2013 Medicare Advantage Plan Information
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| Plan Name |
County |
Monthly Prem. (incl. Part C & D) |
Deduct- ible |
(Donut Hole) Gap Coverage |
Plan ID |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits |
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
AARP MedicareComplete (HMO)

 |
Lee |
$0.00 |
$0 | No Gap Coverage |
H1080 -045 | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $3,900 Browse Formulary |
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 |
 |
AARP MedicareComplete Choice (PPO)

 |
Lee |
$0.00 |
$0 | No Gap Coverage |
H5532 -001 | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $4,500 Browse Formulary |
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 |
 |
AARP MedicareComplete Choice Essential (Regional PPO)

 |
Lee |
$0.00 |
No Rx Coverage |
R5287 -002 | This Plan does NOT include Prescription Drug coverage. | $3,500 |
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 |
 |
AARP MedicareComplete Choice Plan 2 (Regional PPO)

 |
Lee |
$0.00 |
$0 | No Gap Coverage |
R5287 -001 | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $4,900 Browse Formulary |
 |
 |
 |
AARP MedicareComplete Plus (HMO-POS)

 |
Lee |
$0.00 |
$0 | No Gap Coverage |
H1080 -004 | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $4,200 Browse Formulary |
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 |
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| Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Gap Coverage |
Plan ID |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
| Service |
Exper. |
CostInfo |
BlueMedicare Regional PPO (Regional PPO)

 |
Lee |
$0.00 |
$0 | No Gap Coverage |
R3332 -001 | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
 |
 |
 |
Freedom Medicare Plan Rx (HMO)

 |
Lee |
$0.00 |
$0 | Many Generics |
H5427 -059 | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
 |
 |
 |
Freedom Savings Plan (HMO)

 |
Lee |
$0.00 |
No Rx Coverage |
H5427 -052 | This Plan does NOT include Prescription Drug coverage. | $3,400 |
 |
 |
 |
Freedom Savings Plan Rx (HMO)

 |
Lee |
$0.00 |
$0 | No Gap Coverage |
H5427 -053 | Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $65.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
 |
 |
 |
Freedom VIP Savings (HMO SNP)

 |
Lee |
$0.00 |
$0 | No Gap Coverage |
H5427 -082 | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33%
| tbd Browse Formulary |
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Freedom VIP Savings COPD (HMO SNP)

 |
Lee |
$0.00 |
$0 | No Gap Coverage |
H5427 -083 | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33%
| tbd Browse Formulary |
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| Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Gap Coverage |
Plan ID |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
| Service |
Exper. |
CostInfo |
Humana Gold Plus H5426-008 (HMO)

 |
Lee |
$0.00 |
$0 | Few Generics and Few Brands |
H5426 -008 | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $43.00 Non-Preferred Brand: $86.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
 |
 |
 |
Humana Reader's Digest Healthy Living Plan (Regional PPO)

 |
Lee |
$0.00 |
$0 | Few Generics and Few Brands |
R5826 -074 | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $4,950 Browse Formulary |
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 |
 |
HumanaChoice R5826-018 (Regional PPO)

 |
Lee |
$0.00 |
No Rx Coverage |
R5826 -018 | This Plan does NOT include Prescription Drug coverage. | $4,000 |
 |
 |
 |
WellCare Advance (HMO)

 |
Lee |
$0.00 |
No Rx Coverage |
H1032 -037 | This Plan does NOT include Prescription Drug coverage. | $3,400 |
 |
 |
 |
WellCare Essential (HMO)

 |
Lee |
$0.00 |
$0 | All Generics |
H1032 -133 | Generic: $0.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
 |
 |
 |
WellCare Liberty (HMO SNP)

 |
LEE |
$8.70 |
$325 | to be determined |
H1032 -124 | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| tbd Browse Formulary |
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| Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Gap Coverage |
Plan ID |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
| Service |
Exper. |
CostInfo |
WellCare Access (HMO SNP)

 |
LEE |
$12.10 |
$325 | to be determined |
H1032 -175 | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| tbd Browse Formulary |
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 |
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WellCare Select (HMO-POS SNP)

 |
LEE |
$12.50 |
$325 | to be determined |
H1032 -101 | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| tbd Browse Formulary |
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UnitedHealthcare Dual Complete LP (HMO SNP)

 |
LEE |
$22.10 |
$325 | to be determined |
H1080 -036 | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
| tbd Browse Formulary |
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Freedom Medi-Medi Full (HMO SNP)

 |
LEE |
$23.10 |
$325 | to be determined |
H5427 -087 | Tier 1: 25% Tier 2: 0% Tier 3: 0% Tier 4 Tier 5
| tbd Browse Formulary |
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UnitedHealthcare Nursing Home Plan (PPO SNP)

 |
Lee |
$23.80 |
$325 | No Gap Coverage |
H5417 -001 | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
| tbd Browse Formulary |
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-- |
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Freedom Medi-Medi Partial (HMO SNP)

 |
LEE |
$24.70 |
$325 | to be determined |
H5427 -078 | Tier 1: 25% Tier 2: 0% Tier 3: 0% Tier 4 Tier 5
| tbd Browse Formulary |
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| Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Gap Coverage |
Plan ID |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
| Service |
Exper. |
CostInfo |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)

 |
Statewide |
$24.80 |
$325 | to be determined |
R5287 -003 | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
| tbd Browse Formulary |
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Humana Gold Plus H5426-002 (HMO)

 |
Lee |
$32.00 |
$0 | Few Generics and Few Brands |
H5426 -002 | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $44.00 Non-Preferred Brand: $80.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
 |
 |
 |
Aetna Medicare Premier Plan (PPO)

 |
Lee |
$33.00 |
$0 | No Gap Coverage |
H5521 -033 | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
 |
 |
 |
Aetna Medicare Value Plan (HMO)

 |
Lee |
$39.00 |
$0 | No Gap Coverage |
H5414 -009 | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
 |
 |
 |
HumanaChoice R5826-005 (Regional PPO)

 |
Lee |
$85.00 |
$0 | Few Generics and Few Brands |
R5826 -005 | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $4,750 Browse Formulary |
 |
 |
 |
Humana Gold Choice H8145-061 (PFFS)

 |
Lee |
$102.00 |
$0 | Few Generics and Few Brands |
H8145 -061 | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $0 Browse Formulary |
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 |
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| Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Gap Coverage |
Plan ID |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
| Service |
Exper. |
CostInfo |
BlueMedicare PPO (PPO)

 |
Lee |
$152.00 |
$0 | No Gap Coverage |
H5434 -002 | Preferred Generic: $10.00 Non-Preferred Generic: $17.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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