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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Commonwealth Care Alliance (Medicare-Medicaid Plan) - H0137-001-0 Benefit Details |
Franklin | $0.00 | $0 | All Generics, All Brands | Tier 1: 0% Tier 2: 0% Tier 3: 0% Tier 4: 0% Tier 5: 0% Tier 6: 0% | n/a Browse Formulary | |||||
Fallon Senior Plan Super Saver Rx (HMO) - H9001-032-6 Benefit Details |
Franklin | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Non-Preferred Generic: $5.00 Preferred Brand: $32.00 Non-Preferred Brand: $76.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Medicare PPO Blue SaverRx (PPO) - H2230-017-0 Benefit Details |
Franklin | $0.00 | $310 | 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: 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 | |||||||||
HNE Medicare Basic No Rx (HMO) - H8578-009-0 Benefit Details |
Franklin | $14.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HNE Medicare Value (HMO) - H8578-012-0 Benefit Details |
Franklin | $18.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Medicare HMO Blue ValueRx (HMO) - H2261-019-0 Benefit Details |
Franklin | $26.00 | $310 | 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: 25% | $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 | |||||||||
NaviCare (HMO SNP) - H9001-019-0 Benefit Details |
Franklin | $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 | |||||
AARP MedicareComplete Choice (Regional PPO) - R7444-001-0 Benefit Details |
Franklin | $30.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Senior Care Options Program (HMO SNP) - H2225-001-0 Benefit Details |
Franklin | $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% | 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 | |||||||||
Fallon Senior Plan Saver (HMO) - H9001-029-6 Benefit Details |
Franklin | $44.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Medicare PPO Blue ValueRx (PPO) - H2230-016-0 Benefit Details |
Franklin | $51.00 | $310 | 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: 25% | $3,400 Browse Formulary | |||||
Fallon Senior Plan Saver Enhanced Rx (HMO-POS) - H9001-013-0 Benefit Details |
Franklin | $69.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Non-Preferred Generic: $5.00 Preferred Brand: $27.00 Non-Preferred Brand: $76.00 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 | |||||||||
HNE Medicare Basic (HMO) - H8578-007-0 Benefit Details |
Franklin | $72.00 | $0 | All Generics | Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
HNE Medicare Premium No Rx (HMO) - H8578-003-0 Benefit Details |
Franklin | $84.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HNE Medicare Plus (HMO) - H8578-004-0 Benefit Details |
Franklin | $107.00 | $0 | All Generics | Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $75.00 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 | |||||||||
Fallon Senior Plan Standard (HMO) - H9001-001-0 Benefit Details |
Franklin | $116.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Medicare PPO Blue PlusRx (PPO) - H2230-002-0 Benefit Details |
Franklin | $124.00 | $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: 30% | $3,400 Browse Formulary | |||||
HNE Medicare Premium (HMO) - H8578-001-0 Benefit Details |
Franklin | $158.00 | $0 | All Generics | Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $75.00 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 | |||||||||
Fallon Senior Plan Standard Enhanced Rx (HMO) - H9001-015-0 Benefit Details |
Franklin | $167.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Non-Preferred Generic: $5.00 Preferred Brand: $27.00 Non-Preferred Brand: $76.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Medicare HMO Blue PlusRx (HMO) - H2261-005-0 Benefit Details |
Franklin | $167.00 | $120 | 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: 30% | $3,400 Browse Formulary | |||||
HNE Medicare Freedom (HMO-POS) - H8578-010-0 Benefit Details |
Franklin | $203.00 | $0 | All Generics | Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $75.00 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 | |||||||||
Fallon Senior Plan Plus Enhanced RX (HMO) - H9001-031-6 Benefit Details |
Franklin | $226.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Non-Preferred Generic: $5.00 Preferred Brand: $27.00 Non-Preferred Brand: $76.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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