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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Gundersen Lutheran Sr. Pref. Value (no RX) (HMO) - H5262-004-0 Benefit Details |
Grant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice R5826-023 (Regional PPO) - R5826-023-0 Benefit Details |
Grant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) - H5262-003-0 Benefit Details |
Grant | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $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 | |||||||||
UCare for Seniors Essentials (HMO-POS) - H4270-005-0 Benefit Details |
Grant | $43.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
UCare for Seniors Essentials Rx (HMO-POS) - H4270-006-0 Benefit Details |
Grant | $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 |
Grant | $60.00 | 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 | |||||||||
UCare for Seniors Standard D (HMO-POS) - H4270-004-0 Benefit Details |
Grant | $66.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
DeanCare Gold Shared Value (Cost) - H5264-005-0 Benefit Details |
Grant | $68.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
HumanaChoice R5826-009 (Regional PPO) - R5826-009-0 Benefit Details |
Grant | $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 | |||||
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 | |||||||||
Medical Associates SmartPlan (Cost) - H5256-001-0 Benefit Details |
Grant | $98.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
UCare for Seniors Value Plus (HMO-POS) - H4270-003-0 Benefit Details |
Grant | $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 | |||||
Gundersen Lutheran Sr. Pref. Elite (no RX) (HMO) - H5262-005-0 Benefit Details |
Grant | $100.00 | 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 | |||||||||
DeanCare Gold Basic (Cost) - H5264-003-0 Benefit Details |
Grant | $108.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
DeanCare Gold Enhanced (Cost) - H5264-002-0 Benefit Details |
Grant | $113.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Medical Associates Community Plan (Cost) - H5256-002-0 Benefit Details |
Grant | $127.00 | 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 | |||||||||
Medical Associates Freedom Plan (Cost) - H5256-004-0 Benefit Details |
Grant | $127.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Gundersen Lutheran Senior Pref. Elite (w/RX) (HMO) - H5262-001-0 Benefit Details |
Grant | $142.20 | $50 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 31% | $3,400 Browse Formulary | |||||
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