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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Anthem Senior Advantage Basic (HMO) - H3655-013-0 Benefit Details |
Licking | $0.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $11.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Injectable Drugs: 33% Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare Access Classic (Regional PPO) - R5941-007-0 Benefit Details |
Licking | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 | ||||||
Humana Gold Plus H8953-005 (HMO) - H8953-005-0 Benefit Details |
Licking | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $4,900 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 Plus SNP-CHF/DM H8953-012 (HMO SNP) - H8953-012-0 Benefit Details |
Licking | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
HumanaChoice R5826-021 (Regional PPO) - R5826-021-0 Benefit Details |
Licking | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
MediGold Essential Care (HMO) - H3668-011-0 Benefit Details |
Licking | $0.00 | $0 | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | $3,200 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 Plus SNP-DE H8953-008 (HMO SNP) - H8953-008-0 Benefit Details |
Licking | $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 Preferred Brand: $41.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
CareSource Advantage (HMO SNP) - H6178-001-0 Benefit Details |
Licking | $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 | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Blue Medicare Access Value (Regional PPO) - R5941-008-0 Benefit Details |
Licking | $36.00 | $95 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Injectable Drugs: 33% Specialty Tier: 33% | $6,000 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 H8145-135 (PFFS) - H8145-135-0 Benefit Details |
Licking | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
MediGold Medical Only (HMO) - H3668-013-0 Benefit Details |
Licking | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,200 | ||||||
Anthem Senior Advantage Plus (HMO) - H3655-030-0 Benefit Details |
Licking | $42.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Injectable Drugs: 33% 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 | |||||||||
Anthem Medicare Preferred Standard (PPO) - H5529-001-0 Benefit Details |
Licking | $55.00 | $90 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $13.00 Preferred Brand: $44.00 Non-Preferred Brand: $95.00 Injectable Drugs: 33% Specialty Tier: 33% | $5,100 Browse Formulary | |||||
Humana Prime Choice H3619-012 (PPO) - H3619-012-0 Benefit Details |
Licking | $60.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,900 Browse Formulary | |||||
HumanaChoice R5826-007 (Regional PPO) - R5826-007-0 Benefit Details |
Licking | $74.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | $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 H8145-032 (PFFS) - H8145-032-0 Benefit Details |
Licking | $92.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
MediGold Classic Preferred (HMO) - H3668-005-0 Benefit Details |
Licking | $99.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $38.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,200 Browse Formulary | |||||
MediGold Network Choice (PPO) - H1846-001-0 Benefit Details |
Licking | $145.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | $3,200 Browse Formulary | |||||
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