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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Group Health Cooperative Clear Care Vital (HMO) - H5050-013-0 Benefit Details |
San Juan | $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 | |||||
Regence MedAdvantage Basic (PPO) - H5009-001-0 Benefit Details |
San Juan | $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 |
San Juan | $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 | |||||||||
Regence MedAdvantage + Rx Classic (PPO) - H5009-002-0 Benefit Details |
San Juan | $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 | |||||
Group Health Cooperative Clear Care Essential (HMO) - H5050-009-0 Benefit Details |
San Juan | $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 | |||||
Group Health Cooperative Clear Care Key (HMO) - H5050-014-0 Benefit Details |
San Juan | $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 | |||||
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 Optimal (HMO) - H5050-004-0 Benefit Details |
San Juan | $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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