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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AARP MedicareComplete (HMO) - H5253-011-0 Benefit Details |
Shawano | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,200 Browse Formulary | |||||
Advocare Essence (HMO-POS) - H5211-003-0 Benefit Details |
Shawano | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Care Improvement Plus Gold Rx (PPO SNP) - H0294-002-0 Benefit Details |
Shawano | $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 | |||||
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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 | |||||||||
Care Improvement Plus Medicare Advantage (PPO) - H0294-004-0 Benefit Details |
Shawano | $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 | |||||
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Humana Gold Plus H6622-001 (HMO) - H6622-001-0 Benefit Details |
Shawano | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,900 Browse Formulary | |||||
HumanaChoice R5826-023 P (Regional PPO) - R5826-023-0 Benefit Details |
Shawano | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
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 | |||||||||
Network PlatinumSelect (PPO) - H5215-008-0 Benefit Details |
Shawano | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,100 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Today's Options Premier 900 (PFFS) - H6169-012-0 Benefit Details |
Shawano | $22.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Humana Gold Choice H8145-153 (PFFS) - H8145-153-0 Benefit Details |
Shawano | $24.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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 | |||||||||
Anthem Medicare Preferred Core (PPO) - H4036-004-0 Benefit Details |
Shawano | $26.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: 33% Specialty Tier: 33% | $4,000 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
UnitedHealthcare Dual Complete LP (HMO SNP) - H5253-024-0 Benefit Details |
Shawano | $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: 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15% | n/a Browse Formulary | |||||
Advantage by Managed Health Services (HMO SNP) - H8189-001-0 Benefit Details |
Shawano | $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 | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Injectable Drugs: $95.00 | n/a Browse Formulary | |||||
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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 | |||||||||
Care Improvement Plus Dual Advantage (PPO SNP) - H0294-006-0 Benefit Details |
Shawano | $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 | |||||
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iCare Medicare Plan (HMO SNP) - H2237-001-0 Benefit Details |
Shawano | $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 | Generic: $8.00 Brand: $48.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
NetworkCares (PPO SNP) - H5215-007-0 Benefit Details |
Shawano | $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: $1.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 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 | |||||||||
UnitedHealthcare Nursing Home Plan (HMO-POS SNP) - H5253-007-0 Benefit Details |
Shawano | $37.00 | $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 | |||||
Network PlatinumPlus (PPO) - H5215-001-0 Benefit Details |
Shawano | $46.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,800 | ||||||
Advocare Essence Rx (HMO-POS) - H5211-002-0 Benefit Details |
Shawano | $54.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Vaccines: $0.00 | $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 | |||||||||
Today's Options Premier Plus 950B (PFFS) - H6169-032-0 Benefit Details |
Shawano | $71.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
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Humana Gold Choice H8145-006 (PFFS) - H8145-006-0 Benefit Details |
Shawano | $82.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Today's Options Advantage Plus 950E (PPO) - H5378-184-0 Benefit Details |
Shawano | $86.00 | $110 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | $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 | |||||||||
Network PlatinumPlus Pharmacy (PPO) - H5215-002-0 Benefit Details |
Shawano | $87.00 | $0 | Many Generics | Preferred Generic: $1.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $2,800 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
HumanaChoice R5826-009 P (Regional PPO) - R5826-009-0 Benefit Details |
Shawano | $112.00 | $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% | $6,700 Browse Formulary | |||||
Advocare Spirit (HMO-POS) - H5211-001-0 Benefit Details |
Shawano | $135.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,200 | ||||||
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 | |||||||||
Network PlatinumPremier (PPO) - H5215-006-0 Benefit Details |
Shawano | $150.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,200 | ||||||
Advocare Spirit Rx (HMO-POS) - H5211-004-0 Benefit Details |
Shawano | $199.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Tier 6: $0.00 | $1,200 Browse Formulary | |||||
Network PlatinumPremier Pharmacy (PPO) - H5215-005-0 Benefit Details |
Shawano | $227.00 | $0 | Many Generics | Preferred Generic: $1.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $2,200 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 | |||||||||
Advocare Vitality (HMO-POS) - H5211-006-0 Benefit Details |
Shawano | $242.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,000 | ||||||
Advocare Vitality Rx (HMO-POS) - H5211-005-0 Benefit Details |
Shawano | $320.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Tier 6: $0.00 | $1,000 Browse Formulary | |||||
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