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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AHM Basic (HMO) - H5774-003-0 Benefit Details |
Yabucoa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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AHM Classic (HMO) - H5774-008-0 Benefit Details |
Yabucoa | $0.00 | $0 | All Generics | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
AHM Classic Plus (HMO SNP) - H5774-009-0 Benefit Details |
Yabucoa | $0.00 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $50.00 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 | |||||||||
AHM Platino Plus (HMO SNP) - H5774-019-0 Benefit Details |
Yabucoa | $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 | |||||
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AHM Standard (HMO) - H5774-005-0 Benefit Details |
Yabucoa | $0.00 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,000 Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
First Care+Plus (HMO) - H5887-001-0 Benefit Details |
Yabucoa | $0.00 | $0 | All Generics | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $25.00 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 |
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Service | Exper. | Cost Info | |||||||||
First+Plus Advantage (PPO) - H4011-001-0 Benefit Details |
Yabucoa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
First+Plus Advantage Plus (PPO) - H4011-003-0 Benefit Details |
Yabucoa | $0.00 | $0 | All Generics | Preferred Generic: $6.00 Non-Preferred Generic: $12.00 Preferred Brand: $35.00 Non-Preferred Brand: $55.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
First+Plus Complete (HMO SNP) - H5887-007-0 Benefit Details |
Yabucoa | $0.00 | $0 | All Generics | Preferred Generic: $6.00 Non-Preferred Generic: $12.00 Preferred Brand: $30.00 Non-Preferred Brand: $50.00 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 |
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Service | Exper. | Cost Info | |||||||||
First+Plus Platino (HMO SNP) - H5887-010-0 Benefit Details |
Yabucoa | $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 | |||||
First+Plus Smart Premium (HMO) - H5887-012-0 Benefit Details |
Yabucoa | $0.00 | $0 | All Generics | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $55.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
First+Plus Smart Value (HMO) - H5887-013-0 Benefit Details |
Yabucoa | $0.00 | $0 | All Generics | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $65.00 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 Plus H4007-012 (HMO) - H4007-012-0 Benefit Details |
Yabucoa | $0.00 | $310 | Few Generics, Few Brands | Preferred Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Brand: $30.00 Specialty Tier: 25% | $3,500 Browse Formulary | |||||
Humana Gold Plus H4007-013 (HMO) - H4007-013-0 Benefit Details |
Yabucoa | $0.00 | $0 | Few Generics | Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $45.00 | $5,000 Browse Formulary | |||||
Humana Gold Plus SNP-DE H4007-005 (HMO SNP) - H4007-005-0 Benefit Details |
Yabucoa | $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 |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus SNP-DE H4007-016 (HMO SNP) - H4007-016-0 Benefit Details |
Yabucoa | $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 | |||||
MCS Classicare B-Max (HMO) - H4006-025-0 Benefit Details |
Yabucoa | $0.00 | $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 | |||||
MCS Classicare Essential (HMO-POS) - H5577-008-0 Benefit Details |
Yabucoa | $0.00 | $0 | Many Generics | Preferred Generic: $4.00 Non-Preferred Generic: $5.00 Preferred Brand: $29.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $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 | |||||||||
MCS Classicare InteliCare (HMO) - H5577-005-0 Benefit Details |
Yabucoa | $0.00 | $0 | Many Generics | Preferred Generic: $4.00 Non-Preferred Generic: $5.00 Preferred Brand: $29.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare MA (HMO) - H4006-001-0 Benefit Details |
Yabucoa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
MCS Classicare Platino Ideal (HMO SNP) - H5577-002-0 Benefit Details |
Yabucoa | $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% | 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 | |||||||||
MCS Classicare Platino M - H5577-009-0 Benefit Details |
Yabucoa | $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% | n/a Browse Formulary | |||||
MCS Classicare Platino Superior (HMO SNP) - H5577-010-0 Benefit Details |
Yabucoa | $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% | n/a Browse Formulary | |||||
MCS Classicare Premium Health (HMO) - H4006-007-0 Benefit Details |
Yabucoa | $0.00 | $0 | Many Generics | Preferred Generic: $4.00 Non-Preferred Generic: $5.00 Preferred Brand: $29.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $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 | |||||||||
Medicare y Mucho Mas - BASICO EXTRA (HMO) - H4003-024-0 Benefit Details |
Yabucoa | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% | $3,250 Browse Formulary | |||||
Medicare y Mucho Mas - DIAMANTE CHOICE (HMO SNP) - H4003-017-0 Benefit Details |
Yabucoa | $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% | n/a Browse Formulary | |||||
Medicare y Mucho Mas - DIAMANTE EXTRA (HMO SNP) - H4003-021-0 Benefit Details |
Yabucoa | $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% | 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 | |||||||||
Medicare y Mucho Mas - ELITE ULTRA (HMO-POS) - H4003-027-0 Benefit Details |
Yabucoa | $0.00 | $0 | Some Generics | Preferred Generic: $10.00 Preferred Brand: $40.00 Specialty Tier: 25% | $3,250 Browse Formulary | |||||
Medicare y Mucho Mas - UNICO EXTRA (HMO) - H4003-015-0 Benefit Details |
Yabucoa | $0.00 | $0 | Some Generics | Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 25% | $3,250 Browse Formulary | |||||
PMC Max - EXTRA (HMO-POS) - H4004-053-0 Benefit Details |
Yabucoa | $0.00 | $0 | Some Generics | Preferred Generic: $10.00 Preferred Brand: $40.00 Specialty Tier: 25% | $3,250 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 | |||||||||
Premier Preferred (HMO SNP) - H4004-048-0 Benefit Details |
Yabucoa | $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% | n/a Browse Formulary | |||||
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Triple-S Medicare Optimo (PPO) - H4005-001-0 Benefit Details |
Yabucoa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Triple-S Medicare Optimo Select (HMO) (HMO) - H4012-008-0 Benefit Details |
Yabucoa | $0.00 | $0 | All Generics | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: 25% Specialty Tier: 33% | $6,700 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 | |||||||||
Triple-S Medicare Selecto with Medicare Platino (HMO SNP) - H4012-003-0 Benefit Details |
Yabucoa | $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 | |||||
PMC Max (HMO) - H4004-050-0 Benefit Details |
Yabucoa | $10.00 | $0 | Some Generics | Preferred Generic: $7.00 Preferred Brand: $35.00 Specialty Tier: 25% | $3,250 Browse Formulary | |||||
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Medicare y Mucho Mas - Unico (HMO) - H4003-019-0 Benefit Details |
Yabucoa | $25.00 | $0 | Some Generics | Preferred Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $60.00 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 |
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Service | Exper. | Cost Info | |||||||||
Triple-S Medicare Optimo Premier (HMO) - H5732-001-0 Benefit Details |
Yabucoa | $27.00 | $0 | All Generics | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: 25% Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Dorado (HMO) - H4004-025-0 Benefit Details |
Yabucoa | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,250 | ||||||
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Medicare y Mucho Mas - Original (HMO) - H4003-018-0 Benefit Details |
Yabucoa | $30.00 | 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 |
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Service | Exper. | Cost Info | |||||||||
AHM Opal (HMO-POS) - H5774-014-0 Benefit Details |
Yabucoa | $33.00 | $0 | All Generics | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
Medicare y Mucho Mas - ELITE (HMO-POS) - H4003-001-0 Benefit Details |
Yabucoa | $33.50 | $0 | Some Generics | Preferred Generic: $4.00 Preferred Brand: $20.00 Non-Preferred Brand: $50.00 Specialty Tier: 25% | $3,250 Browse Formulary | |||||
Medicare y Mucho Mas - SUPREMO (HMO SNP) - H4003-009-0 Benefit Details |
Yabucoa | $34.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $5.00 Preferred Brand: $45.00 Specialty Tier: 25% Select Diabetic Drugs: $10.00 | 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 | |||||||||
Elite Dorado (HMO-POS) - H4004-015-0 Benefit Details |
Yabucoa | $34.50 | $0 | Some Generics | Preferred Generic: $5.00 Preferred Brand: $29.00 Non-Preferred Brand: $50.00 Specialty Tier: 25% | $3,250 Browse Formulary | |||||
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HumanaChoice H2029-001 (PPO) - H2029-001-0 Benefit Details |
Yabucoa | $45.00 | $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 | |||||
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Triple-S Medicare Optimo Plus (PPO) - H4005-004-0 Benefit Details |
Yabucoa | $73.00 | $0 | All Generics | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $20.00 Non-Preferred Brand: 25% Specialty Tier: 25% | $6,700 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 | |||||||||
Medicare y Mucho Mas - ELITE EXTRA (HMO-POS) - H4003-025-0 Benefit Details |
Yabucoa | $76.30 | $0 | Some 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 | |||||
MCS Classicare Advanced Health (HMO-POS) - H4006-008-0 Benefit Details |
Yabucoa | $79.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $3.00 Preferred Brand: $18.00 Non-Preferred Brand: $34.00 Specialty Tier: 25% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) - H2029-002-0 Benefit Details |
Yabucoa | $103.00 | $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 | |||||
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