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 Plus (HMO-POS) - H5253-011-0 Benefit Details |
Green Lake | $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% | $3,400 Browse Formulary | |||||
Care Improvement Plus Copper RX (PPO SNP) - H0294-008-0 Benefit Details |
Green Lake | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Care Improvement Plus Gold Rx (PPO SNP) - H0294-002-0 Benefit Details |
Green Lake | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
Care Improvement Plus Medicare Advantage (PPO) - H0294-004-0 Benefit Details |
Green Lake | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
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Humana Gold Choice H8145-153 (PFFS) - H8145-153-0 Benefit Details |
Green Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
HumanaChoice R5826-023 (Regional PPO) - R5826-023-0 Benefit Details |
Green Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
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 | |||||||||
Network PlatinumSelect (PPO) - H5215-008-0 Benefit Details |
Green Lake | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,000 Browse Formulary | |||||
Today's Options Premier 600 (PFFS) - H6169-012-0 Benefit Details |
Green Lake | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Humana Gold Plus H6622-001 (HMO) - H6622-001-0 Benefit Details |
Green Lake | $21.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,500 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 | |||||||||
Anthem Medicare Preferred Core (PPO) - H4036-004-0 Benefit Details |
Green Lake | $26.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Injectable Drugs: 33% Specialty Tier: 33% | $4,000 Browse Formulary | |||||
UnitedHealthcare Dual Complete LP (HMO SNP) - H5253-024-0 Benefit Details |
Green Lake | $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% Tier 5: 25% | n/a Browse Formulary | |||||
Care Improvement Plus Chrome RX (PPO SNP) - H0294-007-0 Benefit Details |
Green Lake | $38.30 | $325 | 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 | |||||
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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 | |||||||||
Care Improvement Plus Dual Advantage (PPO SNP) - H0294-006-0 Benefit Details |
Green Lake | $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 | |||||
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Care Improvement Plus Silver Rx (PPO SNP) - H0294-001-0 Benefit Details |
Green Lake | $38.30 | $325 | 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 | |||||
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NetworkCares (PPO SNP) - H5215-007-0 Benefit Details |
Green Lake | $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: $1.00 Non-Preferred Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Brand: $93.00 Specialty Tier: 33% | 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 | |||||||||
Network PlatinumPlus (PPO) - H5215-001-0 Benefit Details |
Green Lake | $42.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Today's Options Premier 300 (PFFS) - H6169-050-0 Benefit Details |
Green Lake | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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HumanaChoice H5216-003 (PPO) - H5216-003-0 Benefit Details |
Green Lake | $52.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $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 | |||||||||
Today's Options Premier Plus 650B (PFFS) - H6169-032-0 Benefit Details |
Green Lake | $64.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
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Humana Gold Choice H8145-006 (PFFS) - H8145-006-0 Benefit Details |
Green Lake | $72.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Preferred Brand: $41.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Network PlatinumPlus Pharmacy (PPO) - H5215-002-0 Benefit Details |
Green Lake | $83.00 | $0 | Many Generics | Preferred Generic: $1.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $70.00 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 | |||||||||
HumanaChoice R5826-009 (Regional PPO) - R5826-009-0 Benefit Details |
Green Lake | $89.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $6,700 Browse Formulary | |||||
Today's Options Premier Plus 350A (PFFS) - H6169-054-0 Benefit Details |
Green Lake | $117.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Network PlatinumPremier (PPO) - H5215-006-0 Benefit Details |
Green Lake | $145.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,000 | ||||||
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 | |||||||||
Network PlatinumPremier Pharmacy (PPO) - H5215-005-0 Benefit Details |
Green Lake | $215.00 | $0 | Many Generics | Preferred Generic: $1.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $2,000 Browse Formulary | |||||
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