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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AARP MedicareComplete (HMO) - H4604-003-0 Benefit Details |
Tooele | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,900 Browse Formulary | |||||
AARP MedicareComplete Essential (HMO) - H4604-005-0 Benefit Details |
Tooele | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Altius Advantra (HMO-POS) - H8649-003-0 Benefit Details |
Tooele | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $87.00 Specialty Tier: 33% | $3,900 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 Prime Choice H4606-006 (PPO) - H4606-006-0 Benefit Details |
Tooele | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Regence MedAdvantage Basic (PPO) - H4605-001-0 Benefit Details |
Tooele | $32.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Molina Medicare Options Plus (HMO SNP) - H5628-001-0 Benefit Details |
TOOELE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 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 | |||||||||
Humana Prime Choice H4606-007 (PPO) - H4606-007-0 Benefit Details |
Tooele | $48.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Regence MedAdvantage + Rx Classic (PPO) - H4605-002-0 Benefit Details |
Tooele | $69.00 | $190 | 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: 28% Injectable Drugs: 28% | $3,400 Browse Formulary | |||||
Regence MedAdvantage + Rx Enhanced (PPO) - H4605-004-0 Benefit Details |
Tooele | $168.00 | $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 | |||||
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 Prime Choice H4606-009 (PPO) - H4606-009-0 Benefit Details |
Tooele | $202.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | $6,700 Browse Formulary | |||||
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