2014 Medicare Advantage Plans in Waupaca County Wisconsin


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2014 Medicare Advantage Plans in Waupaca County Wisconsin

There are 25 Medicare Advantage Plans available in Waupaca County WI from 8 health insurance providers and 9 Special Needs Plans available. 8 Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $1000 and the highest out of pocket is $6700. The highest rated plan available in Waupaca 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 Wisconsin
AARP MedicareComplete (HMO)
(H5253-011)
Local HMO $0 $0 No Gap Coverage $4,200
Advocare Essence (HMO-POS)
(H5211-003)
Local HMO * $0 $3,400
Advocare Essence Rx (HMO-POS)
(H5211-002)
Local HMO $54.00 $0 Few Generics $3,400
Advocare Spirit (HMO-POS)
(H5211-001)
Local HMO * $135.00 $1,200
Advocare Spirit Rx (HMO-POS)
(H5211-004)
Local HMO $199.00 $0 Few Generics $1,200
Advocare Vitality (HMO-POS)
(H5211-006)
Local HMO * $242.00 $1,000
Advocare Vitality Rx (HMO-POS)
(H5211-005)
Local HMO $320.00 $0 Few Generics $1,000
Anthem Medicare Preferred Standard (PPO)
(H4036-005)
Local PPO $62.00 $176.00 No Gap Coverage $4,200
Care Improvement Plus Medicare Advantage (PPO)
(H0294-004)
Local PPO $0 $0 No Gap Coverage $6,700 NA
Humana Gold Choice H8145-006 (PFFS)
(H8145-006)
PFFS $82.00 $0 Few Generics, Few Brands N/A
Humana Gold Choice H8145-153 (PFFS)
(H8145-153)
PFFS * $24.00 N/A
Humana Gold Plus H6622-001 (HMO)
(H6622-001)
Local HMO $0 $0 Few Generics, Few Brands $4,900
HumanaChoice H5216-003 (PPO)
(H5216-003)
Local PPO $42.00 $0 Few Generics, Few Brands $6,700
HumanaChoice R5826-009 P (Regional PPO)
(R5826-009)
Regional PPO $112.00 $310.00 No Gap Coverage $6,700
HumanaChoice R5826-023 P (Regional PPO)
(R5826-023)
Regional PPO * $0 $4,500
Network PlatinumPlus (PPO)
(H5215-001)
Local PPO * $46.00 $2,800
Network PlatinumPlus Pharmacy (PPO)
(H5215-002)
Local PPO $87.00 $0 Many Generics $2,800
Network PlatinumPremier (PPO)
(H5215-006)
Local PPO * $150.00 $2,200
Network PlatinumPremier Pharmacy (PPO)
(H5215-005)
Local PPO $227.00 $0 Many Generics $2,200
Network PlatinumSelect (PPO)
(H5215-008)
Local PPO $0 $0 No Gap Coverage $3,100
Today's Options Advantage Plus 950B (PPO)
(H5378-190)
Local PPO $37.00 $0 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 Waupaca county Wisconsin

Plan Name Type Consolidated Premium C+D Part D
Deductible
Gap Special Needs Type Overall Rating
Advantage by Managed Health Services (HMO SNP)
(H8189- 001)
Local HMO $34.00 $310.00 No Gap Coverage Dual-EligibleNA
Care Improvement Plus Dual Advantage (PPO SNP)
(H0294- 006)
Local PPO $34.30 $310.00 No Gap Coverage Dual-EligibleNA
Care Improvement Plus Gold Rx (PPO SNP)
(H0294- 002)
Local PPO $0 $0 No Gap Coverage Chronic or Disabling ConditionNA
Community Care's Partnership Program (HMO SNP)
(H2034- 001)
Local HMO $37.00 $310.00 No Gap Coverage Dual-EligibleNA
Community Care's Partnership Program Disabled (HMO SNP)
(H2034- 002)
Local HMO $37.00 $310.00 No Gap Coverage Dual-EligibleNA
iCare Medicare Plan (HMO SNP)
(H2237- 001)
Local HMO $37.00 $310.00 No Gap Coverage Dual-Eligible
NetworkCares (PPO SNP)
(H5215- 007)
Local PPO $37.00 $0 No Gap Coverage Dual-Eligible
UnitedHealthcare Dual Complete LP (HMO SNP)
(H5253- 024)
Local HMO $31.60 $310.00 No Gap Coverage Dual-Eligible
UnitedHealthcare Nursing Home Plan (HMO-POS SNP)
(H5253- 007)
Local HMO $37.00 $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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