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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AARP MedicareComplete Essential (HMO) - H3659-054-0 Benefit Details |
Trumbull | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
AARP MedicareComplete Plan 1 (HMO) - H3659-003-0 Benefit Details |
Trumbull | $0.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,900 Browse Formulary | |||||
AARP MedicareComplete Plan 2 (HMO) - H3659-031-0 Benefit Details |
Trumbull | $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 |
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Service | Exper. | Cost Info | |||||||||
Advantra Silver (PPO) - H8980-002-0 Benefit Details |
Trumbull | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $17.00 Preferred Brand: $41.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $4,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Aetna Medicare Value Plan (HMO) - H3623-004-0 Benefit Details |
Trumbull | $0.00 | $0 | Few Generics | Generic: $10.00 Preferred Brand: 25% Non-Preferred Brand: 50% Specialty Tier: 33% Select Care Drugs: $0.00 | $5,100 Browse Formulary | |||||
Anthem Senior Advantage Basic (HMO) - H3655-013-0 Benefit Details |
Trumbull | $0.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: 33% Tier 6: 33% | $4,200 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
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 | |||||||||
Gateway Health Medicare Assured Choice (HMO) - H9190-005-0 Benefit Details |
Trumbull | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
Humana Gold Plus H8953-009 (HMO) - H8953-009-0 Benefit Details |
Trumbull | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,900 Browse Formulary | |||||
HumanaChoice R5826-021 P (Regional PPO) - R5826-021-0 Benefit Details |
Trumbull | $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 | |||||||||
SecureCare - Option I (HMO) - H3672-014-0 Benefit Details |
Trumbull | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
SecureCare - Option IV (HMO) - H3672-018-0 Benefit Details |
Trumbull | $0.00 | $0 | Few Generics | Preferred Generic: $10.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Specialty Tier: 33% | $4,250 Browse Formulary | |||||
SummaCare Medicare Ruby (HMO) - H3660-044-0 Sanctioned Plan |
Trumbull | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 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 | |||||||||
WellCare Value (HMO) - H0117-005-0 Benefit Details |
Trumbull | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $69.00 Specialty Tier: 33% | $4,000 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
SecureCare SNP (HMO SNP) - H3672-017-0 Benefit Details |
Trumbull | $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: 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% | n/a Browse Formulary | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H3659-056-0 Benefit Details |
Trumbull | $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: 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15% | 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 | |||||||||
WellCare Access (HMO SNP) - H0117-007-0 Benefit Details |
Trumbull | $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: $4.00 Preferred Brand: $20.00 Non-Preferred Brand: $50.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
UnitedHealthcare Nursing Home Plan (HMO-POS SNP) - H5322-001-0 Benefit Details |
Trumbull | $18.80 | $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 | |||||
new | new | new | |||||||||
Blue Medicare Access Classic (Regional PPO) - R5941-007-0 Benefit Details |
Trumbull | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 | ||||||
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 | |||||||||
SecureChoice - Option I (PPO) - H8604-002-0 Benefit Details |
Trumbull | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Gateway Health Medicare Assured Ruby (HMO SNP) - H9190-002-0 Benefit Details |
Trumbull | $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: 15% | n/a Browse Formulary | |||||
new | new | new | |||||||||
Gateway Health Medicare Assured Gold (HMO SNP) - H9190-003-0 Benefit Details |
Trumbull | $27.60 | $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% Tier 6: $10.00 | n/a Browse Formulary | |||||
new | new | new | |||||||||
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 | |||||||||
CareSource Advantage (HMO SNP) - H6178-001-0 Benefit Details |
Trumbull | $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 | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Gateway Health Medicare Assured Diamond (HMO SNP) - H9190-001-0 Benefit Details |
Trumbull | $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% | n/a Browse Formulary | |||||
new | new | new | |||||||||
HumanaChoice H6609-087 (PPO) - H6609-087-0 Benefit Details |
Trumbull | $30.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Advantra Gold (PPO) - H8980-004-0 Benefit Details |
Trumbull | $39.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Anthem Medicare Preferred Standard (PPO) - H5529-001-0 Benefit Details |
Trumbull | $50.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $14.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: 33% Specialty Tier: 33% | $5,100 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
SecureCare - Option II (HMO) - H3672-013-0 Benefit Details |
Trumbull | $50.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Specialty Tier: 33% | $3,400 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 | |||||||||
Anthem Senior Advantage Plus (HMO) - H3655-030-0 Benefit Details |
Trumbull | $53.00 | $60 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: 33% Tier 6: 33% | $4,100 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Gateway Health Medicare Assured Platinum (HMO SNP) - H9190-004-0 Benefit Details |
Trumbull | $56.50 | $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: $95.00 Specialty Tier: 33% Tier 6: $10.00 | n/a Browse Formulary | |||||
new | new | new | |||||||||
Gateway Health Medicare Assured Prime (HMO) - H9190-006-0 Benefit Details |
Trumbull | $64.40 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
SummaCare Medicare Sapphire (HMO-POS) - H3660-029-0 Sanctioned Plan |
Trumbull | $65.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare Access Value (Regional PPO) - R5941-008-0 Benefit Details |
Trumbull | $70.00 | $120 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: 33% Tier 6: 33% | $6,000 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
SecureChoice - Option II (PPO) - H8604-001-0 Benefit Details |
Trumbull | $70.00 | $0 | Many Generics | Preferred Generic: $8.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-007 P (Regional PPO) - R5826-007-0 Benefit Details |
Trumbull | $74.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Brand: $93.00 Specialty Tier: 29% | $6,700 Browse Formulary | |||||
SecureCare - Option III (HMO) - H3672-016-0 Benefit Details |
Trumbull | $74.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Anthem Medicare Preferred Select (PPO) - H5529-004-0 Benefit Details |
Trumbull | $85.00 | $70 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: 33% Tier 6: 33% | $4,100 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H8145-032 (PFFS) - H8145-032-0 Benefit Details |
Trumbull | $95.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
SecureChoice - Option III (PPO) - H8604-005-0 Benefit Details |
Trumbull | $119.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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SummaCare Medicare Emerald (HMO-POS) - H3660-028-0 Sanctioned Plan |
Trumbull | $165.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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