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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HumanaChoice H5868-011 (PPO) - H5868-011-0 Benefit Details |
Grand | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 | ||||||
AB Basic Plan (Cost) - H0602-026-0 Benefit Details |
Grand | $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 |
Grand | $10.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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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 H8145-120 (PFFS) - H8145-120-0 Benefit Details |
Grand | $15.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Rocky Mountain Thrifty Plan (Cost) - H0602-027-0 Benefit Details |
Grand | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,000 | ||||||
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HumanaChoice H5868-012 (PPO) - H5868-012-0 Benefit Details |
Grand | $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 | |||||||||
Rocky Mountain Standard Plan (Cost) - H0602-001-0 Benefit Details |
Grand | $68.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Rocky Mountain Green Plan + Rx (Cost) - H0602-043-0 Benefit Details |
Grand | $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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HumanaChoice H5868-010 (PPO) - H5868-010-0 Benefit Details |
Grand | $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 | |||||
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 Thrifty Plan + Rx (Cost) - H0602-039-0 Benefit Details |
Grand | $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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Humana Gold Choice H8145-123 (PFFS) - H8145-123-0 Benefit Details |
Grand | $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 | |||||
Rocky Mountain Standard Plan + Rx (Cost) - H0602-017-0 Benefit Details |
Grand | $127.70 | $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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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 Plus Plan (Cost) - H0602-003-0 Benefit Details |
Grand | $158.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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Rocky Mountain Plus Plan + Rx (Cost) - H0602-019-0 Benefit Details |
Grand | $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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HumanaChoice H5868-013 (PPO) - H5868-013-0 Benefit Details |
Grand | $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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