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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Horizon Medicare Blue Value (HMO) - H3154-013-0 Benefit Details |
Warren | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
AmeriHealth 65 Preferred Medical Only (HMO) - H3156-033-0 Benefit Details |
Warren | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Horizon Medicare Blue TotalCare (HMO SNP) - H3154-020-0 Benefit Details |
Warren | $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: 0% Tier 2: 0% Tier 3: 0% Tier 4: 0% Tier 5: 0% | n/a 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 | |||||||||
Aetna Medicare Value Plan (HMO) - H3152-046-0 Benefit Details |
Warren | $44.00 | $0 | Few Generics | Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $6,700 Browse Formulary | |||||
Horizon Medicare Blue Value w/ Rx (HMO) - H3154-004-0 Benefit Details |
Warren | $58.20 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Brand: $84.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
AmeriHealth 65 Preferred Rx (HMO) - H3156-034-0 Benefit Details |
Warren | $69.00 | $295 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
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