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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Commonwealth Care Alliance (Medicare-Medicaid Plan) - H0137-001-0 Benefit Details |
Plymouth | $0.00 | $0 | All Generics, All Brands | Tier 1: 0% Tier 2: 0% Tier 3: 0% Tier 4: 0% Tier 5: 0% Tier 6: 0% | n/a Browse Formulary | |||||
Fallon Senior Plan Super Saver Rx (HMO) - H9001-032-2 Benefit Details |
Plymouth | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Non-Preferred Generic: $5.00 Preferred Brand: $32.00 Non-Preferred Brand: $76.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Medicare PPO Blue SaverRx (PPO) - H2230-017-0 Benefit Details |
Plymouth | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $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 | |||||||||
Tufts Medicare Preferred HMO Saver Rx (HMO) - H2256-028-0 Benefit Details |
Plymouth | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
UnitedHealthcare Senior Care Options (HMO SNP) - H2226-001-0 Benefit Details |
Plymouth | $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: 0% Tier 2: 0% Tier 3: 0% Tier 4: 0% Tier 5: 0% | n/a Browse Formulary | |||||
Fallon Senior Plan Saver (HMO) - H9001-029-2 Benefit Details |
Plymouth | $15.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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 | |||||||||
Tufts Health Plan Senior Care Options (HMO SNP) - H2256-029-0 Benefit Details |
Plymouth | $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: 0% Tier 2: 0% Tier 3: 0% Tier 4: 0% Tier 5: 0% | n/a Browse Formulary | |||||
Erickson Advantage Guardian (HMO-POS SNP) - H5322-019-0 Benefit Details |
Plymouth | $26.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
new | new | new | |||||||||
Medicare HMO Blue ValueRx (HMO) - H2261-019-0 Benefit Details |
Plymouth | $26.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 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 | |||||||||
UnitedHealthcare Nursing Home Plan (PPO SNP) - H2228-001-0 Benefit Details |
Plymouth | $26.00 | $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 | |||||
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NaviCare (HMO SNP) - H9001-019-0 Benefit Details |
Plymouth | $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 | Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% | n/a Browse Formulary | |||||
Senior Whole Health (HMO SNP) - H2224-001-0 Benefit Details |
Plymouth | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Call plan for details | Preferred Generic: 25% Preferred Brand: 25% Specialty Tier: 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 | |||||||||
Senior Whole Health NHC (HMO SNP) - H2224-003-0 Benefit Details |
Plymouth | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Call plan for details | Preferred Generic: 25% Preferred Brand: 25% Specialty Tier: 25% | n/a Browse Formulary | |||||
AARP MedicareComplete Choice (Regional PPO) - R7444-001-0 Benefit Details |
Plymouth | $30.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Senior Care Options Program (HMO SNP) - H2225-001-0 Benefit Details |
Plymouth | $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: 0% Tier 2: 0% Tier 3: 0% Tier 4: 0% | 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 | |||||||||
Tufts Medicare Preferred HMO Basic Rx (HMO) - H2256-026-2 Benefit Details |
Plymouth | $35.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $93.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Fallon Senior Plan Saver Enhanced RX (HMO) - H9001-030-2 Benefit Details |
Plymouth | $37.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Non-Preferred Generic: $5.00 Preferred Brand: $27.00 Non-Preferred Brand: $76.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Erickson Advantage Freedom (HMO-POS) - H5652-006-0 Benefit Details |
Plymouth | $48.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 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 | |||||||||
Medicare PPO Blue ValueRx (PPO) - H2230-016-0 Benefit Details |
Plymouth | $51.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $3,400 Browse Formulary | |||||
Tufts Medicare Preferred HMO Value No Rx (HMO) - H2256-019-7 Benefit Details |
Plymouth | $93.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Tufts Medicare Preferred HMO Value Rx (HMO) - H2256-018-7 Benefit Details |
Plymouth | $117.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $93.00 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 | |||||||||
Medicare PPO Blue PlusRx (PPO) - H2230-002-0 Benefit Details |
Plymouth | $124.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Tufts Medicare Preferred HMO Prime No Rx (HMO) - H2256-016-2 Benefit Details |
Plymouth | $127.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Fallon Senior Plan Plus Enhanced RX (HMO) - H9001-031-2 Benefit Details |
Plymouth | $143.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Non-Preferred Generic: $5.00 Preferred Brand: $27.00 Non-Preferred Brand: $76.00 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 | |||||||||
Erickson Advantage Signature without Drugs (HMO-POS) - H5652-002-0 Benefit Details |
Plymouth | $149.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
Tufts Medicare Preferred HMO Prime Rx (HMO) - H2256-015-2 Benefit Details |
Plymouth | $151.90 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $93.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Medicare HMO Blue PlusRx (HMO) - H2261-005-0 Benefit Details |
Plymouth | $167.00 | $120 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $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 | |||||||||
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) - H2256-001-2 Benefit Details |
Plymouth | $185.70 | $0 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Erickson Advantage Champion (HMO-POS SNP) - H5652-004-0 Benefit Details |
Plymouth | $189.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Erickson Advantage Signature with Drugs (HMO-POS) - H5652-001-0 Benefit Details |
Plymouth | $189.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
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