2014 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
Geisinger Gold Reserve 100 (MSA) - H2792-001-0 Benefit Details |
Monmouth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
AARP MedicareComplete Essential (HMO) - H3107-008-0 Benefit Details |
Monmouth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
AARP MedicareComplete Plan 1 (HMO) - H3107-004-0 Benefit Details |
Monmouth | $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% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Aetna Medicare Basic Plan (HMO) - H3152-045-0 Benefit Details |
Monmouth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Geisinger Gold Classic 300 $0 Deductible Rx (HMO) - H3954-146-0 Benefit Details |
Monmouth | $0.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,500 Browse Formulary | |||||
Erickson Advantage Guardian (HMO-POS SNP) - H5652-003-0 Benefit Details |
Monmouth | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
AmeriHealth 65 Preferred Medical Only (HMO) - H3156-033-0 Benefit Details |
Monmouth | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
-- | -- | ||||||||||
UnitedHealthcare Nursing Home Plan (HMO SNP) - H3113-001-0 Benefit Details |
Monmouth | $30.10 | $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 | |||||
-- | -- | ||||||||||
Amerivantage Specialty + Rx (HMO SNP) - H3240-013-0 Benefit Details |
Monmouth | $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% Tier 5: 0% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Horizon Medicare Blue TotalCare (HMO SNP) - H3154-020-0 Benefit Details |
Monmouth | $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% Tier 5: 0% | n/a Browse Formulary | |||||
Erickson Advantage Freedom (HMO-POS) - H5652-006-0 Benefit Details |
Monmouth | $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 | |||||
Geisinger Gold Preferred 200 (PPO) - H9412-002-0 Benefit Details |
Monmouth | $58.00 | 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 |
|||||
Service | Exper. | Cost Info | |||||||||
AmeriHealth 65 Preferred Rx (HMO) - H3156-034-0 Benefit Details |
Monmouth | $69.00 | $295 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
-- | -- | ||||||||||
Geisinger Gold Secure 200 (HMO SNP) - H3954-148-0 Benefit Details |
Monmouth | $70.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Geisinger Gold Classic 100 Plus (HMO-POS) - H3954-142-0 Benefit Details |
Monmouth | $85.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,800 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Geisinger Gold Preferred 200 $0 Deductible Rx (PPO) - H9412-003-0 Benefit Details |
Monmouth | $98.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
-- | -- | -- | |||||||||
Geisinger Gold Classic 100 Plus $0 Deductible Rx (HMO-POS) - H3954-143-0 Benefit Details |
Monmouth | $125.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,800 Browse Formulary | |||||
Aetna Medicare Premier Plan (HMO) - H3152-048-0 Benefit Details |
Monmouth | $145.00 | $0 | Few Generics | Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Erickson Advantage Signature without Drugs (HMO-POS) - H5652-002-0 Benefit Details |
Monmouth | $149.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
Horizon Medicare Blue Choice w/Rx (HMO) - H3154-022-0 Benefit Details |
Monmouth | $153.70 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Brand: $84.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Erickson Advantage Champion (HMO-POS SNP) - H5652-004-0 Benefit Details |
Monmouth | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Erickson Advantage Signature with Drugs (HMO-POS) - H5652-001-0 Benefit Details |
Monmouth | $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 | |||||
|