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 Plan 3 (HMO) - H5005-019-0 Benefit Details |
Clark | $0.00 | $0 | 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 Specialty Tier: 33% | $5,700 Browse Formulary | |||||
Community HealthFirst MA Extra Plan (HMO) - H5826-010-0 Benefit Details |
Clark | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Community HealthFirst MA Plan (HMO) - H5826-006-0 Benefit Details |
Clark | $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) - H5520-005-0 Benefit Details |
Clark | $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 | |||||
Humana Gold Choice H8145-097 (PFFS) - H8145-097-0 Benefit Details |
Clark | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Humana Gold Plus H2012-031 (HMO) - H2012-031-0 Benefit Details |
Clark | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $5,700 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 | |||||||||
Providence Medicare Choice (HMO-POS) - H9047-035-0 Benefit Details |
Clark | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
AARP MedicareComplete Essential (HMO) - H5005-018-0 Benefit Details |
Clark | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 | ||||||
Regence MedAdvantage Basic (PPO) - H3817-001-0 Benefit Details |
Clark | $35.00 | 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 | |||||||||
Community HealthFirst MA Pharmacy Plan (HMO) - H5826-008-0 Benefit Details |
Clark | $37.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Community HealthFirst MA Special Needs Plan (HMO SNP) - H5826-005-0 Benefit Details |
Clark | $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 | |||||
Kaiser Permanente Senior Advantage Basic (HMO) - H9003-006-0 Benefit Details |
Clark | $39.00 | $0 | All Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $65.00 Specialty Tier: 25% Vaccines: $0.00 | $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 Aqua (PPO) - H5520-001-0 Benefit Details |
Clark | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Providence Medicare Choice + RX (HMO-POS) - H9047-024-0 Benefit Details |
Clark | $52.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Injectable Drugs: 33% Specialty Tier: 33% | $3,000 Browse Formulary | |||||
Regence MedAdvantage + Rx Classic (PPO) - H3817-002-0 Benefit Details |
Clark | $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 | |||||
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 | |||||||||
AARP MedicareComplete Plan 1 (HMO) - H5005-011-0 Benefit Details |
Clark | $73.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $44.00 Non-Preferred Brand: $88.00 Specialty Tier: 33% | $4,200 Browse Formulary | |||||
Humana Prime Choice H6609-062 (PPO) - H6609-062-0 Benefit Details |
Clark | $78.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
Providence Medicare Extra (HMO) - H9047-033-0 Benefit Details |
Clark | $87.00 | 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 | |||||||||
Health Net Violet Option 1 (PPO) - H5520-002-0 Benefit Details |
Clark | $99.00 | $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 | |||||
Kaiser Permanente Senior Advantage (HMO) - H9003-001-0 Benefit Details |
Clark | $99.00 | $0 | All Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $65.00 Specialty Tier: 25% Vaccines: $0.00 | $2,500 Browse Formulary | |||||
Providence Medicare Extra + RX (HMO) - H9047-001-0 Benefit Details |
Clark | $133.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Injectable Drugs: 33% Specialty Tier: 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 | |||||||||
Providence Medicare Open (PPO) - H5016-002-0 Benefit Details |
Clark | $133.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
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Regence MedAdvantage + Rx Enhanced (PPO) - H3817-003-0 Benefit Details |
Clark | $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 | |||||
Health Net Healthy Heart (PPO) - H5520-009-0 Benefit Details |
Clark | $159.00 | $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 | |||||
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 | |||||||||
Providence Medicare Open + RX (PPO) - H5016-001-0 Benefit Details |
Clark | $188.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Injectable Drugs: 33% Specialty Tier: 33% | $2,500 Browse Formulary | |||||
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Humana Prime Choice H6609-073 (PPO) - H6609-073-0 Benefit Details |
Clark | $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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