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 |
|||||||||
Lovelace Medicare Plan of San Juan County (HMO) - H3251-024-0 Benefit Details |
San Juan | $19.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $7.00 Preferred Brand: $36.00 Non-Preferred Brand: $70.00 Specialty Tier: Lesser of $350 or : 33% | $2,800 Browse Formulary | |||||
Molina Medicare Options Plus (HMO SNP) - H9082-007-0 Benefit Details |
San Juan | $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% | n/a Browse Formulary | |||||
Molina Medicare Options (HMO) - H9082-002-0 Benefit Details |
San Juan | $40.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $2,800 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Presbyterian MediCare PPO Plan 1 (PPO) - H3206-003-0 Benefit Details |
San Juan | $52.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
Presbyterian MediCare PPO Plan 2 with Rx (PPO) - H3206-001-0 Benefit Details |
San Juan | $90.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 3 with Rx (PPO) - H3206-002-0 Benefit Details |
San Juan | $118.00 | $0 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,000 Browse Formulary | |||||
|