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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HumanaChoice R5826-063 (Regional PPO) - R5826-063-0 Benefit Details |
Falls Church City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Kaiser Permanente Medicare Plus Basic w/o D (AB) (Cost) - H2150-017-0 Benefit Details |
Falls Church City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Kaiser Permanente Medicare Plus Std w/o D (AB) (Cost) - H2150-022-0 Benefit Details |
Falls Church City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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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 | |||||||||
Kaiser Permanente Medicare Plus Std w/Part D (AB) (Cost) - H2150-009-0 Benefit Details |
Falls Church City | $15.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% Tier 6: $0.00 | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
Humana Gold Plus H2012-092 (HMO) - H2012-092-0 Benefit Details |
Falls Church City | $20.00 | $210 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $18.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Aetna Medicare Value Plan (HMO) - H4910-005-0 Benefit Details |
Falls Church City | $40.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00 | $5,200 Browse Formulary | |||||
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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 | |||||||||
Kaiser Permanente Medicare Plus High w/o D (AB) (Cost) - H2150-021-0 Benefit Details |
Falls Church City | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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HumanaChoice H5041-006 (PPO) - H5041-006-0 Benefit Details |
Falls Church City | $72.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $16.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-079 (Regional PPO) - R5826-079-0 Benefit Details |
Falls Church City | $72.00 | $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% | $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 | |||||||||
Humana Gold Choice H8145-004 (PFFS) - H8145-004-0 Benefit Details |
Falls Church City | $74.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $18.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Aetna Medicare Standard Plan (PPO) - H5521-027-0 Benefit Details |
Falls Church City | $77.00 | $0 | Few Generics | Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-003 (Regional PPO) - R5826-003-0 Benefit Details |
Falls Church City | $81.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 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 | |||||||||
Kaiser Permanente Medicare Plus High w/Part D (AB) (Cost) - H2150-002-0 Benefit Details |
Falls Church City | $113.00 | $0 | All Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Vaccines: $0.00 | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: |
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