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 |
Wayne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Medicare Blue Choice Value (HMO) - H3351-011-0 Benefit Details |
Wayne | $0.00 | $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% | $5,000 Browse Formulary | |||||
Today's Options Premier 700 (PFFS) - H2816-008-0 Benefit Details |
Wayne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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 (Regional PPO) - R5342-001-0 Benefit Details |
Wayne | $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 | |||||
UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) - R5342-002-0 Benefit Details |
Wayne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,200 | ||||||
WellCare Advance (HMO) - H3361-059-0 Benefit Details |
Wayne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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 | |||||||||
WellCare Value (HMO-POS) - H3361-099-0 Benefit Details |
Wayne | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $44.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
WellCare Access (HMO SNP) - H3361-065-0 Benefit Details |
Wayne | $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 | Preferred Generic: $0.00 Non-Preferred Generic: $2.00 Preferred Brand: $15.00 Non-Preferred Brand: $40.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
BasiCare with Part D (PPO) - H9615-008-0 Benefit Details |
Wayne | $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 | |||||||||
HealthNow SelectSaver HMO (HMO-POS) - H3384-057-0 Benefit Details |
Wayne | $29.00 | $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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WellCare Liberty (HMO SNP) - H3361-098-0 Benefit Details |
Wayne | $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 | Preferred Generic: $0.00 Non-Preferred Generic: $2.00 Preferred Brand: $15.00 Non-Preferred Brand: $40.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Preferred Gold without Part D (HMO-POS) - H3305-007-0 Benefit Details |
Wayne | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
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 | |||||||||
Today's Options Premier 100 (PFFS) - H2816-002-0 Benefit Details |
Wayne | $47.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
GoldAnywhere with Part D - Option 2 (PPO) - H9615-007-0 Benefit Details |
Wayne | $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 |
Wayne | $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 | |||||
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 Blue Choice Value Plus (HMO) - H3351-013-0 Benefit Details |
Wayne | $80.00 | $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 | |||||
Medicare Blue PPO Plan 201 (PPO) - H3335-032-0 Benefit Details |
Wayne | $95.00 | $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 | |||||
Medicare Blue Choice Platinum (HMO-POS) - H3351-007-0 Benefit Details |
Wayne | $96.00 | 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 | |||||||||
Medicare Blue Choice Optimum (HMO-POS) - H3351-006-0 Benefit Details |
Wayne | $140.00 | $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% | $3,600 Browse Formulary | |||||
Preferred Gold with Part D (HMO-POS) - H3305-011-0 Benefit Details |
Wayne | $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 | |||||
GoldAnywhere with Part D - Option 1 (PPO) - H9615-002-0 Benefit Details |
Wayne | $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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