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 SecureHorizons Essential (HMO) - H0609-018-0 Benefit Details |
Douglas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
AARP MedicareComplete SecureHorizons Plan 2 (HMO) - H0609-012-0 Benefit Details |
Douglas | $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% | $4,500 Browse Formulary | |||||
Aetna Medicare Value Plan (HMO) - H6923-005-0 Benefit Details |
Douglas | $0.00 | $0 | Few Generics | Generic: $10.00 Preferred Brand: 25% Non-Preferred Brand: 50% Specialty Tier: 33% Select Care Drugs: $0.00 | $6,700 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 | |||||||||
Humana Gold Plus H5291-002 (HMO) - H5291-002-0 Benefit Details |
Douglas | $0.00 | $200 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 15% Non-Preferred Brand: 30% Specialty Tier: 27% | $5,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
HumanaChoice H5868-011 (PPO) - H5868-011-0 Benefit Details |
Douglas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 | ||||||
Kaiser Permanente Senior Advantage Core (HMO) - H0630-013-0 Benefit Details |
Douglas | $0.00 | $0 | All Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Vaccines: $0.00 | $4,900 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 | |||||||||
AB Basic Plan (Cost) - H0602-026-0 Benefit Details |
Douglas | $5.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Rocky Mountain Green Plan (Cost) - H0602-042-0 Benefit Details |
Douglas | $10.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Humana Gold Choice H8145-120 (PFFS) - H8145-120-0 Benefit Details |
Douglas | $15.00 | 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 | |||||||||
UnitedHealthcare Dual Complete (HMO SNP) - H0624-001-0 Benefit Details |
Douglas | $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 | |||||
UnitedHealthcare Nursing Home Plan (PPO SNP) - H0620-002-0 Benefit Details |
Douglas | $24.40 | $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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Senior Advantage Medicare Medicaid Plan (HMO SNP) - H0630-014-0 Benefit Details |
Douglas | $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% Tier 6: 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 | |||||||||
Erickson Advantage Guardian (HMO-POS SNP) - H5322-019-0 Benefit Details |
Douglas | $26.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
new | new | new | |||||||||
Colorado Access Advantage Peak Plan (HMO) - H0621-006-0 Benefit Details |
Douglas | $26.90 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Colorado Access Advantage Summit Plan (HMO SNP) - H0621-010-0 Benefit Details |
Douglas | $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: $0.00 Non-Preferred Generic: $17.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 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 | |||||||||
Humana Gold Plus H5291-001 (HMO) - H5291-001-0 Benefit Details |
Douglas | $27.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $89.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Rocky Mountain Thrifty Plan (Cost) - H0602-027-0 Benefit Details |
Douglas | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,000 | ||||||
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Aetna Medicare Select Plan (HMO) - H6923-001-0 Benefit Details |
Douglas | $38.00 | $0 | Few Generics | Generic: $10.00 Preferred Brand: 25% Non-Preferred Brand: 50% Specialty Tier: 33% Select Care Drugs: $0.00 | $4,400 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 | |||||||||
AARP MedicareComplete SecureHorizons Plan 1 (HMO) - H0609-007-0 Benefit Details |
Douglas | $45.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $42.00 Non-Preferred Brand: $91.00 Specialty Tier: 33% | $3,900 Browse Formulary | |||||
Erickson Advantage Freedom (HMO-POS) - H5652-006-0 Benefit Details |
Douglas | $48.00 | $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% | $6,700 Browse Formulary | |||||
HumanaChoice H5868-012 (PPO) - H5868-012-0 Benefit Details |
Douglas | $49.00 | $200 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 15% Non-Preferred Brand: 30% Specialty Tier: 27% | $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 | |||||||||
Kaiser Permanente Senior Advantage Silver (HMO) - H0630-015-0 Benefit Details |
Douglas | $49.00 | $0 | All Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Vaccines: $0.00 | $4,200 Browse Formulary | |||||
Rocky Mountain Standard Plan (Cost) - H0602-009-0 Benefit Details |
Douglas | $61.50 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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Rocky Mountain Green Plan + Rx (Cost) - H0602-043-0 Benefit Details |
Douglas | $69.40 | $120 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 30% | 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 | |||||||||
HumanaChoice H5868-010 (PPO) - H5868-010-0 Benefit Details |
Douglas | $79.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Brand: $84.00 Specialty Tier: 33% | $5,500 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) - H0602-039-0 Benefit Details |
Douglas | $80.90 | $75 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $25.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 31% | n/a Browse Formulary | |||||
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Aetna Medicare Select Plan (PPO) - H5521-028-0 Benefit Details |
Douglas | $87.00 | $0 | Few Generics | Generic: $10.00 Preferred Brand: 25% Non-Preferred Brand: 50% Specialty Tier: 33% Select Care Drugs: $0.00 | $6,700 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 | |||||||||
Humana Gold Choice H8145-123 (PFFS) - H8145-123-0 Benefit Details |
Douglas | $98.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $89.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Kaiser Permanente Senior Advantage Plus Choice (HMO-POS) - H0630-019-0 Benefit Details |
Douglas | $99.00 | $0 | All Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Vaccines: $0.00 | $4,200 Browse Formulary | |||||
Erickson Advantage Signature without Drugs (HMO-POS) - H5652-002-0 Benefit Details |
Douglas | $149.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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 | |||||||||
Rocky Mountain Standard Plan + Rx (Cost) - H0602-022-0 Benefit Details |
Douglas | $152.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Rocky Mountain Plus Plan (Cost) - H0602-003-0 Benefit Details |
Douglas | $158.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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Erickson Advantage Champion (HMO-POS SNP) - H5652-004-0 Benefit Details |
Douglas | $189.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | 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 | |||||||||
Erickson Advantage Signature with Drugs (HMO-POS) - H5652-001-0 Benefit Details |
Douglas | $189.00 | $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% | $5,000 Browse Formulary | |||||
Kaiser Permanente Senior Advantage Gold (HMO) - H0630-016-0 Benefit Details |
Douglas | $191.00 | $0 | All Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Vaccines: $0.00 | $3,400 Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) - H0602-019-0 Benefit Details |
Douglas | $261.30 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 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 | |||||||||
HumanaChoice H5868-013 (PPO) - H5868-013-0 Benefit Details |
Douglas | $302.00 | $170 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28% | $6,700 Browse Formulary | |||||
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