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 Plan 1 (HMO) - H0303-013-0 Benefit Details |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,900 Browse Formulary | |||||
AARP MedicareComplete Plus (HMO-POS) - H0316-002-0 Benefit Details |
Pima | $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% | $6,700 Browse Formulary | |||||
CareMore Breathe (HMO SNP) - H2593-005-0 Benefit Details |
Pima | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | 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 | |||||||||
CareMore Diabetes (HMO SNP) - H2593-006-0 Benefit Details |
Pima | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
CareMore Heart (HMO SNP) - H2593-013-0 Benefit Details |
Pima | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
CareMore StartSmart Plus (HMO) - H2593-018-0 Benefit Details |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Tier 6: $10.00 | $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 | |||||||||
CareMore Touch (HMO SNP) - H2593-003-0 Benefit Details |
Pima | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
CareMore Value Plus (HMO) - H2593-001-0 Benefit Details |
Pima | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $3,400 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Health Net Green (HMO) - H0351-030-0 Benefit Details |
Pima | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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 | |||||||||
Health Net Jade (HMO SNP) - H0351-038-0 Benefit Details |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $44.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
Health Net Jade Cardiovascular (HMO SNP) - H0351-042-0 Benefit Details |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $44.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
Health Net Ruby 4 (HMO) - H0351-035-0 Benefit Details |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $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 | |||||||||
Health Net Ruby Select (HMO) - H0351-041-0 Benefit Details |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $12.00 Preferred Brand: $44.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $3,800 Browse Formulary | |||||
Heart First (HMO SNP) - H9385-003-0 Benefit Details |
Pima | $0.00 | $0 | Some Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Tier 6: $0.00 | n/a Browse Formulary | |||||
Humana Gold Plus H2649-031 (HMO) - H2649-031-0 Benefit Details |
Pima | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $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 | |||||||||
HumanaChoice R5826-070 P (Regional PPO) - R5826-070-0 Benefit Details |
Pima | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Phoenix Advantage (HMO) - H5985-001-0 Benefit Details |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
SCAN Balance (HMO SNP) - H9385-004-0 Benefit Details |
Pima | $0.00 | $0 | Some Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Tier 6: $0.00 | 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 | |||||||||
SCAN Classic (HMO) - H9385-002-0 Benefit Details |
Pima | $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: $85.00 Specialty Tier: 33% Select Care Drugs: $10.00 | $5,000 Browse Formulary | |||||
WellCare Dividend (HMO) - H0320-008-0 Benefit Details |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $30.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
WellCare Value (HMO) - H0320-009-0 Benefit Details |
Pima | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $30.00 Non-Preferred Brand: $60.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
UnitedHealthcare Dual Complete (HMO SNP) - H0321-002-0 Benefit Details |
Pima | $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 | |||||
ONECare by Care1st Health Plan Arizona, Inc. (HMO SNP) - H5430-001-0 Benefit Details |
Pima | $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: 0% Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
Health Choice Generations (HMO SNP) - H5587-002-0 Benefit Details |
Pima | $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 | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Mercy Care Advantage (HMO SNP) - H5580-004-0 Benefit Details |
Pima | $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% | n/a Browse Formulary | |||||
Mercy Care Advantage (HMO SNP) - H5580-005-0 Benefit Details |
Pima | $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% | n/a Browse Formulary | |||||
Mercy Care Advantage (HMO SNP) - H5580-001-0 Benefit Details |
Pima | $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% | 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 | |||||||||
UnitedHealthcare Nursing Home Plan (PPO SNP) - H0319-001-0 Benefit Details |
Pima | $27.50 | $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 | |||||
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Phoenix Advantage Select (HMO) - H5985-005-0 Benefit Details |
Pima | $39.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Specialty Tier: 33% | $3,500 Browse Formulary | |||||
Health Net Ruby 1 (HMO) - H0351-043-2 Benefit Details |
Pima | $49.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $5,300 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H2649-041 (HMO) - H2649-041-0 Benefit Details |
Pima | $52.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H0317-004 (PPO) - H0317-004-0 Benefit Details |
Pima | $125.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-014 P (Regional PPO) - R5826-014-0 Benefit Details |
Pima | $152.00 | $175 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H8145-103 (PFFS) - H8145-103-0 Benefit Details |
Pima | $180.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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