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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AB Basic Plan (Cost) - H0602-026-0 Benefit Details |
Kiowa | $3.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Rocky Mountain Green Plan (Cost) - H0602-042-0 Benefit Details |
Kiowa | $5.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Rocky Mountain Thrifty Plan (Cost) - H0602-027-0 Benefit Details |
Kiowa | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,000 | ||||||
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 | |||||||||
Rocky Mountain Standard Plan (Cost) - H0602-007-0 Benefit Details |
Kiowa | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
Rocky Mountain Green Plan + Rx (Cost) - H0602-043-0 Benefit Details |
Kiowa | $56.00 | $125 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $13.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) - H0602-039-0 Benefit Details |
Kiowa | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 | |||||||||
Rocky Mountain Standard Plan + Rx (Cost) - H0602-020-0 Benefit Details |
Kiowa | $103.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
Rocky Mountain Plus Plan (Cost) - H0602-003-0 Benefit Details |
Kiowa | $147.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Rocky Mountain Plus Plan + Rx (Cost) - H0602-019-0 Benefit Details |
Kiowa | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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