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 (HMO) - H4514-007-0 Benefit Details |
Montgomery | $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% | $4,900 Browse Formulary | |||||
Advantra (HMO) - H5048-002-0 Benefit Details |
Montgomery | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $3.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,900 Browse Formulary | |||||
new | new | new | Higher cost-sharing at standard network pharmacies. Details: | ||||||||
Advantra (PPO) - H7306-001-0 Benefit Details |
Montgomery | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $3.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 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 | |||||||||
Aetna Medicare Premier Plan (HMO) - H4523-015-0 Benefit Details |
Montgomery | $0.00 | $0 | Few Generics | Generic: $10.00 Preferred Brand: 25% Non-Preferred Brand: 50% Specialty Tier: 33% Select Care Drugs: $0.00 | $4,900 Browse Formulary | |||||
Amerivantage Classic+ Rx (HMO) - H5817-010-0 Benefit Details |
Montgomery | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Care Improvement Plus Gold Rx (PPO SNP) - H0084-004-0 Benefit Details |
Montgomery | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | 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 | |||||||||
Care Improvement Plus Gold Rx (Regional PPO SNP) - R6801-009-0 Benefit Details |
Montgomery | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (PPO) - H0084-001-0 Benefit Details |
Montgomery | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (Regional PPO) - R6801-012-0 Benefit Details |
Montgomery | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 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 | |||||||||
Cigna-HealthSpring Advantage (HMO) - H4513-009-0 Benefit Details |
Montgomery | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Cigna-HealthSpring Preferred (HMO) - H4513-001-0 Benefit Details |
Montgomery | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Humana Gold Plus H4510-028 (HMO) - H4510-028-0 Benefit Details |
Montgomery | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 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 | |||||||||
HumanaChoice R5826-026 (Regional PPO) - R5826-026-0 Benefit Details |
Montgomery | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
KelseyCare Advantage Essential (HMO) - H0332-001-0 Benefit Details |
Montgomery | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
KelseyCare Advantage Essential+Choice (HMO-POS) - H0332-003-0 Benefit Details |
Montgomery | $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 | |||||||||
KelseyCare Advantage Rx (HMO) - H0332-002-0 Benefit Details |
Montgomery | $0.00 | $50 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $30.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 31% | $3,400 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
TexanPlus Choice (HMO-POS) - H4506-029-0 Benefit Details |
Montgomery | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
TexanPlus Classic (HMO) - H4506-003-0 Benefit Details |
Montgomery | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
TexanPlus Value (HMO) - H4506-010-0 Benefit Details |
Montgomery | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
WellCare Dividend (HMO) - H1264-008-0 Benefit Details |
Montgomery | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $30.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
WellCare Value (HMO-POS) - H1264-004-0 Benefit Details |
Montgomery | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $30.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-091 (Regional PPO) - R5826-091-0 Benefit Details |
Montgomery | $10.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
WellCare Access (HMO SNP) - H1264-007-0 Benefit Details |
Montgomery | $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: $7.00 Preferred Brand: $20.00 Non-Preferred Brand: $50.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Humana Gold Plus SNP-DE H4510-031 (HMO SNP) - H4510-031-0 Benefit Details |
Montgomery | $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 | |||||||||
Humana Gold Choice H8145-126 (PFFS) - H8145-126-0 Benefit Details |
Montgomery | $15.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Care Improvement Plus Silver Rx (Regional PPO SNP) - R6801-008-0 Benefit Details |
Montgomery | $15.50 | $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 | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H4514-001-0 Benefit Details |
Montgomery | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Cigna-HealthSpring TotalCare (HMO SNP) - H4513-010-0 Benefit Details |
Montgomery | $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 | |||||
Care Improvement Plus Dual Advantage (Regional PPO SNP) - R6801-011-0 Benefit Details |
Montgomery | $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 | |||||
Amerivantage Specialty + Rx (HMO SNP) - H5817-009-0 Benefit Details |
Montgomery | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Blue Cross Medicare Advantage Choice Plus (PPO) - H1666-006-0 Benefit Details |
Montgomery | $34.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $2.00 Preferred Brand: $39.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
-- | -- | -- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||
Cigna-HealthSpring Achieve (HMO SNP) - H4528-014-0 Benefit Details |
Montgomery | $47.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% Tier 6: $5.00 | n/a Browse Formulary | |||||
Blue Cross Medicare Advantage Choice Premier (PPO) - H1666-003-0 Benefit Details |
Montgomery | $54.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $2.00 Preferred Brand: $39.00 Non-Preferred Brand: $85.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-012 (Regional PPO) - R5826-012-0 Benefit Details |
Montgomery | $65.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $89.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
HumanaChoice H4520-006 (PPO) - H4520-006-0 Benefit Details |
Montgomery | $66.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Brand: $83.00 Specialty Tier: 33% | $6,600 Browse Formulary | |||||
KelseyCare Advantage Rx+Choice (HMO-POS) - H0332-004-0 Benefit Details |
Montgomery | $77.00 | $50 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $30.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 31% | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Aetna Medicare Value Plan (PPO) - H4524-013-0 Benefit Details |
Montgomery | $78.50 | $0 | Few Generics | Generic: $10.00 Preferred Brand: 25% Non-Preferred Brand: 50% Specialty Tier: 33% Select Care Drugs: $0.00 | $6,700 Browse Formulary | |||||
Humana Gold Choice H8145-084 (PFFS) - H8145-084-0 Benefit Details |
Montgomery | $89.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
KelseyCare Advantage Rx Premier (HMO) - H0332-006-0 Benefit Details |
Montgomery | $223.10 | $50 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $20.00 Preferred Brand: $20.00 Non-Preferred Brand: $50.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: |
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