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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Platinum Blue Core Plan (Cost) - H2461-005-0 Benefit Details |
Stevens | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
PrimeWest Senior Health Complete (HMO SNP) - H2416-001-0 Benefit Details |
Stevens | $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% | n/a Browse Formulary | |||||
UCare for Seniors Value (HMO-POS) - H2459-001-0 Benefit Details |
Stevens | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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 | |||||||||
HealthPartners Freedom Basic (Cost) - H2462-004-0 Benefit Details |
Stevens | $47.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Prime Health Complete (HMO SNP) - H2926-001-0 Benefit Details |
Stevens | $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% | n/a Browse Formulary | |||||
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UCare for Seniors Essentials Rx (HMO-POS) - H2459-019-0 Benefit Details |
Stevens | $48.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $25.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 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 | |||||||||
HealthPartners Freedom Vital (Cost) - H2462-018-0 Benefit Details |
Stevens | $54.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Medica Clear Solution Essential (PPO) - H3283-003-0 Benefit Details |
Stevens | $58.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $4,000 Browse Formulary | |||||
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Medica Prime Solution Thrift with Part D Option 1 (Cost) - H2450-007-0 Benefit Details |
Stevens | $60.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 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 | |||||||||
HealthPartners Freedom Vital with Rx (Cost) - H2462-019-0 Benefit Details |
Stevens | $66.10 | $175 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Platinum Blue Choice Plan (Cost) - H2461-006-0 Benefit Details |
Stevens | $74.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Medica Prime Solution Value with Part D Option 1 (Cost) - H2450-022-0 Benefit Details |
Stevens | $84.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 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 | |||||||||
Blue Essentials (HMO-POS) - H2425-002-0 Benefit Details |
Stevens | $93.60 | $160 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $40.00 Non-Preferred Brand: 45% | $4,000 Browse Formulary | |||||
HealthPartners Freedom Balance (Cost) - H2462-007-0 Benefit Details |
Stevens | $94.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Medica Prime Solution Basic with Part D Option 1 (Cost) - H2450-016-0 Benefit Details |
Stevens | $100.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 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 | |||||||||
UCare for Seniors Value Plus (HMO-POS) - H2459-013-0 Benefit Details |
Stevens | $106.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 25% | $3,400 Browse Formulary | |||||
Platinum Blue Complete Plan (Cost) - H2461-007-0 Benefit Details |
Stevens | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
HealthPartners Freedom Balance with Rx (Cost) - H2462-008-0 Benefit Details |
Stevens | $117.80 | $125 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 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 | |||||||||
Medica Prime Solution Value with Part D Option 2 (Cost) - H2450-023-0 Benefit Details |
Stevens | $125.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) - H2450-001-0 Benefit Details |
Stevens | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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HealthPartners Freedom Ultimate (Cost) - H2462-010-0 Benefit Details |
Stevens | $145.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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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 | |||||||||
Medica Prime Solution Enhanced w/Part D Option 1 (Cost) - H2450-017-0 Benefit Details |
Stevens | $150.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
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UCare for Seniors Classic (HMO-POS) - H2459-002-0 Benefit Details |
Stevens | $161.00 | $0 | Many Generics | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 25% | $3,400 Browse Formulary | |||||
HealthPartners Freedom Ultimate with Rx (Cost) - H2462-011-0 Benefit Details |
Stevens | $187.70 | $175 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 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 | |||||||||
Medica Prime Solution Enhanced w/Part D Option 2 (Cost) - H2450-002-0 Benefit Details |
Stevens | $191.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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HealthPartners Freedom Ultimate with Enhanced Rx (Cost) - H2462-012-0 Benefit Details |
Stevens | $343.30 | $100 | Many Generics, Some Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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