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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Advocare Essence (HMO-POS) - H5211-003-0 Benefit Details |
Washburn | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Humana Gold Choice H8145-153 (PFFS) - H8145-153-0 Benefit Details |
Washburn | $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 |
Washburn | $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 | |||||||||
UCare for Seniors Essentials (HMO-POS) - H4270-005-0 Benefit Details |
Washburn | $43.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Advocare Essence Rx (HMO-POS) - H5211-002-0 Benefit Details |
Washburn | $47.00 | $0 | Few Generics | Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Medica Prime Solution Thrift with Part D Option 1 (Cost) - H2450-007-0 Benefit Details |
Washburn | $51.70 | $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 | |||||
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 | |||||||||
UCare for Seniors Essentials Rx (HMO-POS) - H4270-006-0 Benefit Details |
Washburn | $57.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
UCare for Seniors Value (HMO-POS) - H4270-001-0 Benefit Details |
Washburn | $60.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HealthPartners Wisconsin Freedom Basic (Cost) - H2462-015-0 Benefit Details |
Washburn | $63.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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 | |||||||||
UCare for Seniors Standard D (HMO-POS) - H4270-004-0 Benefit Details |
Washburn | $66.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Humana Gold Choice H8145-006 (PFFS) - H8145-006-0 Benefit Details |
Washburn | $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 | |||||
Medica Prime Solution Value with Part D Option 1 (Cost) - H2450-022-0 Benefit Details |
Washburn | $77.70 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,350 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 |
Washburn | $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 | |||||
Medica Prime Solution Basic with Part D Option 1 (Cost) - H2450-016-0 Benefit Details |
Washburn | $95.70 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,000 Browse Formulary | |||||
UCare for Seniors Value Plus (HMO-POS) - H4270-003-0 Benefit Details |
Washburn | $98.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 25% | $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 | |||||||||
Medica Prime Solution Value with Part D Option 2 (Cost) - H2450-023-0 Benefit Details |
Washburn | $111.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,350 Browse Formulary | |||||
Advocare Spirit (HMO-POS) - H5211-001-0 Benefit Details |
Washburn | $118.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,000 | ||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) - H2450-001-0 Benefit Details |
Washburn | $129.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,000 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 | |||||||||
Medica Prime Solution Enhanced w/Part D Option 1 (Cost) - H2450-017-0 Benefit Details |
Washburn | $149.70 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Value with Part D Option 3 (Cost) - H2450-028-0 Benefit Details |
Washburn | $171.80 | $0 | Many Generics | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,350 Browse Formulary | |||||
Advocare Spirit Rx (HMO-POS) - H5211-004-0 Benefit Details |
Washburn | $173.00 | $0 | Few Generics | Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $1,000 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 | |||||||||
Medica Prime Solution Enhanced w/Part D Option 2 (Cost) - H2450-002-0 Benefit Details |
Washburn | $183.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,000 Browse Formulary | |||||
HealthPartners Wisconsin Freedom Balance (Cost) - H2462-016-0 Benefit Details |
Washburn | $187.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
Medica Prime Solution Basic with Part D Option 3 (Cost) - H2450-005-0 Benefit Details |
Washburn | $189.80 | $0 | Many Generics | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,000 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 | |||||||||
Advocare Vitality (HMO-POS) - H5211-006-0 Benefit Details |
Washburn | $215.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $500 | ||||||
HealthPartners Wisconsin Freedom Balance with Rx (Cost) - H2462-017-0 Benefit Details |
Washburn | $219.20 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced w/Part D Option 3 (Cost) - H2450-006-0 Benefit Details |
Washburn | $243.80 | $0 | Many Generics | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty Tier: 25% | $3,000 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 | |||||||||
Advocare Vitality Rx (HMO-POS) - H5211-005-0 Benefit Details |
Washburn | $286.00 | $0 | Few Generics | Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $500 Browse Formulary | |||||
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