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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Horizon Medicare Blue Value (HMO) - H3154-013-0 Benefit Details |
Salem | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Horizon Medicare Blue Value w/ Rx Standard (HMO) - H3154-004-0 Benefit Details |
Salem | $0.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Brand: $84.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
AmeriHealth 65 Preferred Medical Only (HMO) - H3156-029-0 Benefit Details |
Salem | $24.30 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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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 | |||||||||
Horizon Medicare Blue TotalCare (HMO SNP) - H3154-020-0 Benefit Details |
Salem | $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% Tier 5: 25% | n/a Browse Formulary | |||||
Horizon Medicare Blue Access (HMO-POS) - H3154-005-0 Benefit Details |
Salem | $71.80 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
AmeriHealth 65 Preferred Rx (HMO) - H3156-030-0 Benefit Details |
Salem | $74.90 | $295 | No additional gap coverage, only the Donut Hole Discount | Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 25% | $6,700 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 | |||||||||
Aetna Medicare Standard Plan (HMO) - H3152-022-0 Benefit Details |
Salem | $102.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $33.00 Preferred Brand: $41.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Horizon Medicare Blue Value w/ Rx Enhanced (HMO) - H3154-016-0 Benefit Details |
Salem | $110.80 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $42.00 Non-Preferred Brand: $84.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Horizon Medicare Blue Access w/ Rx Standard (HMO-POS) - H3154-012-0 Benefit Details |
Salem | $134.10 | $325 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Brand: $84.00 Specialty Tier: 25% | $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 | |||||||||
Horizon Medicare Blue Access w/Rx Enhanced (HMO-POS) - H3154-006-0 Benefit Details |
Salem | $175.80 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
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