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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ActiveSaver MSA (MSA) - H9788-003-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Medicare BlueClassic PPO (PPO) - H3335-038-0 Benefit Details |
Jefferson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Jefferson | $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% | $5,200 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 | |||||||||
UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) - R5342-002-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,200 | ||||||
Today's Options Advantage 900 (PPO) - H2775-095-0 Benefit Details |
Jefferson | $10.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Today's Options Advantage Plus 950B (PPO) - H2775-089-0 Benefit Details |
Jefferson | $43.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | $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 | |||||||||
Medicare BlueBasic PPO (PPO) - H3335-043-0 Benefit Details |
Jefferson | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,800 | ||||||
Medicare BlueSecure PPO (PPO) - H3335-014-0 Benefit Details |
Jefferson | $72.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,500 Browse Formulary | |||||
Today's Options Advantage Plus 350A (PPO) - H2775-083-0 Benefit Details |
Jefferson | $117.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,250 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 | |||||||||
Medicare BlueEnhanced PPO (PPO) - H3335-015-0 Benefit Details |
Jefferson | $123.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,000 Browse Formulary | |||||
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