70 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $6,700 Browse Formulary | |||||
HumanaChoice H6609-017 (PPO) - H6609-017-0 Benefit Details |
Grand Forks | $58.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value with Part D Option 1 (Cost) - H2450-022-0 Benefit Details |
Grand Forks | $77.70 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Basic with Part D Option 1 (Cost) - H2450-016-0 Benefit Details |
Grand Forks | $95.70 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,000 Browse Formulary | |||||
Medica Clear Solution Essential (PPO) - H3283-003-0 Benefit Details |
Grand Forks | $102.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $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 | |||||||||
Medica Prime Solution Value with Part D Option 2 (Cost) - H2450-023-0 Benefit Details |
Grand Forks | $111.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Basic with Part D Option 2 (Cost) - H2450-001-0 Benefit Details |
Grand Forks | $129.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced w/Part D Option 1 (Cost) - H2450-017-0 Benefit Details |
Grand Forks | $149.70 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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 | |||||||||
Medica Prime Solution Value with Part D Option 3 (Cost) - H2450-028-0 Benefit Details |
Grand Forks | $171.80 | $0 | Many Generics | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Enhanced w/Part D Option 2 (Cost) - H2450-002-0 Benefit Details |
Grand Forks | $183.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Basic with Part D Option 3 (Cost) - H2450-005-0 Benefit Details |
Grand Forks | $189.80 | $0 | Many Generics | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 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 | |||||||||
Medica Clear Solution Premier (PPO) - H3283-001-0 Benefit Details |
Grand Forks | $206.70 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $2,500 Browse Formulary | |||||
-- | -- | -- | |||||||||
Medica Prime Solution Enhanced w/Part D Option 3 (Cost) - H2450-006-0 Benefit Details |
Grand Forks | $243.80 | $0 | Many Generics | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,000 Browse Formulary | |||||
|