2012 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 Plus Plan 1 (HMO-POS) - H5749-001-0 Benefit Details |
Jackson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $45.00 Tier 4: $92.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Advantra Advantage (HMO) - H2672-001-0 Benefit Details |
Jackson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Advantra Freedom (PPO) - H5509-001-0 Benefit Details |
Jackson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $35.00 Tier 3: $65.00 Tier 4: 33% | $3,950 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 | |||||||||
Any, Any, Any Gold (PFFS) - H8098-001-0 Benefit Details |
Jackson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $85.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
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Any, Any, Any Gold MA Only (PFFS) - H8098-003-0 Benefit Details |
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Care Improvement Plus Gold Rx (PPO SNP) - H6528-013-0 Benefit Details |
Jackson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | n/a 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 | |||||||||
Care Improvement Plus Gold Rx (Regional PPO SNP) - R3444-009-0 Benefit Details |
Jackson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | n/a Browse Formulary | |||||
Humana Gold Choice H8145-120 (PFFS) - H8145-120-0 Benefit Details |
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Humana Gold Plus H2649-012 (HMO) - H2649-012-0 Benefit Details |
Jackson | $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 | |||||||||
Humana Reader's Digest Healthy Living Plan (HMO) - H2649-024-0 Benefit Details |
Jackson | $0.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $4,100 Browse Formulary | |||||
HumanaChoice R5826-067 (Regional PPO) - R5826-067-0 Benefit Details |
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Universal Hassle-Free (PPO) - H5096-001-0 Benefit Details |
Jackson | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $85.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
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 | |||||||||
Universal Hassle-Free MA Only (PPO) - H5096-002-0 Benefit Details |
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
Humana Gold Plus H2649-004 (HMO) - H2649-004-0 Benefit Details |
Jackson | $20.00 | $0 | Some Generics, Few Brands | Tier 1: $5.00 Tier 2: $40.00 Tier 3: $75.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
WindsorSterling Emerald Connect Plan (PFFS) - H3410-004-12 Benefit Details |
Jackson | $28.50 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $33.00 Tier 4: $87.00 Tier 5: 29% | $6,700 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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) - H3410-002-12 Benefit Details |
Jackson | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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Care Improvement Plus Silver Rx (Regional PPO SNP) - R3444-008-0 Benefit Details |
Jackson | $31.80 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 29% | n/a Browse Formulary | |||||
Care Improvement Plus Dual Advantage (Regional PPO SNP) - R3444-011-0 Benefit Details |
Jackson | $ 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: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 27% | 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 Dual Advantage (PPO SNP) - H6528-014-0 Benefit Details |
Jackson | $ 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: $10.00 Tier 2: $44.00 Tier 3: $95.00 Tier 4: 29% | n/a Browse Formulary | |||||
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Care Improvement Plus Silver Rx (PPO SNP) - H6528-012-0 Benefit Details |
Jackson | $32.10 | $205 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 27% | n/a Browse Formulary | |||||
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Humana Gold Choice H8145-125 (PFFS) - H8145-125-0 Benefit Details |
Jackson | $33.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $5,000 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 | |||||||||
Care Improvement Plus Medicare Advantage (PPO) - H6528-005-0 Benefit Details |
Jackson | $38.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $44.00 Tier 3: $95.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
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HumanaChoice H1716-020 (PPO) - H1716-020-0 Benefit Details |
Jackson | $39.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $5,000 Browse Formulary | |||||
WindsorSterling Gold Plus Plan (PPO) - H5162-006-0 Benefit Details |
Jackson | $50.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $16.00 Tier 3: $36.00 Tier 4: $90.00 Tier 5: 30% | $4,000 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 | |||||||||
Today's Options Advantage Plus 450F (PPO) - H5378-184-0 Benefit Details |
Jackson | $51.00 | $75 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
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WindsorSterling Gold Connect Plan (PFFS) - H3410-003-12 Benefit Details |
Jackson | $59.00 | $50 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $15.00 Tier 3: $34.00 Tier 4: $84.00 Tier 5: 30% | $4,000 Browse Formulary | |||||
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Care Improvement Plus Medicare Advantage (Regional PPO) - R3444-012-0 Benefit Details |
Jackson | $60.00 | $215 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 27% | $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 H1716-001 (PPO) - H1716-001-0 Benefit Details |
Jackson | $63.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
HumanaChoice R5826-010 (Regional PPO) - R5826-010-0 Benefit Details |
Jackson | $105.00 | $320 | 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 | |||||
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Today's Options Advantage Plus 250A (PPO) - H5378-200-0 Benefit Details |
Jackson | $122.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,250 Browse Formulary | |||||
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