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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AARP MedicareComplete Plan 3 (HMO) - H5005-019-0 Benefit Details |
Lewis | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Soundpath Health Peak + Rx (HMO) - H9302-011-0 Benefit Details |
Lewis | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $18.00 Preferred Brand: $36.00 Non-Preferred Brand: $60.00 Specialty Tier: 25% | $5,900 Browse Formulary | |||||
Soundpath Health Alpine (HMO) - H9302-004-0 Benefit Details |
Lewis | $28.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,250 | ||||||
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 | |||||||||
Soundpath Health Sound + Rx (HMO) - H9302-007-0 Benefit Details |
Lewis | $34.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $18.00 Preferred Brand: $36.00 Non-Preferred Brand: $60.00 Specialty Tier: 25% | $3,400 Browse Formulary | |||||
Community HealthFirst MA Special Needs Plan (HMO SNP) - H5826-005-0 Benefit Details |
Lewis | $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% | n/a Browse Formulary | |||||
Kaiser Permanente Senior Advantage Basic (HMO) - H9003-006-0 Benefit Details |
Lewis | $39.00 | $0 | All Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% Tier 6: $0.00 | $4,900 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 | |||||||||
AARP MedicareComplete Plan 1 (HMO) - H5005-011-0 Benefit Details |
Lewis | $73.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $44.00 Non-Preferred Brand: $88.00 Specialty Tier: 33% | $4,200 Browse Formulary | |||||
Community HealthFirst MA Pharmacy Plan (HMO) - H5826-009-0 Benefit Details |
Lewis | $77.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Group Health Cooperative Clear Care Vital (HMO) - H5050-013-0 Benefit Details |
Lewis | $78.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $20.00 Non-Preferred Brand: 50% | $3,500 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 H6609-065 (PPO) - H6609-065-0 Benefit Details |
Lewis | $86.00 | $0 | Few Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $5,100 Browse Formulary | |||||
Regence MedAdvantage Basic (PPO) - H5009-001-0 Benefit Details |
Lewis | $89.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Group Health Cooperative Clear Care Basic (HMO) - H5050-001-0 Benefit Details |
Lewis | $99.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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 | |||||||||
Kaiser Permanente Senior Advantage (HMO) - H9003-001-0 Benefit Details |
Lewis | $109.00 | $0 | All Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% Tier 6: $0.00 | $2,500 Browse Formulary | |||||
Soundpath Health Charter + Rx (HMO) - H9302-003-0 Benefit Details |
Lewis | $129.00 | $0 | Some Generics | Preferred Generic: $6.00 Non-Preferred Generic: $18.00 Preferred Brand: $36.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $2,500 Browse Formulary | |||||
Regence MedAdvantage + Rx Classic (PPO) - H5009-002-0 Benefit Details |
Lewis | $137.00 | $235 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 26% | $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 | |||||||||
HumanaChoice H6609-073 (PPO) - H6609-073-0 Benefit Details |
Lewis | $205.00 | $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% | $6,700 Browse Formulary | |||||
Group Health Cooperative Clear Care Essential (HMO) - H5050-009-0 Benefit Details |
Lewis | $207.00 | $250 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $22.00 Non-Preferred Brand: 50% | $3,000 Browse Formulary | |||||
Soundpath Health Apex + Rx (HMO) - H9302-001-0 Benefit Details |
Lewis | $210.00 | $0 | Many Generics | Preferred Generic: $6.00 Non-Preferred Generic: $18.00 Preferred Brand: $36.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $1,400 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 | |||||||||
Group Health Cooperative Clear Care Key (HMO) - H5050-014-0 Benefit Details |
Lewis | $294.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $23.00 Non-Preferred Brand: 50% | $2,500 Browse Formulary | |||||
Group Health Cooperative Clear Care Optimal (HMO) - H5050-004-0 Benefit Details |
Lewis | $328.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $25.00 Non-Preferred Brand: 50% | $2,000 Browse Formulary | |||||
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