2014 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
Blue Shield 65 Plus (HMO) - H0504-032-0 Benefit Details |
Santa Clara | $0.00 | $0 | Many Generics | Preferred Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Injectable Drugs: 25% Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Care1st AdvantageOptimum Plan (HMO) - H5928-016-0 Benefit Details |
Santa Clara | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $50.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
CareMore Connect (HMO SNP) - H0544-041-0 Benefit Details |
Santa Clara | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
CareMore StartSmart Plus (HMO) - H0544-021-0 Benefit Details |
Santa Clara | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: tbd | $6,700 Browse Formulary | |||||
Citizens Choice Healthplan (HMO) - H3815-007-0 Benefit Details |
Santa Clara | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $75.00 Injectable Drugs: 33% Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Easy Choice Best Plan (HMO) - H5087-014-0 Benefit Details |
Santa Clara | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H0108-040 (HMO) - H0108-040-0 Benefit Details |
Santa Clara | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Senior Advantage Medicare Medi-Cal Plan North (HMO SNP) - H0524-030-0 Benefit Details |
Santa Clara | $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: $8.00 Non-Preferred Generic: $13.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Vaccines: $0.00 | n/a Browse Formulary | |||||
Humana Gold Plus H0108-037 (HMO) - H0108-037-0 Benefit Details |
Santa Clara | $19.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Satellite Health Plan (HMO SNP) - H5765-001-0 Benefit Details |
Santa Clara | $25.10 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $65.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
new | new | new | |||||||||
Coordinated Choice Plan (HMO) - H5928-037-0 Benefit Details |
Santa Clara | $26.30 | $310 | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $3,400 Browse Formulary | |||||
Care1st TotalDual Plan (HMO SNP) - H5928-025-0 Benefit Details |
Santa Clara | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-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 |
|||||
Service | Exper. | Cost Info | |||||||||
Easy Choice Plus Plan (HMO) - H5087-002-0 Benefit Details |
Santa Clara | $28.10 | $310 | Call plan for details | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $6,700 Browse Formulary | |||||
-- | |||||||||||
Humana Gold Plus H0108-034 (HMO) - H0108-034-0 Benefit Details |
Santa Clara | $49.00 | $0 | Some Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
CareMore Breathe (HMO SNP) - H0544-024-0 Benefit Details |
Santa Clara | $55.00 | $0 | Many Generics, Few Brands | Preferred Generic: tbd | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
CareMore Diabetes (HMO SNP) - H0544-025-0 Benefit Details |
Santa Clara | $55.00 | $0 | Many Generics, Few Brands | Preferred Generic: tbd | n/a Browse Formulary | |||||
CareMore Heart (HMO SNP) - H0544-037-0 Benefit Details |
Santa Clara | $55.00 | $0 | Many Generics, Few Brands | Preferred Generic: tbd | n/a Browse Formulary | |||||
CareMore Value Plus (HMO) - H0544-012-0 Benefit Details |
Santa Clara | $55.00 | $0 | Many Generics | Preferred Generic: tbd | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Health Net Ruby Select (HMO) - H0562-089-0 Benefit Details |
Santa Clara | $69.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $3,400 Browse Formulary | |||||
Kaiser Permanente Senior Advantage Santa Clara (HMO) - H0524-039-0 Benefit Details |
Santa Clara | $72.00 | $0 | All Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Vaccines: $0.00 | $5,900 Browse Formulary | |||||
SCAN Balance (HMO SNP) - H5425-050-0 Benefit Details |
Santa Clara | $76.00 | $0 | Some Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Tier 6: $0.00 | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
SCAN Classic (HMO) - H5425-020-0 Benefit Details |
Santa Clara | $76.00 | $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% Select Care Drugs: $10.00 | $5,000 Browse Formulary | |||||
AARP MedicareComplete SecureHorizons (HMO) - H0543-029-0 Benefit Details |
Santa Clara | $107.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,900 Browse Formulary | |||||
Health Net Seniority Plus Ruby (HMO) - H0562-095-0 Benefit Details |
Santa Clara | $232.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $18.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $5,000 Browse Formulary | |||||
|