2015 Medicare Advantage Plans in Duval County Florida


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2015 Medicare Advantage Plans in Duval County Florida

There are 23 Medicare Advantage Plans available in Duval County FL from 11 health insurance providers and 10 Special Needs Plans available. 11 Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $3200 and the highest out of pocket is $6700. The highest rated plan available in Duval County received a 5 overall star rating from CMS and the lowest rated plan is 2 stars.

(Click the Plan Name for More Details)

Plan Name Type Premium
C+D
Part D
Deductible
 Gap  Max Out of
Pocket
Overall Rating Formulary
Return to Counties In Florida
AARP MedicareComplete Choice Essential (Regional PPO)
(R5287-002)
Regional PPO * $0.00 $6,700
AARP MedicareComplete Choice Plan 2 (Regional PPO)
(R5287-001)
Regional PPO $0.00 $200.00 No $6,700 Browse
Formulary
AARP MedicareComplete Focus (HMO)
(H1045-026)
Local HMO $0.00 $200.00 No $5,200 Browse
Formulary
Aetna Medicare Premier Plan (PPO)
(H5521-033)
Local PPO $35.00 $0.00 No $6,700 Browse
Formulary
Aetna Medicare Select Plus Plan (HMO)
(H5414-025)
Local HMO $139.00 $0.00 Yes $3,300 Browse
Formulary
Aetna Medicare Select Plus Plan (PPO)
(H5521-052)
Local PPO $139.00 $0.00 Yes $3,300 Browse
Formulary
Aetna Medicare Value Plan (HMO)
(H5414-019)
Local HMO $0.00 $0.00 Yes $6,700 Browse
Formulary
BlueMedicare HMO LifeTime (HMO)
(H1026-040)
Local HMO $0.00 $0.00 Yes $4,400 Browse
Formulary
BlueMedicare PPO (PPO)
(H5434-002)
Local PPO $127.10 $0.00 Yes $3,200 Browse
Formulary
BlueMedicare Regional PPO (Regional PPO)
(R3332-001)
Regional PPO $36.10 $100.00 No $6,700 Browse
Formulary
CareOne (HMO)
(H1019-069)
Local HMO $0.00 $0.00 Yes $6,700 Browse
Formulary
Coventry Summit Ideal (HMO)
(H1013-033)
Local HMO $0.00 $0.00 Yes $3,400 Browse
Formulary
Day Break (HMO)
(H4199-008)
Local HMO $0.00 $0.00 Yes $3,400 Browse
Formulary
Humana Gold Plus H1036-081D (HMO)
(H1036-081)
Local HMO $0.00 $0.00 Yes $6,700 Browse
Formulary
HumanaChoice R5826-005 (Regional PPO)
(R5826-005)
Regional PPO $95.00 $100.00 Yes $6,700 Browse
Formulary
HumanaChoice R5826-018 (Regional PPO)
(R5826-018)
Regional PPO * $0.00 $5,000
HumanaChoice R5826-074 (Regional PPO)
(R5826-074)
Regional PPO $0.00 $200.00 No $6,700 Browse
Formulary
Sunrise (HMO)
(H4199-007)
Local HMO $0.00 $0.00 Yes $3,400 Browse
Formulary
WellCare Advance (HMO)
(H1032-037)
Local HMO * $0.00 $6,700
WellCare Choice (HMO-POS)
(H1032-002)
Local HMO $46.00 $0.00 No $6,700 Browse
Formulary
WellCare Dividend (HMO)
(H1032-180)
Local HMO $0.00 $0.00 No $6,700 Browse
Formulary
WellCare Rx (HMO-POS)
(H1032-181)
Local HMO $17.90 $320.00 No $6,700 Browse
Formulary
WellCare Value (HMO)
(H1032-073)
Local HMO $0.00 $0.00 No $6,700 Browse
Formulary

* Plan Type Indicates plan does not offer Part D drug coverage.



Medicare Special Needs Plans in Duval county Florida

Plan Name Consolidated
Premium C+D
Part D
Deductible
 Gap  Special Needs
Type
Overall Rating Formulary
CareNeeds (HMO SNP)
(H1019- 073)
   $20.20 $200.00  No Dual-EligibleBrowse
Formulary
Coventry Summit Maximum (HMO SNP)
(H1013- 034)
   $9.70 $0.00  No Dual-EligibleBrowse
Formulary
Humana Gold Plus - Diabetes (HMO SNP)
(H1036- 175)
   $0.00 $0.00  Yes Chronic or Disabling ConditionBrowse
Formulary
Humana Gold Plus SNP-DE H1036-210 (HMO SNP)
(H1036- 210)
   $21.10 $190.00  No Dual-EligibleBrowse
Formulary
PHP (HMO SNP)
(H3132- 001)
   $0.00 $320.00  No Chronic or Disabling ConditionNABrowse
Formulary
Sunshine Health Advantage (HMO SNP)
(H5190- 001)
   $25.80 $320.00  No Dual-EligibleNABrowse
Formulary
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
(R5287- 003)
   $25.80 $320.00  No Dual-EligibleBrowse
Formulary
UnitedHealthcare Nursing Home Plan (PPO SNP)
(H5417- 001)
   $24.30 $320.00  No InstitutionalBrowse
Formulary
WellCare Access (HMO SNP)
(H1032- 124)
   $17.70 $320.00  No Dual-EligibleBrowse
Formulary
WellCare Liberty (HMO SNP)
(H1032- 175)
   $18.90 $320.00  No Dual-EligibleBrowse
Formulary


Source: CMS.

Plans as of September 2, 2014.

Plans are subject to change as contracts are finalized.

Includes 2015 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded. For 2015, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.



Plan Type Is the type of organization offering the Medicare Plans.

  • HMO - Health Maintenance Organization
  • PPO - Preferred Provider Organization
  • PDP - Prescription Drug Plan
  • SNP - Special Needs Plan
  • POS - Point of Service
  • PFFS - Private Fee For Service

Monthly Consolidated Premium (Includes Part C + D) Your premium may be lower depending on your eligibility for medical assistance. Call your plan for details.

Part D Total Premium: The Part D Total Premium is the sum of the Basic and Supplemental Premiums. Note: the Part D Total Premium is net of any Part A/B rebates applied to "buy down" the drug premium for Medicare Advantage plans; for some plans the total premium may be lower than the sum of the basic and supplemental premiums due to negative basic or supplemental premiums.

Benefit Type

Enhanced Alternative plans may offer additional gap coverage which is calculated as the percentage of “generic” formulary products with coverage above standard "generic" coverage gap cost-sharing benefit and/or the percentage of “brand” formulary products covered in addition to the coverage gap discount for applicable drugs.

GAP

In 2015 once you and your plan provider have spent $2,960 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") Once you reach the coverage gap you will pay 45% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. You will still receive a 55% discount on brand-name drugs and a 35% discount on generic drugs.

Maximum Out-of-Pocket (MOOP) limit on enrollee spending that includes costs for all in-network Part A and Part B Services. NOT Part D - prescription drugs. N/A is defined as Not Applicable