2014 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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Coventry Advantra Platinum (PPO) - H1608-001-0 Benefit Details |
Lyon | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $3,300 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Humana Gold Choice H8145-155 (PFFS) - H8145-155-0 Benefit Details |
Lyon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
HumanaChoice H5868-004 (PPO) - H5868-004-0 Benefit Details |
Lyon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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 | |||||||||
UnitedHealthcare MedicareDirect Essential (PFFS) - H5435-001-0 Benefit Details |
Lyon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
UnitedHealthcare MedicareDirect Rx (PFFS) - H5435-014-0 Benefit Details |
Lyon | $28.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $44.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
HumanaChoice H5868-009 (PPO) - H5868-009-0 Benefit Details |
Lyon | $56.00 | $310 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 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 |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H8145-127 (PFFS) - H8145-127-0 Benefit Details |
Lyon | $68.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
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