2014 Medicare Advantage Plans in Nueces County Texas


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2014 Medicare Advantage Plans in Nueces County Texas

There are 18 Medicare Advantage Plans available in Nueces County TX from 8 health insurance providers and 9 Special Needs Plans available. 6 Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $3400 and the highest out of pocket is $6700. The highest rated plan available in Nueces County received a 4 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 Texas
AARP MedicareComplete Focus (HMO)
(H4527-001)
Local HMO $0 $0 Some Generics $4,400
AARP MedicareComplete Focus Essential (HMO)
(H4527-024)
Local HMO * $0 $3,900
AARP MedicareComplete SecureHorizons (HMO)
(H4590-025)
Local HMO $0 $0 No Gap Coverage $4,900
Advantra (HMO)
(H5048-002)
Local HMO $0 $0 Many Generics $3,900 Too New
Advantra (PPO)
(H7306-001)
Local PPO $0 $0 No Gap Coverage $3,400
Care Improvement Plus Medicare Advantage (PPO)
(H0084-001)
Local PPO $0 $0 No Gap Coverage $6,700
Care Improvement Plus Medicare Advantage (Regional PPO)
(R6801-012)
Regional PPO $0 $0 No Gap Coverage $6,700
Humana Gold Choice H8145-084 (PFFS)
(H8145-084)
PFFS $89.00 $0 Few Generics, Few Brands N/A
Humana Gold Choice H8145-126 (PFFS)
(H8145-126)
PFFS * $15.00 N/A
Humana Gold Plus H4510-012 (HMO)
(H4510-012)
Local HMO $0 $0 Few Generics, Few Brands $3,400
HumanaChoice H4520-006 (PPO)
(H4520-006)
Local PPO $66.00 $0 Few Generics, Few Brands $6,600
HumanaChoice R5826-012 (Regional PPO)
(R5826-012)
Regional PPO $65.00 $0 Few Generics, Few Brands $6,700
HumanaChoice R5826-026 (Regional PPO)
(R5826-026)
Regional PPO * $0 $3,400
HumanaChoice R5826-091 (Regional PPO)
(R5826-091)
Regional PPO $10.00 $310.00 No Gap Coverage $6,700
Today's Options Premier 500 (PFFS)
(H6169-001)
PFFS * $20.00 $5,000
Today's Options Premier 900 (PFFS)
(H6169-011)
PFFS * $0 N/A
Today's Options Premier Plus 550A (PFFS)
(H6169-021)
PFFS $82.00 $0 No Gap Coverage $5,000
Today's Options Premier Plus 950B (PFFS)
(H6169-031)
PFFS $37.00 $0 No Gap Coverage N/A

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



Medicare Special Needs Plans in Nueces county Texas

Plan Name Type Consolidated Premium C+D Part D
Deductible
Gap Special Needs Type Overall Rating
Advantage by Superior HealthPlan (HMO SNP)
(H5294- 001)
Local HMO $27.70 $310.00 No Gap Coverage Dual-Eligible
Care Improvement Plus Dual Advantage (Regional PPO SNP)
(R6801- 011)
Regional PPO $26.30 $310.00 No Gap Coverage Dual-Eligible
Care Improvement Plus Gold Rx (PPO SNP)
(H0084- 004)
Local PPO $0 $0 No Gap Coverage Chronic or Disabling Condition
Care Improvement Plus Gold Rx (Regional PPO SNP)
(R6801- 009)
Regional PPO $0 $0 No Gap Coverage Chronic or Disabling Condition
Care Improvement Plus Silver Rx (Regional PPO SNP)
(R6801- 008)
Regional PPO $15.50 $310.00 No Gap Coverage Chronic or Disabling Condition
Humana Gold Plus SNP-CHF/DM H4510-029 (HMO SNP)
(H4510- 029)
Local HMO $0 $0 Few Generics, Few Brands Chronic or Disabling Condition
Humana Gold Plus SNP-DE H4510-024 (HMO SNP)
(H4510- 024)
Local HMO $23.20 $310.00 No Gap Coverage Dual-Eligible
UnitedHealthcare Dual Complete (HMO SNP)
(H4590- 033)
Local HMO $9.50 $310.00 No Gap Coverage Dual-Eligible
UnitedHealthcare Dual Complete Focus (HMO SNP)
(H4527- 004)
Local HMO $6.20 $310.00 No Gap Coverage Dual-Eligible


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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