2013 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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Advocare Essence (HMO-POS) - H5211-003-0 Benefit Details |
Dane | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Humana Gold Choice H8145-153 (PFFS) - H8145-153-0 Benefit Details |
Dane | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
HumanaChoice R5826-023 (Regional PPO) - R5826-023-0 Benefit Details |
Dane | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
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 | |||||||||
UnitedHealthcare Dual Complete LP (HMO SNP) - H5253-024-0 Benefit Details |
Dane | $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: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
Partnership (HMO SNP) - H5209-002-0 Benefit Details |
Dane | $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: 25% Tier 2: 25% | n/a Browse Formulary | |||||
iCare Medicare Plan (HMO SNP) - H2237-001-0 Benefit Details |
Dane | $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 | Generic: $10.00 Brand: $48.00 | 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 | |||||||||
UnitedHealthcare Nursing Home Plan (HMO-POS SNP) - H5253-007-0 Benefit Details |
Dane | $38.30 | $325 | 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 | |||||
HumanaChoice H5216-006 (PPO) - H5216-006-0 Benefit Details |
Dane | $42.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Advocare Essence Rx (HMO-POS) - H5211-002-0 Benefit Details |
Dane | $47.00 | $0 | Few Generics | Generic: $6.00 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 | |||||||||
Today's Options Premier 600 (PFFS) - H6169-013-0 Benefit Details |
Dane | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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DeanCare Gold Shared Value (Cost) - H5264-005-0 Benefit Details |
Dane | $68.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Humana Gold Choice H8145-006 (PFFS) - H8145-006-0 Benefit Details |
Dane | $72.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Preferred Brand: $41.00 Non-Preferred Brand: $80.00 Specialty Tier: 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 | |||||||||
Today's Options Premier 300 (PFFS) - H6169-051-0 Benefit Details |
Dane | $80.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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HumanaChoice R5826-009 (Regional PPO) - R5826-009-0 Benefit Details |
Dane | $89.00 | $325 | 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 | |||||
Today's Options Premier Plus 650D (PFFS) - H6169-033-0 Benefit Details |
Dane | $92.00 | $85 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | 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 | |||||||||
DeanCare Gold Basic (Cost) - H5264-003-0 Benefit Details |
Dane | $108.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
DeanCare Gold Enhanced (Cost) - H5264-002-0 Benefit Details |
Dane | $113.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Advocare Spirit (HMO-POS) - H5211-001-0 Benefit Details |
Dane | $118.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,000 | ||||||
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 Premier Plus 350A (PFFS) - H6169-024-0 Benefit Details |
Dane | $152.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Advocare Spirit Rx (HMO-POS) - H5211-004-0 Benefit Details |
Dane | $173.00 | $0 | Few Generics | Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $1,000 Browse Formulary | |||||
Advocare Vitality (HMO-POS) - H5211-006-0 Benefit Details |
Dane | $215.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $500 | ||||||
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 | |||||||||
Advocare Vitality Rx (HMO-POS) - H5211-005-0 Benefit Details |
Dane | $286.00 | $0 | Few Generics | Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $500 Browse Formulary | |||||
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