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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BCN Advantage HMO-POS Basic (HMO-POS) - H5883-004-2 Benefit Details |
Monroe | $0.00 | $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% | $4,200 Browse Formulary | |||||
HumanaChoice R5826-053 (Regional PPO) - R5826-053-0 Benefit Details |
Monroe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 | ||||||
Paramount Elite - Standard Medical and Drug (HMO) - H3653-015-0 Benefit Details |
Monroe | $0.00 | $75 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Brand: $15.00 Preferred Brand: $45.00 Injectable Drugs: 33% 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 | |||||||||
Paramount Elite - Enhanced Medical Only (HMO) - H3653-018-0 Benefit Details |
Monroe | $11.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Medicare Plus Blue PPO Essential (PPO) - H9572-004-2 Benefit Details |
Monroe | $12.50 | $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% | $6,400 Browse Formulary | |||||
Humana Gold Choice H8145-121 (PFFS) - H8145-121-0 Benefit Details |
Monroe | $19.00 | 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 | |||||||||
BCN Advantage HMO-POS Elements (HMO-POS) - H5883-001-2 Benefit Details |
Monroe | $28.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,600 | ||||||
CareSource Advantage (HMO SNP) - H0141-001-0 Benefit Details |
Monroe | $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 | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
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PriorityMedicare Value (HMO-POS) - H2320-012-0 Benefit Details |
Monroe | $43.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 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 | |||||||||
HAP Senior Plus - Expanded Network (HMO-POS) - H2312-012-0 Benefit Details |
Monroe | $44.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: 33% Specialty Tier: 33% | $3,000 Browse Formulary | |||||
PriorityMedicare Merit (PPO) - H4875-016-1 Benefit Details |
Monroe | $47.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
Medicare Plus Blue PPO Vitality (PPO) - H9572-002-2 Benefit Details |
Monroe | $56.00 | $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% | $5,400 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 | |||||||||
HumanaChoice H5470-002 (PPO) - H5470-002-0 Benefit Details |
Monroe | $62.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $83.00 Specialty Tier: 33% | $5,500 Browse Formulary | |||||
HumanaChoice R5826-072 (Regional PPO) - R5826-072-0 Benefit Details |
Monroe | $66.00 | $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 | |||||
Humana Gold Choice H8145-005 (PFFS) - H8145-005-0 Benefit Details |
Monroe | $72.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $80.00 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 | |||||||||
Paramount Elite - Enhanced Medical and Drug (HMO) - H3653-004-0 Benefit Details |
Monroe | $86.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Brand: $8.00 Preferred Brand: $40.00 Injectable Drugs: 33% Specialty Tier: 33% | $3,400 Browse Formulary | |||||
BCN Advantage HMO-POS Classic (HMO-POS) - H5883-002-2 Benefit Details |
Monroe | $88.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
HAP Senior Plus - Expanded Network (HMO-POS) - H2312-007-0 Benefit Details |
Monroe | $94.00 | $25 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: 32% Specialty Tier: 32% | $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 | |||||||||
HumanaChoice R5826-006 (Regional PPO) - R5826-006-0 Benefit Details |
Monroe | $99.00 | $0 | Few Generics, Few Brands | Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Alliance Medicare PPO (PPO) - H2322-008-0 Benefit Details |
Monroe | $103.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: 33% Specialty Tier: 33% | $3,400 Browse Formulary | |||||
PriorityMedicare (HMO-POS) - H2320-008-0 Benefit Details |
Monroe | $107.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $80.00 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 | |||||||||
PriorityMedicare Select (PPO) - H4875-013-0 Benefit Details |
Monroe | $111.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Medicare Plus Blue PPO Signature (PPO) - H9572-001-2 Benefit Details |
Monroe | $128.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $4,400 Browse Formulary | |||||
HAP Senior Plus - Expanded Network (HMO-POS) - H2312-010-0 Benefit Details |
Monroe | $169.00 | $25 | All Generics | Preferred Generic: $2.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: 32% Specialty Tier: 32% | $2,800 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 | |||||||||
Alliance Medicare PPO (PPO) - H2322-004-0 Benefit Details |
Monroe | $174.00 | $50 | All Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: 31% Specialty Tier: 31% | $3,400 Browse Formulary | |||||
Medicare Plus Blue PPO Assure (PPO) - H9572-003-2 Benefit Details |
Monroe | $194.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
BCN Advantage HMO-POS Prestige (HMO-POS) - H5883-003-2 Benefit Details |
Monroe | $218.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $75.00 Specialty Tier: 30% | $3,200 Browse Formulary | |||||
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