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 SecureHorizons Plan 2 (HMO) - H3749-017-0 Benefit Details |
Tulsa | $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 | |||||
GlobalHealth Medicare Option 1 (HMO) - H0435-001-0 Benefit Details |
Tulsa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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HumanaChoice R5826-069 (Regional PPO) - R5826-069-0 Benefit Details |
Tulsa | $0.00 | 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 Value (HMO) - H6801-002-0 Benefit Details |
Tulsa | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $32.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $4,500 Browse Formulary | |||||
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Senior Health Plan Silver (HMO) - H3755-002-0 Benefit Details |
Tulsa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Senior Health Plan Silver Plus (HMO) - H3755-005-0 Benefit Details |
Tulsa | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $13.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Tier 6: 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 | |||||||||
Humana Gold Choice H8145-120 (PFFS) - H8145-120-0 Benefit Details |
Tulsa | $15.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Today's Options Premier 900 (PFFS) - H6169-016-0 Benefit Details |
Tulsa | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Coventry Freedom (PPO) - H5509-017-0 Benefit Details |
Tulsa | $33.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Brand: $92.00 Specialty Tier: 33% | $3,400 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 | |||||||||
Senior Health Plan Platinum (HMO) - H3755-001-0 Benefit Details |
Tulsa | $41.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Injectable Drugs: 33% | $3,400 Browse Formulary | |||||
GlobalHealth Medicare Option 2 (HMO) - H0435-002-0 Benefit Details |
Tulsa | $47.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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HumanaChoice H8644-005 (PPO) - H8644-005-0 Benefit Details |
Tulsa | $52.00 | $275 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 15% Non-Preferred Brand: 30% Specialty Tier: 25% | $6,700 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 | |||||||||
AARP MedicareComplete SecureHorizons Plan 1 (HMO) - H3749-004-0 Benefit Details |
Tulsa | $55.00 | $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% | $4,900 Browse Formulary | |||||
HumanaChoice H8644-003 (PPO) - H8644-003-0 Benefit Details |
Tulsa | $68.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
Today's Options Advantage Plus 950B (PPO) - H5378-016-0 Benefit Details |
Tulsa | $80.00 | $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 | |||||||||
Today's Options Premier Plus 950B (PFFS) - H6169-036-0 Benefit Details |
Tulsa | $95.00 | $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% | n/a Browse Formulary | |||||
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GlobalHealth Medicare Option 3 (HMO) - H0435-003-0 Benefit Details |
Tulsa | $99.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Senior Health Plan Platinum Plus (HMO) - H3755-004-0 Benefit Details |
Tulsa | $110.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Tier 6: 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 | |||||||||
Humana Gold Choice H8145-001 (PFFS) - H8145-001-0 Benefit Details |
Tulsa | $162.00 | $125 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $12.00 Preferred Brand: $43.00 Non-Preferred Brand: $85.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
HumanaChoice R5826-013 (Regional PPO) - R5826-013-0 Benefit Details |
Tulsa | $167.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $3,400 Browse Formulary | |||||
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