2013 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
AHM_Basic (HMO) - H5774-003-0 Benefit Details |
Aguadilla | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
AHM_Classic (HMO) - H5774-008-0 Benefit Details |
Aguadilla | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
AHM_Classic Plus (HMO SNP) - H5774-009-0 Benefit Details |
Aguadilla | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $50.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
AHM_Platino Plus (HMO SNP) - H5774-019-0 Benefit Details |
Aguadilla | $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% | n/a Browse Formulary | |||||
AHM_Standard (HMO) - H5774-005-0 Benefit Details |
Aguadilla | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,000 Browse Formulary | |||||
Dorado (HMO) - H4004-025-0 Benefit Details |
Aguadilla | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,250 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Elite Dorado (HMO-POS) - H4004-015-0 Benefit Details |
Aguadilla | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $29.00 Non-Preferred Brand: $50.00 Specialty Tier: 25% | $3,250 Browse Formulary | |||||
First Care+Plus (HMO) - H5887-001-0 Benefit Details |
Aguadilla | $0.00 | $0 | All Generics | Preferred Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $45.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
First+Plus Advantage (PPO) - H4011-001-0 Benefit Details |
Aguadilla | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
First+Plus Advantage Plus (PPO) - H4011-003-0 Benefit Details |
Aguadilla | $0.00 | $0 | All Generics | Preferred Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $45.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
First+Plus Complete (HMO SNP) - H5887-007-0 Benefit Details |
Aguadilla | $0.00 | $0 | All Generics | Preferred Generic: $4.00 Preferred Brand: $20.00 Non-Preferred Brand: $40.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
First+Plus Platino (HMO SNP) - H5887-010-0 Benefit Details |
Aguadilla | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
First+Plus Smart Plus (HMO) - H5887-011-0 Benefit Details |
Aguadilla | $0.00 | $0 | All Generics | Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $50.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
First+Plus Smart Premium (HMO) - H5887-012-0 Benefit Details |
Aguadilla | $0.00 | $0 | All Generics | Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $50.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Humana Gold Plus H4007-012 (HMO) - H4007-012-0 Benefit Details |
Aguadilla | $0.00 | $0 | Few Generics | Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $45.00 | $3,500 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-013 (HMO) - H4007-013-0 Benefit Details |
Aguadilla | $0.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% | $5,000 Browse Formulary | |||||
Humana Gold Plus SNP-DB H4007-014 (HMO SNP) - H4007-014-0 Benefit Details |
Aguadilla | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $20.00 Non-Preferred Brand: $45.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Humana Gold Plus SNP-DE H4007-005 (HMO SNP) - H4007-005-0 Benefit Details |
Aguadilla | $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 | Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
MAPFRE Medicare Excel Advance (HMO) - H5821-021-0 Benefit Details |
Aguadilla | $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% | $6,700 Browse Formulary | |||||
MCS Classicare B-Max (HMO) - H4006-025-0 Benefit Details |
Aguadilla | $0.00 | $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 | |||||
MCS Classicare InteliCare (HMO) - H5577-005-0 Benefit Details |
Aguadilla | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
MCS Classicare MA (HMO) - H4006-001-0 Benefit Details |
Aguadilla | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
MCS Classicare Platino Especial (HMO SNP) - H4006-013-0 Benefit Details |
Aguadilla | $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 | |||||
MCS Classicare Platino Ideal (HMO SNP) - H5577-002-0 Benefit Details |
Aguadilla | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
MCS Classicare Platino Superior (HMO SNP) - H5577-010-0 Benefit Details |
Aguadilla | $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 | |||||
MCS Classicare Premium Health (HMO) - H4006-007-0 Benefit Details |
Aguadilla | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Medicare en el Hogar Plus (HMO SNP) - H4004-035-0 Benefit Details |
Aguadilla | $0.00 | $0 | Many Generics | Generic: $5.00 Brand: $29.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medicare y Mucho Mas - BASICO EXTRA (HMO) - H4003-024-0 Benefit Details |
Aguadilla | $0.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% | $3,400 Browse Formulary | |||||
Medicare y Mucho Mas - BASICO SELECT (HMO) - H4003-015-0 Benefit Details |
Aguadilla | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 Brand: $35.00 Specialty Tier: 30% | $3,250 Browse Formulary | |||||
Medicare y Mucho Mas - DIAMANTE CHOICE (HMO SNP) - H4003-017-0 Benefit Details |
Aguadilla | $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% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medicare y Mucho Mas - DIAMANTE EXTRA (HMO SNP) - H4003-021-0 Benefit Details |
Aguadilla | $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% | n/a Browse Formulary | |||||
Medicare y Mucho Mas - ELITE (HMO-POS) - H4003-001-0 Benefit Details |
Aguadilla | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $29.00 Non-Preferred Brand: $50.00 Specialty Tier: 25% | $3,250 Browse Formulary | |||||
Medicare y Mucho Mas - Original (HMO) - H4003-018-0 Benefit Details |
Aguadilla | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,250 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medicare y Mucho Mas - SUPREMO (HMO SNP) - H4003-009-0 Benefit Details |
Aguadilla | $0.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $5.00 Preferred Brand: $20.00 Non-Preferred Brand: $45.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Medicare y Mucho Mas - Unico (HMO) - H4003-019-0 Benefit Details |
Aguadilla | $0.00 | $0 | Many Generics | Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $60.00 Specialty Tier: 25% | $3,250 Browse Formulary | |||||
PMC Max (HMO) - H4004-050-0 Benefit Details |
Aguadilla | $0.00 | $0 | Many Generics | Generic: $5.00 Brand: $25.00 Specialty Tier: 25% | $3,250 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Premier Preferred (HMO SNP) - H4004-048-0 Benefit Details |
Aguadilla | $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% | n/a Browse Formulary | |||||
Triple-S Medicare Optimo (PPO) - H4005-001-0 Benefit Details |
Aguadilla | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Triple-S Medicare Optimo Basic (PPO) - H4005-005-0 Benefit Details |
Aguadilla | $0.00 | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Triple-S Medicare Optimo Select (HMO) (HMO) - H4012-008-0 Benefit Details |
Aguadilla | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $20.00 Non-Preferred Brand: $45.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Triple-S Medicare Selecto with Medicare Platino (HMO SNP) - H4012-003-0 Benefit Details |
Aguadilla | $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 | |||||
Triple-S Medicare Selecto with Medicare Platino 2 (HMO SNP) - H4012-009-0 Benefit Details |
Aguadilla | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
MCS Classicare Platino Esencial (HMO SNP) - H5577-011-0 Benefit Details |
Aguadilla | $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 | |||||
AHM_Opal (HMO-POS) - H5774-014-0 Benefit Details |
Aguadilla | $10.00 | $0 | Many Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Triple-S Medicare Optimo Premier (HMO) - H5732-001-0 Benefit Details |
Aguadilla | $17.50 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $50.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
MAPFRE Medicare Excel VIP (HMO) - H5821-020-0 Benefit Details |
Aguadilla | $23.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Non-Preferred Generic: $5.00 Preferred Brand: $18.00 Non-Preferred Brand: $45.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Medicare y Mucho Mas - ELITE EXTRA (HMO-POS) - H4003-025-0 Benefit Details |
Aguadilla | $41.80 | $0 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 30% | $3,250 Browse Formulary | |||||
HumanaChoice H2029-001 (PPO) - H2029-001-0 Benefit Details |
Aguadilla | $42.00 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
MCS Classicare FlexiCare (HMO-POS) - H5577-012-0 Benefit Details |
Aguadilla | $43.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $14.00 Non-Preferred Brand: $28.00 Specialty Tier: 25% | $3,400 Browse Formulary | |||||
MAPFRE Medicare Excel Extended (HMO-POS) - H5821-013-0 Benefit Details |
Aguadilla | $58.00 | $0 | Many Generics, Few Brands | Preferred Generic: 0% Non-Preferred Generic: $3.00 Preferred Brand: $25.00 Non-Preferred Brand: $45.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Triple-S Medicare Optimo Plus (PPO) - H4005-004-0 Benefit Details |
Aguadilla | $62.50 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: Greater of $35 or : 25% Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
MAPFRE Medicare Excel Complete Care (HMO-POS) - H5821-022-0 Benefit Details |
Aguadilla | $64.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Non-Preferred Generic: $5.00 Preferred Brand: $18.00 Non-Preferred Brand: $45.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
MCS Classicare Advanced Health (HMO-POS) - H4006-008-0 Benefit Details |
Aguadilla | $91.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $3.00 Preferred Brand: $18.00 Non-Preferred Brand: $36.00 Specialty Tier: 25% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) - H2029-002-0 Benefit Details |
Aguadilla | $100.00 | $0 | Some Generics, Few Brands | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $30.00 Non-Preferred Brand: $68.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
|