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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Advantra Freedom (PPO) - H5509-001-0 Benefit Details |
Henry | $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 | |||||
Care Improvement Plus Gold Rx (PPO SNP) - H6528-013-0 Benefit Details |
Henry | $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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Care Improvement Plus Gold Rx (Regional PPO SNP) - R3444-009-0 Benefit Details |
Henry | $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 | |||||
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 H8145-120 (PFFS) - H8145-120-0 Benefit Details |
Henry | $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 |
Henry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Humana Reader's Digest Healthy Living Plan (HMO) - H2649-024-0 Benefit Details |
Henry | $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 | |||||
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 R5826-067 (Regional PPO) - R5826-067-0 Benefit Details |
Henry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Humana Gold Plus H2649-004 (HMO) - H2649-004-0 Benefit Details |
Henry | $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 | |||||
Care Improvement Plus Silver Rx (Regional PPO SNP) - R3444-008-0 Benefit Details |
Henry | $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 | |||||
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 (Regional PPO SNP) - R3444-011-0 Benefit Details |
Henry | $ 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 | |||||
Care Improvement Plus Dual Advantage (PPO SNP) - H6528-014-0 Benefit Details |
Henry | $ 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 |
Henry | $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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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 H8145-125 (PFFS) - H8145-125-0 Benefit Details |
Henry | $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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Care Improvement Plus Medicare Advantage (PPO) - H6528-005-0 Benefit Details |
Henry | $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 |
Henry | $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 | |||||
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 (Regional PPO) - R3444-012-0 Benefit Details |
Henry | $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 | |||||
HumanaChoice H1716-001 (PPO) - H1716-001-0 Benefit Details |
Henry | $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 |
Henry | $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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