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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Lovelace Medicare Plan $0 (HMO) - H3251-002-0 Benefit Details |
Lea | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
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Lovelace Medicare Plan Deluxe (HMO) - H3251-027-0 Benefit Details |
Lea | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
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Presbyterian MediCare PPO Plan 1 (PPO) - H3206-003-0 Benefit Details |
Lea | $55.00 | 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 | |||||||||
Lovelace Medicare Plan Enhanced (HMO-POS) - H3251-021-0 Benefit Details |
Lea | $89.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
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Presbyterian MediCare PPO Plan 2 with Rx (PPO) - H3206-001-0 Benefit Details |
Lea | $102.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Presbyterian MediCare PPO Plan 3 with Rx (PPO) - H3206-002-0 Benefit Details |
Lea | $132.00 | $0 | Many Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,000 Browse Formulary | |||||
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