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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BlueSaver MSA (MSA) - H9788-001-0 Benefit Details |
Orleans | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
BlueCross BlueShield Senior Blue 650 Part D (HMO-POS) - H3384-058-0 Benefit Details |
Orleans | $0.00 | $0 | 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: 50% Specialty Tier: 30% | $3,400 Browse Formulary | |||||
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BlueCross BlueShield Senior Blue HMO 601 (HMO) - H3384-022-0 Benefit Details |
Orleans | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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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 | |||||||||
Independent Health Encompass 65 (HMO) - H3362-016-0 Benefit Details |
Orleans | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Independent Health's Encompass 65 Essential (HMO-POS) - H3362-026-0 Benefit Details |
Orleans | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Orleans | $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 |
Orleans | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,200 | ||||||
Univera SeniorChoice Value (HMO) - H3351-010-0 Benefit Details |
Orleans | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,000 Browse Formulary | |||||
BasiCare with Part D (PPO) - H9615-008-0 Benefit Details |
Orleans | $27.00 | $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% | $4,000 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 | |||||||||
BlueCross BlueShield Senior Blue HMO 651 PartD (HMO) - H3384-019-0 Benefit Details |
Orleans | $28.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $3,400 Browse Formulary | |||||
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UnitedHealthcare Nursing Home Plan (HMO SNP) - H3379-022-0 Benefit Details |
Orleans | $35.20 | $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 | |||||
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Independent Health Medicare Family Choice (HMO SNP) - H3362-020-0 Benefit Details |
Orleans | $37.20 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | 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 | |||||||||
Preferred Gold without Part D (HMO-POS) - H3305-007-0 Benefit Details |
Orleans | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
Univera SeniorChoice Value Plus (HMO) - H3351-012-0 Benefit Details |
Orleans | $49.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
Univera Medicare Classic PPO (PPO) - H3335-002-0 Benefit Details |
Orleans | $55.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,000 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 | |||||||||
GoldAnywhere with Part D - Option 2 (PPO) - H9615-007-0 Benefit Details |
Orleans | $64.00 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $4,000 Browse Formulary | |||||
GoldValue with Part D (HMO-POS) - H3305-015-0 Benefit Details |
Orleans | $72.00 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $6,000 Browse Formulary | |||||
Univera SeniorChoice Select (HMO-POS) - H3351-001-0 Benefit Details |
Orleans | $80.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 | ||||||
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 | |||||||||
Independent Health Encompass 65 Basic (HMO) - H3362-017-0 Benefit Details |
Orleans | $87.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
BlueCross BlueShield Senior Blue HMO 654 (HMO) - H3384-056-0 Benefit Details |
Orleans | $99.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $3,400 Browse Formulary | |||||
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Independent Health Medicare Passport Advantage (PPO) - H3344-005-0 Benefit Details |
Orleans | $121.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 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 |
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Service | Exper. | Cost Info | |||||||||
Univera SeniorChoice Secure (HMO-POS) - H3351-002-0 Benefit Details |
Orleans | $124.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,500 Browse Formulary | |||||
BlueCross BlueShield Forever Blue Medicare PPO 751 (PPO) - H5526-004-0 Benefit Details |
Orleans | $125.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Preferred Gold with Part D (HMO-POS) - H3305-011-0 Benefit Details |
Orleans | $159.50 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $4,500 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 | |||||||||
GoldAnywhere with Part D - Option 1 (PPO) - H9615-002-0 Benefit Details |
Orleans | $238.00 | $0 | Few Generics | Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $2,000 Browse Formulary | |||||
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