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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Gundersen Senior Preferred Value (no RX) (HMO) - H5262-004-0 Benefit Details |
La Crosse | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice R5826-023 P (Regional PPO) - R5826-023-0 Benefit Details |
La Crosse | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
Humana Gold Choice H8145-153 (PFFS) - H8145-153-0 Benefit Details |
La Crosse | $24.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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 | |||||||||
UCare for Seniors Value (HMO-POS) - H4270-001-0 Benefit Details |
La Crosse | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
UnitedHealthcare Dual Complete LP (HMO SNP) - H5253-024-0 Benefit Details |
La Crosse | $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 | |||||
UnitedHealthcare Nursing Home Plan (HMO-POS SNP) - H5253-007-0 Benefit Details |
La Crosse | $37.00 | $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% | 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 | |||||||||
Gundersen Senior Preferred Value (w/RX) (HMO) - H5262-003-0 Benefit Details |
La Crosse | $38.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Humana Gold Plus H6622-003 (HMO) - H6622-003-0 Benefit Details |
La Crosse | $40.00 | $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% | $6,700 Browse Formulary | |||||
UCare for Seniors Essentials Rx (HMO-POS) - H4270-006-0 Benefit Details |
La Crosse | $48.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $25.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 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 | |||||||||
Humana Gold Choice H8145-006 (PFFS) - H8145-006-0 Benefit Details |
La Crosse | $82.00 | $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 | |||||
Gundersen Senior Preferred Elite (no RX) (HMO) - H5262-005-0 Benefit Details |
La Crosse | $100.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
UCare for Seniors Value Plus (HMO-POS) - H4270-003-0 Benefit Details |
La Crosse | $106.00 | $0 | 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: $80.00 Specialty Tier: 25% | $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 | |||||||||
HumanaChoice R5826-009 P (Regional PPO) - R5826-009-0 Benefit Details |
La Crosse | $112.00 | $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 | |||||
Gundersen Senior Preferred Elite (w/RX) (HMO) - H5262-001-0 Benefit Details |
La Crosse | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
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