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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ATRIO Bronze (PPO) - H6743-006-0 Benefit Details |
Douglas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
ATRIO Bronze Rx (Umpqua) (PPO) - H6743-007-0 Benefit Details |
Douglas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
CareSource Silver (HMO) - H3810-006-0 Benefit Details |
Douglas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | |||||||||
Health Net Violet Option 2 (PPO) - H5520-006-0 Benefit Details |
Douglas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Regence MedAdvantage Basic (PPO) - H3817-001-0 Benefit Details |
Douglas | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
CareSource - SNP (HMO SNP) - H3810-002-0 Benefit Details |
Douglas | $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% | 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 | |||||||||
CareSource Bronze Rx (HMO) - H3810-019-0 Benefit Details |
Douglas | $37.40 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% | $3,400 Browse Formulary | |||||
ATRIO Special Needs Plan (HMO SNP) - H3814-007-0 Benefit Details |
Douglas | $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% | n/a Browse Formulary | |||||
Health Net Aqua (PPO) - H5520-003-0 Benefit Details |
Douglas | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
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 | |||||||||
ATRIO Silver (PPO) - H6743-002-0 Benefit Details |
Douglas | $52.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Regence MedAdvantage + Rx Classic (PPO) - H3817-002-0 Benefit Details |
Douglas | $53.00 | $165 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.50 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% Injectable Drugs: 29% | $3,400 Browse Formulary | |||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Douglas | $57.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | |||||||||
ODS Advantage PPORX (PPO) - H3813-006-0 Benefit Details |
Douglas | $68.00 | $120 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $33.00 Preferred Brand: $41.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $3,400 Browse Formulary | |||||
CareSource Gold (HMO) - H3810-001-0 Benefit Details |
Douglas | $74.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,000 | ||||||
CareSource Silver Plus Rx (HMO) - H3810-007-0 Benefit Details |
Douglas | $83.50 | $0 | Many Generics | Preferred Generic: $5.00 Non-Preferred Generic: $29.00 Preferred Brand: $39.00 Non-Preferred Brand: $69.00 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 | |||||||||
Health Net Violet Option 1 (PPO) - H5520-004-0 Benefit Details |
Douglas | $95.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $2,500 Browse Formulary | |||||
ATRIO Silver Rx (PPO) - H6743-003-0 Benefit Details |
Douglas | $97.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
CareSource Platinum (HMO-POS) - H3810-004-0 Benefit Details |
Douglas | $132.90 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,000 | ||||||
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 | |||||||||
CareSource Gold Plus Rx (HMO) - H3810-003-0 Benefit Details |
Douglas | $138.20 | $0 | Many Generics | Preferred Generic: $5.00 Non-Preferred Generic: $29.00 Preferred Brand: $39.00 Non-Preferred Brand: $69.00 Specialty Tier: 33% | $2,000 Browse Formulary | |||||
Health Net Healthy Heart (PPO) - H5520-010-0 Benefit Details |
Douglas | $139.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $2,000 Browse Formulary | |||||
ODS Advantage PPORX Select (PPO) - H3813-003-0 Benefit Details |
Douglas | $139.00 | $120 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $33.00 Preferred Brand: $41.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $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 | |||||||||
Regence MedAdvantage + Rx Enhanced (PPO) - H3817-003-0 Benefit Details |
Douglas | $143.00 | $0 | Many Generics | Preferred Generic: $5.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Injectable Drugs: 33% | $2,500 Browse Formulary | |||||
ATRIO Gold Rx (PPO) - H6743-004-0 Benefit Details |
Douglas | $152.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $4.00 Preferred Brand: $35.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | $2,000 Browse Formulary | |||||
ATRIO Platinum Rx (PPO) - H6743-005-0 Benefit Details |
Douglas | $192.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $4.00 Preferred Brand: $35.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | $1,300 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 | |||||||||
CareSource Platinum Plus Rx (HMO-POS) - H3810-005-0 Benefit Details |
Douglas | $221.90 | $0 | Many Generics | Preferred Generic: $5.00 Non-Preferred Generic: $29.00 Preferred Brand: $39.00 Non-Preferred Brand: $69.00 Specialty Tier: 33% | $1,000 Browse Formulary | |||||
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