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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Advantra Silver (HMO) - H1692-002-0 Benefit Details |
Cabell | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
new | new | new | Higher cost-sharing at standard network pharmacies. Details: | ||||||||
Humana Gold Choice H8145-050 (PFFS) - H8145-050-0 Benefit Details |
Cabell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Cabell | $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 | |||||||||
SecureCare - Option I (HMO) - H5151-004-0 Benefit Details |
Cabell | $16.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Freedom Blue PPO HD (PPO) - H5106-025-0 Benefit Details |
Cabell | $19.00 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $20.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
SecureCare SNP (HMO SNP) - H5151-007-0 Benefit Details |
Cabell | $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 | |||||
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 | |||||||||
Freedom Blue PPO ValueRx (PPO) - H5106-027-0 Benefit Details |
Cabell | $31.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $20.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
HumanaChoice H5041-001 (PPO) - H5041-001-0 Benefit Details |
Cabell | $41.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $18.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,900 Browse Formulary | |||||
SecureChoice - Option I (PPO) - H8604-004-0 Benefit Details |
Cabell | $46.00 | 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 | |||||||||
Freedom Blue PPO Value (PPO) - H5106-017-0 Benefit Details |
Cabell | $53.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Advantra Gold (PPO) - H8980-006-0 Benefit Details |
Cabell | $59.00 | $0 | Some Generics | Preferred Generic: $5.00 Non-Preferred Generic: $20.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Humana Gold Choice H8145-051 (PFFS) - H8145-051-0 Benefit Details |
Cabell | $59.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $16.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | 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 | |||||||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Cabell | $78.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $6,700 Browse Formulary | |||||
Humana Gold Choice H8145-049 (PFFS) - H8145-049-0 Benefit Details |
Cabell | $85.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $18.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Cabell | $88.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $18.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,900 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 | |||||||||
SecureCare - Option II (HMO) - H5151-002-0 Benefit Details |
Cabell | $111.10 | $0 | Few Generics | Preferred Generic: $10.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SecureChoice - Option II (PPO) - H8604-003-0 Benefit Details |
Cabell | $134.00 | $0 | Few Generics | Preferred Generic: $10.00 Non-Preferred Generic: $20.00 Preferred Brand: $45.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Freedom Blue PPO Standard (PPO) - H5106-013-0 Benefit Details |
Cabell | $139.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 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 | |||||||||
SecureCare - Option III (HMO) - H5151-006-0 Benefit Details |
Cabell | $147.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SecureChoice - Option III (PPO) - H8604-006-0 Benefit Details |
Cabell | $170.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Freedom Blue PPO Deluxe (PPO) - H5106-014-0 Benefit Details |
Cabell | $176.00 | $0 | Many Generics | Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
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