2014 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
Amerivantage Classic+ Rx (HMO) - H7200-007-0 Benefit Details |
Cannon | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
BlueAdvantage Sapphire (PPO) - H7917-030-0 Benefit Details |
Cannon | $0.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,400 Browse Formulary | |||||
Cigna-HealthSpring Advantage (HMO) - H4454-012-0 Benefit Details |
Cannon | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Cigna-HealthSpring Preferred (HMO) - H4454-002-0 Benefit Details |
Cannon | $0.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
HumanaChoice R5826-065 (Regional PPO) - R5826-065-0 Benefit Details |
Cannon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Windsor Medicare Extra Silver Plan (HMO) - H5698-035-0 Benefit Details |
Cannon | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
UnitedHealthcare Dual Complete (HMO SNP) - H0251-002-0 Benefit Details |
Cannon | $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% Tier 2: 0% Tier 3: 0% Tier 4: 0% Tier 5: 0% | n/a Browse Formulary | |||||
Cigna-HealthSpring TotalCare (HMO SNP) - H4454-020-0 Benefit Details |
Cannon | $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 | |||||
Amerivantage Specialty + Rx (HMO SNP) - H7200-006-0 Benefit Details |
Cannon | $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% Tier 2: 0% Tier 3: 0% Tier 4: 0% Tier 5: 0% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Comp Plus Plan (HMO SNP) - H5698-140-0 Benefit Details |
Cannon | $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% Tier 2: 0% Tier 3: 0% Tier 4: 0% Tier 5: 0% | n/a Browse Formulary | |||||
BlueCare Plus (HMO SNP) - H3259-001-0 Benefit Details |
Cannon | $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 | |||||
new | new | new | |||||||||
BlueAdvantage Ruby (PPO) - H7917-014-0 Benefit Details |
Cannon | $69.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $3.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $3,800 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-001 (Regional PPO) - R5826-001-0 Benefit Details |
Cannon | $69.00 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $5,900 Browse Formulary | |||||
Cigna-HealthSpring Premier (HMO-POS) - H4454-030-0 Benefit Details |
Cannon | $72.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
BlueAdvantage Diamond (PPO) - H7917-010-0 Benefit Details |
Cannon | $196.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $3.00 Preferred Brand: $30.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $2,700 Browse Formulary | |||||
|