2014 Medicare Advantage Plans in Bernalillo County New Mexico


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2014 Medicare Advantage Plans in Bernalillo County New Mexico

There are 21 Medicare Advantage Plans available in Bernalillo County NM from 10 health insurance providers and 7 Special Needs Plans available. 8 Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $1500 and the highest out of pocket is $6700. The highest rated plan available in Bernalillo County received a 4.5 overall star rating from CMS and the lowest rated plan is 3 stars.

(Click the Plan Name for More Details)

Plan Name Type Premium C+D Part D
Deductible
Gap Max Out of Pocket Overall Rating
Return to Counties In New Mexico
Amerivantage Classic + Rx (HMO)
(H5746-012)
Local HMO $0 $0 Some Generics $6,700
Blue Cross Medicare Advantage Basic (HMO)
(H3822-002)
Local HMO $0 $0 No Gap Coverage $2,400 Too New
Blue Cross Medicare Advantage Choice (PPO)
(H8634-002)
Local PPO $27.00 $0 No Gap Coverage $4,500 Too New
Blue Cross Medicare Advantage Premier (HMO)
(H3822-003)
Local HMO $32.00 $0 No Gap Coverage $1,500 Too New
Blue Cross Medicare Advantage Premier Plus (HMO-POS)
(H3822-005)
Local HMO $37.00 $0 No Gap Coverage $2,350 Too New
Blue Cross Medicare Advantage Value (HMO)
(H3822-004)
Local HMO $0 $0 No Gap Coverage $2,800 Too New
Care Improvement Plus Medicare Advantage (PPO)
(H0084-064)
Local PPO $0 $0 No Gap Coverage $4,500
Humana Gold Choice H8145-078 (PFFS)
(H8145-078)
PFFS $62.00 $0 Few Generics, Few Brands N/A
Humana Gold Plus H2649-029 (HMO)
(H2649-029)
Local HMO $0 $0 Few Generics, Few Brands $3,900
HumanaChoice H6411-007 (PPO)
(H6411-007)
Local PPO $33.00 $0 Few Generics, Few Brands $6,700
HumanaChoice H6411-008 (PPO)
(H6411-008)
Local PPO * $0 $3,400
Lovelace Medicare Plan $0 (HMO)
(H3251-002)
Local HMO $0 $0 Many Generics $5,000
Lovelace Medicare Plan Deluxe (HMO)
(H3251-027)
Local HMO $0 $310.00 No Gap Coverage $6,700
Lovelace Medicare Plan Enhanced (HMO-POS)
(H3251-021)
Local HMO $89.00 $0 Many Generics $6,700
Molina Medicare Options (HMO)
(H9082-002)
Local HMO $69.00 $0 No Gap Coverage $2,800 NA
Presbyterian MediCare PPO Plan 1 (PPO)
(H3206-003)
Local PPO * $55.00 $3,400
Presbyterian MediCare PPO Plan 2 with Rx (PPO)
(H3206-001)
Local PPO $102.00 $0 No Gap Coverage $3,400
Presbyterian MediCare PPO Plan 3 with Rx (PPO)
(H3206-002)
Local PPO $132.00 $0 Many Generics $3,000
Presbyterian Senior Care Plan 1 (HMO)
(H3204-008)
Local HMO * $0 $2,500
Presbyterian Senior Care Plan 2 with Rx (HMO)
(H3204-001)
Local HMO $0 $0 No Gap Coverage $3,400
Presbyterian Senior Care Plan 3 with Rx (HMO)
(H3204-007)
Local HMO $87.00 $0 Many Generics $2,500

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



Medicare Special Needs Plans in Bernalillo county New Mexico

Plan Name Type Consolidated Premium C+D Part D
Deductible
Gap Special Needs Type Overall Rating
Amerivantage Specialty + Rx (HMO SNP)
(H5746- 006)
Local HMO $19.90 $310.00 Many Generics, Few Brands Dual-Eligible
Blue Cross Medicare Advantage Dual Care (HMO SNP)
(H3822- 006)
Local HMO $12.60 $310.00 No Gap Coverage Dual-EligibleToo New
Care Improvement Plus Dual Advantage (PPO SNP)
(H0084- 035)
Local PPO $19.90 $310.00 No Gap Coverage Dual-Eligible
Care Improvement Plus Gold Rx (PPO SNP)
(H0084- 065)
Local PPO $0 $0 No Gap Coverage Chronic or Disabling Condition
Molina Medicare Options Plus (HMO SNP)
(H9082- 007)
Local HMO $19.90 $310.00 No Gap Coverage Dual-EligibleNA
UnitedHealthcare Dual Complete (PPO SNP)
(H3209- 002)
Local PPO $19.30 $310.00 No Gap Coverage Dual-Eligible
UnitedHealthcare Nursing Home Plan (PPO SNP)
(H3209- 001)
Local PPO $19.90 $310.00 No Gap Coverage Institutional


Source: CMS.

Plans as of September 3, 2013.

Plans are subject to change as contracts are finalized.

Includes 2014 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.



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

  • HMO - Health Maintenance Organization
  • PPO - Preferred Provider Organization
  • PDP - Prescrition 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

Coverage gap ("donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs. (Unless you get the low-income subsidy) Once you reach the coverage gap in 2014, you will pay 47.5% of the plan's cost for covered brand-name prescription drugs. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail.

Additional gap coverage levels are determined separately for formulary generic and brand products and are described as follows:

  • All: 100% of formulary drugs are covered through the gap
  • Many: 65% to 100% of formulary drugs are covered through the gap
  • Some: 10% to 65 % of formulary drugs are covered through the gap
  • Few: 0% to 10% of formulary drugs are covered through the gap (and must also be >15 "brand" products covered through the gap)
  • No Gap Coverage: 0% of formulary drugs are covered through the gap (or 15 "brand" products covered through the gap)
  • All Formulary Drugs: cover 100% of “generic” and 100% of “brand” products (either by covering all formulary drug products in the gap or by having no initial coverage limit)

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

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  • Mon-Fri 8:30am-8:00pm
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