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The 2022 Medicare Advantage Plans in Durham County NC.
2014 Medicare Advantage Plans in Durham County North Carolina
There are 18 Medicare Advantage Plans available in Durham County NC from 7 health insurance providers and 2 Special Needs Plans available. 5 Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $2500 and the highest out of pocket is $6700. The highest rated plan available in Durham 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 Type Indicates plan does not offer Part D drug coverage.
Medicare Special Needs Plans in Durham county North Carolina
|Plan Name||Type||Consolidated Premium C+D||Part D
|Gap||Special Needs Type||Overall Rating|
|UnitedHealthcare Dual Complete (HMO SNP)
|Local HMO||$16.60||$310.00||No Gap Coverage||Dual-Eligible|
|UnitedHealthcare Nursing Home Plan (HMO SNP)
|Local HMO||$28.30||$310.00||No Gap Coverage||Institutional|
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