2014 Medicare Advantage Plans in Aguadilla County Puerto Rico


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2014 Medicare Advantage Plans in Aguadilla County Puerto Rico

There are 34 Medicare Advantage Plans available in Aguadilla County PR from 9 health insurance providers and 14 Special Needs Plans available. 26 Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $3000 and the highest out of pocket is $6700. The highest rated plan available in Aguadilla County received a 3 overall star rating from CMS and the lowest rated plan is 2.5 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 Puerto Rico
AHM Basic (HMO)
(H5774-003)
Local HMO * $0 $3,000
AHM Classic (HMO)
(H5774-008)
Local HMO $0 $0 All Generics $3,400
AHM Opal (HMO-POS)
(H5774-014)
Local HMO $33.00 $0 All Generics $3,400
AHM Standard (HMO)
(H5774-005)
Local HMO $0 $0 All Generics $3,000
Dorado (HMO)
(H4004-025)
Local HMO * $30.00 $3,250
Elite Dorado (HMO-POS)
(H4004-015)
Local HMO $34.50 $0 Some Generics $3,250
First Care+Plus (HMO)
(H5887-001)
Local HMO $0 $0 All Generics $6,700
First+Plus Advantage (PPO)
(H4011-001)
Local PPO * $0 $6,700
First+Plus Advantage Plus (PPO)
(H4011-003)
Local PPO $0 $0 All Generics $6,700
First+Plus Smart Premium (HMO)
(H5887-012)
Local HMO $0 $0 All Generics $6,700
First+Plus Smart Value (HMO)
(H5887-013)
Local HMO $0 $0 All Generics $6,700
Humana Gold Plus H4007-012 (HMO)
(H4007-012)
Local HMO $0 $310.00 Few Generics, Few Brands $3,500
Humana Gold Plus H4007-013 (HMO)
(H4007-013)
Local HMO $0 $0 Few Generics $5,000
HumanaChoice H2029-001 (PPO)
(H2029-001)
Local PPO $45.00 $0 Some Generics, Few Brands $6,700
HumanaChoice H2029-002 (PPO)
(H2029-002)
Local PPO $103.00 $0 Some Generics, Few Brands $3,400
MCS Classicare Advanced Health (HMO-POS)
(H4006-008)
Local HMO $79.00 $0 Many Generics $3,400
MCS Classicare B-Max (HMO)
(H4006-025)
Local HMO $0 $310.00 No Gap Coverage $6,700
MCS Classicare Essential (HMO-POS)
(H5577-008)
Local HMO $0 $0 Many Generics $3,400
MCS Classicare InteliCare (HMO)
(H5577-005)
Local HMO $0 $0 Many Generics $3,400
MCS Classicare MA (HMO)
(H4006-001)
Local HMO * $0 $3,400
MCS Classicare Premium Health (HMO)
(H4006-007)
Local HMO $0 $0 Many Generics $3,400
Medicare y Mucho Mas - BASICO EXTRA (HMO)
(H4003-024)
Local HMO $0 $310.00 No Gap Coverage $3,250
Medicare y Mucho Mas - ELITE (HMO-POS)
(H4003-001)
Local HMO $33.50 $0 Some Generics $3,250
Medicare y Mucho Mas - ELITE EXTRA (HMO-POS)
(H4003-025)
Local HMO $76.30 $0 Some Generics $3,250
Medicare y Mucho Mas - ELITE ULTRA (HMO-POS)
(H4003-027)
Local HMO $0 $0 Some Generics $3,250
Medicare y Mucho Mas - Original (HMO)
(H4003-018)
Local HMO * $30.00 $3,250
Medicare y Mucho Mas - Unico (HMO)
(H4003-019)
Local HMO $25.00 $0 Some Generics $3,250
Medicare y Mucho Mas - UNICO EXTRA (HMO)
(H4003-015)
Local HMO $0 $0 Some Generics $3,250
PMC Max (HMO)
(H4004-050)
Local HMO $10.00 $0 Some Generics $3,250
PMC Max - EXTRA (HMO-POS)
(H4004-053)
Local HMO $0 $0 Some Generics $3,250
Triple-S Medicare Optimo (PPO)
(H4005-001)
Local PPO * $0 $6,700
Triple-S Medicare Optimo Plus (PPO)
(H4005-004)
Local PPO $73.00 $0 All Generics $6,700
Triple-S Medicare Optimo Premier (HMO)
(H5732-001)
Local HMO $27.00 $0 All Generics $6,700
Triple-S Medicare Optimo Select (HMO) (HMO)
(H4012-008)
Local HMO $0 $0 All Generics $6,700

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



Medicare Special Needs Plans in Aguadilla county Puerto Rico

Plan Name Type Consolidated Premium C+D Part D
Deductible
Gap Special Needs Type Overall Rating
AHM Classic Plus (HMO SNP)
(H5774- 009)
Local HMO $0 $0 All Generics Chronic or Disabling Condition
AHM Platino Plus (HMO SNP)
(H5774- 019)
Local HMO $0 $310.00 No Gap Coverage Dual-Eligible
First+Plus Complete (HMO SNP)
(H5887- 007)
Local HMO $0 $0 All Generics Chronic or Disabling Condition
First+Plus Platino (HMO SNP)
(H5887- 010)
Local HMO $0 $310.00 No Gap Coverage Dual-Eligible
Humana Gold Plus SNP-DE H4007-005 (HMO SNP)
(H4007- 005)
Local HMO $0 $310.00 No Gap Coverage Dual-Eligible
Humana Gold Plus SNP-DE H4007-016 (HMO SNP)
(H4007- 016)
Local HMO $0 $310.00 No Gap Coverage Dual-Eligible
MCS Classicare Platino Ideal (HMO SNP)
(H5577- 002)
Local HMO $0 $310.00 No Gap Coverage Dual-Eligible
MCS Classicare Platino M
(H5577- 009)
Local HMO $0 $310.00 No Gap Coverage Dual-Eligible
MCS Classicare Platino Superior (HMO SNP)
(H5577- 010)
Local HMO $0 $310.00 No Gap Coverage Dual-Eligible
Medicare y Mucho Mas - DIAMANTE CHOICE (HMO SNP)
(H4003- 017)
Local HMO $0 $310.00 No Gap Coverage Dual-Eligible
Medicare y Mucho Mas - DIAMANTE EXTRA (HMO SNP)
(H4003- 021)
Local HMO $0 $310.00 No Gap Coverage Dual-Eligible
Medicare y Mucho Mas - SUPREMO (HMO SNP)
(H4003- 009)
Local HMO $34.00 $0 Some Generics Chronic or Disabling Condition
Premier Preferred (HMO SNP)
(H4004- 048)
Local HMO $0 $310.00 No Gap Coverage Dual-Eligible
Triple-S Medicare Selecto with Medicare Platino (HMO SNP)
(H4012- 003)
Local HMO $0 $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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