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 2 (HMO) - H4456-010-0 Benefit Details |
Peoria | $0.00 | $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% | $5,900 Browse Formulary | |||||
Care Improvement Plus Gold Rx (PPO SNP) - H0084-004-0 Benefit Details |
Peoria | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (PPO) - H0084-001-0 Benefit Details |
Peoria | $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 | |||||
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 | |||||||||
Coventry Total Care (HMO) - H3144-002-0 Benefit Details |
Peoria | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,200 Browse Formulary | |||||
-- | -- | Higher cost-sharing at standard network pharmacies. Details: | |||||||||
Health Alliance Medicare HMO Basic (HMO) - H1463-008-0 Benefit Details |
Peoria | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice R5826-023 P (Regional PPO) - R5826-023-0 Benefit Details |
Peoria | $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 | |||||||||
Meridian Prime (HMO) - H5779-002-0 Benefit Details |
Peoria | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 25% | $4,000 Browse Formulary | |||||
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Today's Options Premier 900 (PFFS) - H6169-011-0 Benefit Details |
Peoria | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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WellCare Rx (HMO) - H1416-019-0 Benefit Details |
Peoria | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
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 | |||||||||
WellCare Value (HMO-POS) - H1416-009-0 Benefit Details |
Peoria | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $13.00 Preferred Brand: $35.00 Non-Preferred Brand: $69.00 Specialty Tier: 33% | $4,000 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
WellCare Access (HMO SNP) - H1416-007-0 Benefit Details |
Peoria | $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: $0.00 Non-Preferred Generic: $9.00 Preferred Brand: $20.00 Non-Preferred Brand: $50.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Today's Options Premier 500 (PFFS) - H6169-001-0 Benefit Details |
Peoria | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
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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 | |||||||||
Meridian Advantage Plan of Illinois (HMO SNP) - H5779-001-0 Benefit Details |
Peoria | $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% | n/a Browse Formulary | |||||
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Advantra (PPO) - H7301-002-0 Benefit Details |
Peoria | $29.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Brand: $92.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Humana Gold Choice H8145-121 (PFFS) - H8145-121-0 Benefit Details |
Peoria | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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 | |||||||||
Health Alliance Medicare HMO Basic Rx (HMO) - H1463-009-0 Benefit Details |
Peoria | $33.00 | $290 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: tbd | $3,400 Browse Formulary | |||||
Today's Options Premier Plus 950B (PFFS) - H6169-031-0 Benefit Details |
Peoria | $37.00 | $0 | 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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Health Alliance Medicare PPO30 (PPO) - H1417-003-0 Benefit Details |
Peoria | $40.00 | 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 | |||||||||
Advantra (HMO) - H3144-003-0 Benefit Details |
Peoria | $42.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $25.00 Preferred Brand: $42.00 Non-Preferred Brand: $92.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
-- | -- | Higher cost-sharing at standard network pharmacies. Details: | |||||||||
Humana Gold Plus H1468-007 (HMO) - H1468-007-0 Benefit Details |
Peoria | $49.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,500 Browse Formulary | |||||
Health Alliance Medicare PPO30 Rx (PPO) - H1417-004-0 Benefit Details |
Peoria | $73.00 | $230 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: tbd | $3,000 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 | |||||||||
Today's Options Premier Plus 550A (PFFS) - H6169-021-0 Benefit Details |
Peoria | $82.00 | $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% | $5,000 Browse Formulary | |||||
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AARP MedicareComplete Plan 1 (HMO) - H4456-015-0 Benefit Details |
Peoria | $85.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $38.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $4,500 Browse Formulary | |||||
Health Alliance Medicare HMO20 (HMO) - H1463-001-0 Benefit Details |
Peoria | $85.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,500 | ||||||
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 | |||||||||
HumanaChoice H5525-004 (PPO) - H5525-004-0 Benefit Details |
Peoria | $100.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Health Alliance Medicare PPO10 (PPO) - H1417-001-0 Benefit Details |
Peoria | $110.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,500 | ||||||
HumanaChoice R5826-009 P (Regional PPO) - R5826-009-0 Benefit Details |
Peoria | $112.00 | $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 | |||||
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 | |||||||||
Health Alliance Medicare HMO20 Rx (HMO) - H1463-003-0 Benefit Details |
Peoria | $117.00 | $270 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: tbd | $1,500 Browse Formulary | |||||
Health Alliance Medicare PPO10 Rx (PPO) - H1417-002-0 Benefit Details |
Peoria | $145.00 | $230 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: tbd | $1,500 Browse Formulary | |||||
Humana Gold Choice H8145-008 (PFFS) - H8145-008-0 Benefit Details |
Peoria | $152.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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