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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Care Improvement Plus Gold Rx (Regional PPO SNP) - R6801-009-0 Benefit Details |
Sutton | $0.00 | $0 | 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: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (Regional PPO) - R6801-012-0 Benefit Details |
Sutton | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-026 (Regional PPO) - R5826-026-0 Benefit Details |
Sutton | $0.00 | 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 | |||||||||
SeniorCare Sr Select-Medical Only (Cost) - H4564-012-0 Benefit Details |
Sutton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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HumanaChoice R5826-091 (Regional PPO) - R5826-091-0 Benefit Details |
Sutton | $10.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Care Improvement Plus Silver Rx (Regional PPO SNP) - R6801-008-0 Benefit Details |
Sutton | $15.50 | $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 | |||||
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 | |||||||||
Care Improvement Plus Dual Advantage (Regional PPO SNP) - R6801-011-0 Benefit Details |
Sutton | $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 | |||||
SeniorCare Sr Select - Value Rx (Cost) - H4564-015-0 Benefit Details |
Sutton | $43.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Select - Basic Rx (Cost) - H4564-003-0 Benefit Details |
Sutton | $48.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
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 | |||||||||
HumanaChoice R5826-012 (Regional PPO) - R5826-012-0 Benefit Details |
Sutton | $65.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $89.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
SeniorCare Sr Select - Enhanced Rx (Cost) - H4564-006-0 Benefit Details |
Sutton | $81.50 | $0 | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Preferred-Medical Only (Cost) - H4564-011-0 Benefit Details |
Sutton | $87.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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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 | |||||||||
SeniorCare Sr Preferred - Value Rx (Cost) - H4564-014-0 Benefit Details |
Sutton | $130.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Preferred - Basic Rx (Cost) - H4564-002-0 Benefit Details |
Sutton | $135.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr VIP - Medical Only (Cost) - H4564-016-0 Benefit Details |
Sutton | $147.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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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 | |||||||||
SeniorCare Sr MedOption - Medical Only (Cost) - H4564-020-0 Benefit Details |
Sutton | $167.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SeniorCare Sr Preferred - Enhanced Rx (Cost) - H4564-005-0 Benefit Details |
Sutton | $168.40 | $0 | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium-Medical Only (Cost) - H4564-010-0 Benefit Details |
Sutton | $187.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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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 | |||||||||
SeniorCare Sr VIP - Value Rx (Cost) - H4564-019-0 Benefit Details |
Sutton | $190.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr VIP - Basic Rx (Cost) - H4564-017-0 Benefit Details |
Sutton | $195.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr MedOption - Value Rx (Cost) - H4564-023-0 Benefit Details |
Sutton | $210.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
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 | |||||||||
SeniorCare Sr MedOption - Basic Rx (Cost) - H4564-021-0 Benefit Details |
Sutton | $215.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr VIP - Enhanced Rx (Cost) - H4564-018-0 Benefit Details |
Sutton | $228.40 | $0 | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Value Rx (Cost) - H4564-013-0 Benefit Details |
Sutton | $230.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) - H4564-001-0 Benefit Details |
Sutton | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr MedOption - Enhanced Rx (Cost) - H4564-022-0 Benefit Details |
Sutton | $248.40 | $0 | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Enhanced Rx (Cost) - H4564-004-0 Benefit Details |
Sutton | $268.50 | $0 | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: |
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