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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Blue Medicare HMO Medical Only (HMO) - H3449-012-0 Benefit Details |
Lee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Blue Medicare HMO Standard (HMO) - H3449-013-0 Benefit Details |
Lee | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
FirstMedicare Direct HMO Plus (HMO) - H6306-002-0 Benefit Details |
Lee | $0.00 | $0 | Some Generics | Preferred Generic: $7.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 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 | |||||||||
HumanaChoice R5826-063 (Regional PPO) - R5826-063-0 Benefit Details |
Lee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Patriot (PFFS) - H4268-001-0 Benefit Details |
Lee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Blue Medicare HMO Enhanced (HMO) - H3449-005-0 Benefit Details |
Lee | $18.90 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 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 | |||||||||
UnitedHealthcare Nursing Home Plan (HMO SNP) - H3456-010-0 Benefit Details |
Lee | $28.30 | $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 | |||||
FirstMedicare Direct PPO Plus (PPO) - H8064-002-0 Benefit Details |
Lee | $35.00 | $0 | Some Generics | Preferred Generic: $7.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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HumanaChoice H3405-002 (PPO) - H3405-002-0 Benefit Details |
Lee | $37.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) - H3404-001-0 Benefit Details |
Lee | $38.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Ambassador Plus (PPO) - H6881-002-0 Benefit Details |
Lee | $42.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
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Patriot Plus (PFFS) - H4268-002-0 Benefit Details |
Lee | $61.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 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 | |||||||||
HumanaChoice R5826-079 (Regional PPO) - R5826-079-0 Benefit Details |
Lee | $72.00 | $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% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-003 (Regional PPO) - R5826-003-0 Benefit Details |
Lee | $81.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Blue Medicare PPO Enhanced Freedom (PPO) - H3404-002-0 Benefit Details |
Lee | $121.30 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: |
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