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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MyPlan C (HMO SNP) - H3818-002-0 Benefit Details |
Umatilla | $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 | |||||
MyPlan R (HMO) - H3818-004-0 Benefit Details |
Umatilla | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Umatilla | $57.00 | 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 | |||||||||
ODS Advantage PPORX (PPO) - H3813-006-0 Benefit Details |
Umatilla | $68.00 | $120 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $33.00 Preferred Brand: $41.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $3,400 Browse Formulary | |||||
MyPlan A (HMO) - H3818-003-0 Benefit Details |
Umatilla | $74.00 | $190 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 28% | $3,400 Browse Formulary | |||||
MyPlan E (HMO) - H3818-014-0 Benefit Details |
Umatilla | $136.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 | |||||||||
ODS Advantage PPORX Select (PPO) - H3813-003-0 Benefit Details |
Umatilla | $139.00 | $120 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $33.00 Preferred Brand: $41.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $3,400 Browse Formulary | |||||
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