2013 / 2014 Medicare Advantage Plan Information Click here to jump to the Chart Legend | ||||||||||||
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Plan Name | Monthly Premium |
Part A&B Maximum Out-Of |
Part D Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Formulary Drugs | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
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2013 Geisinger Gold Reserve (MSA) | $0.00 | n/a | No Rx Coverage | H8468 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Geisinger Gold Reserve (MSA) | $0.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2013 -- |
H5522 -009 -0 | |||||||||||
2014 Advantra Elite (PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $19.00 | $37.00 | $37.00 | 3,225 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H3959 -011 -0 | |||||||||||
2014 Advantra Silver (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $19.00 | $35.00 | $35.00 | 3,225 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Geisinger Gold Classic 3 (HMO) | $0.00 | $2,000 | No Rx Coverage | H3954 -098 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Geisinger Gold Classic 3 (HMO) | $0.00 | $2,250 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Humana Gold Choice H8145-055 (PFFS) | $0.00 | n/a | No Rx Coverage | H8145 -055 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Humana Gold Choice H8145-055 (PFFS) | $0.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 HumanaChoice R5826-062 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -062 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 HumanaChoice R5826-062 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Security Blue HD (HMO) | $0.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H3957 -037 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 5,246 2013 Formulary | ||
2014 Security Blue HD (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $20.00 | $40.00 | $40.00 | 4,342 2014 Formulary | |||
2013 UPMC for Life (HMO) | $0.00 | $3,400 | No Rx Coverage | H3907 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 UPMC for Life (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Security Blue ValueRx (HMO) | $48.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3957 -032 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 5,246 2013 Formulary | ||
2014 Security Blue ValueRx (HMO) | $10.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 5,227 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Freedom Blue PPO HD Rx (PPO) | $14.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H3916 -020 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 5,246 2013 Formulary | ||
2014 Freedom Blue PPO HD Rx (PPO) | $22.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $20.00 | $40.00 | $40.00 | 4,342 2014 Formulary | |||
2013 Geisinger Gold Preferred 2 (PPO) | $25.00 | $3,400 | No Rx Coverage | H3924 -047 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Geisinger Gold Preferred 2 (PPO) | $28.00 | $3,900 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2013 -- |
H3916 -033 -0 | |||||||||||
2014 Freedom Blue PPO ValueRx (PPO) | $30.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $40.00 | $40.00 | 4,342 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Security Blue Value (HMO) | $32.00 | $3,400 | No Rx Coverage | H3957 -025 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Security Blue Value (HMO) | $32.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Geisinger Gold Secure 1 (HMO SNP) | $38.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H3954 -097 -0 | 25% | 3,253 2013 Formulary | |||||
2014 Geisinger Gold Secure 1 (HMO SNP) | $35.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 3,207 2014 Formulary | ||||||
2013 UPMC for You Advantage (HMO SNP) | $36.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H4279 -001 -0 | $6.00 | $34.00 | $75.00 | $75.00 | 3,359 2013 Formulary | ||
2014 UPMC for You Advantage (HMO SNP) | $35.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $40.00 | $80.00 | $80.00 | 3,300 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 UPMC for Life HMO Deductible with Rx (HMO) | $36.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3907 -037 -0 | $9.00 | $44.00 | $95.00 | $95.00 | 3,359 2013 Formulary | ||
2014 UPMC for Life HMO Deductible with Rx (HMO) | $37.50 | $4,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 3,300 2014 Formulary | |||
2013 UPMC for Life PPO High Deductible with Rx (PPO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5533 -003 -0 | $9.00 | $44.00 | $95.00 | $95.00 | 3,359 2013 Formulary | ||
2014 UPMC for Life PPO High Deductible with Rx (PPO) | $40.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 3,300 2014 Formulary | |||
2013 Geisinger Gold Classic 3 $0 Deductible Rx (HMO) | $41.00 | $2,000 | $0 | Few Generics | H3954 -100 -0 | $3.00 | $7.00 | $39.00 | $39.00 | 3,253 2013 Formulary | ||
2014 Geisinger Gold Classic 3 $0 Deductible Rx (HMO) | $41.00 | $2,250 | $0 | Few Generics | $3.00 | $10.00 | $39.00 | $39.00 | 3,207 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
-- This plan not offered in 2013 -- |
H5522 -005 -0 | |||||||||||
2014 Advantra Silver (PPO) | $48.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $22.00 | $35.00 | $35.00 | 3,225 2014 Formulary | |||
2013 Today's Options Premier 600 (PFFS) | $59.00 | n/a | No Rx Coverage | H2816 -010 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Today's Options Premier 900 (PFFS) | $59.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Geisinger Gold Classic Plus (HMO-POS) | $60.00 | $6,700 | No Rx Coverage | H3954 -150 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Geisinger Gold Classic Plus (HMO-POS) | $60.00 | $4,300 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Humana Gold Choice H8145-052 (PFFS) | $56.00 | n/a | $0 | Few Generics, Few Brands |
H8145 -052 -0 | $6.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Choice H8145-052 (PFFS) | $60.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $18.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Geisinger Gold Preferred 2 $0 Deductible Rx (PPO) | $60.00 | $3,400 | $0 | Few Generics | H3924 -048 -0 | $3.00 | $7.00 | $39.00 | $39.00 | 3,253 2013 Formulary | ||
2014 Geisinger Gold Preferred 2 $0 Deductible Rx (PPO) | $65.00 | $3,900 | $0 | Few Generics | $3.00 | $10.00 | $39.00 | $39.00 | 3,207 2014 Formulary | |||
2013 HumanaChoice R5826-081 (Regional PPO) | $75.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | R5826 -081 -0 | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | ||
2014 HumanaChoice R5826-081 (Regional PPO) | $78.00 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,711 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Freedom Blue PPO Select (PPO) | $81.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3916 -024 -0 | $9.00 | $45.00 | $90.00 | $90.00 | 5,246 2013 Formulary | ||
2014 Freedom Blue PPO Select (PPO) | $82.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $9.00 | $45.00 | $90.00 | $90.00 | 5,227 2014 Formulary | |||
2013 UPMC for Life HMO Rx (HMO) | $77.50 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3907 -029 -0 | $8.00 | $44.00 | $95.00 | $95.00 | 3,359 2013 Formulary | ||
2014 UPMC for Life HMO Rx (HMO) | $84.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $95.00 | $95.00 | 3,300 2014 Formulary | |||
2013 HumanaChoice R5826-002 (Regional PPO) | $85.00 | $5,300 | $0 | Few Generics, Few Brands |
R5826 -002 -0 | $6.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice R5826-002 (Regional PPO) | $88.00 | $5,900 | $0 | Few Generics, Few Brands | $7.00 | $18.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Geisinger Gold Classic 1 (HMO) | $112.00 | $2,800 | No Rx Coverage | H3954 -007 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Geisinger Gold Classic 1 (HMO) | $92.00 | $2,800 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2013 -- |
H3959 -002 -0 | |||||||||||
2014 Advantra Gold (HMO) | $96.00 | $5,900 | $0 | Some Generics | $5.00 | $20.00 | $35.00 | $35.00 | 3,225 2014 Formulary | |||
2013 Geisinger Gold Classic Plus $0 Deductible Rx (HMO-POS) | $100.00 | $6,700 | $0 | Few Generics | H3954 -151 -0 | $3.00 | $7.00 | $39.00 | $39.00 | 3,253 2013 Formulary | ||
2014 Geisinger Gold Classic Plus $0 Deductible Rx (HMO-POS) | $105.00 | $4,300 | $0 | Few Generics | $3.00 | $7.00 | $39.00 | $39.00 | 3,207 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Geisinger Gold Preferred 1 (PPO) | $98.00 | $3,400 | No Rx Coverage | H3924 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Geisinger Gold Preferred 1 (PPO) | $105.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Today's Options Premier Plus 650F (PFFS) | $100.00 | n/a | $100 | No additional gap coverage, only the Donut Hole Discount | H2816 -022 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 2013 Formulary | ||
2014 Today's Options Premier Plus 950F (PFFS) | $105.00 | n/a | $120 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 2,885 2014 Formulary | |||
2013 Today's Options Premier 200 (PFFS) | $110.00 | n/a | No Rx Coverage | H2816 -026 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Today's Options Premier 200 (PFFS) | $110.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
-- This plan not offered in 2013 -- |
H5533 -005 -0 | |||||||||||
2014 UPMC for Life PPO Rx Enhanced (PPO) | $118.50 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 3,300 2014 Formulary | |||
2013 Geisinger Gold Classic 1 $0 Deductible Rx (HMO) | $142.00 | $2,800 | $0 | Few Generics | H3954 -033 -0 | $3.00 | $7.00 | $39.00 | $39.00 | 3,253 2013 Formulary | ||
2014 Geisinger Gold Classic 1 $0 Deductible Rx (HMO) | $127.00 | $2,800 | $0 | Few Generics | $3.00 | $7.00 | $39.00 | $39.00 | 3,207 2014 Formulary | |||
2013 Geisinger Gold Preferred 1 $0 Deductible Rx (PPO) | $150.00 | $3,400 | $0 | Few Generics | H3924 -003 -0 | $3.00 | $7.00 | $39.00 | $39.00 | 3,253 2013 Formulary | ||
2014 Geisinger Gold Preferred 1 $0 Deductible Rx (PPO) | $157.00 | $3,400 | $0 | Few Generics | $3.00 | $10.00 | $39.00 | $39.00 | 3,207 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Today's Options Premier Plus 250A (PFFS) | $157.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H2816 -028 -0 | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | ||
2014 Today's Options Premier Plus 350A (PFFS) | $162.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 2,885 2014 Formulary | |||
2013 Security Blue Standard (HMO) | $173.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3957 -006 -0 | $9.00 | $45.00 | $90.00 | $90.00 | 5,246 2013 Formulary | ||
2014 Security Blue Standard (HMO) | $175.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $9.00 | $45.00 | $90.00 | $90.00 | 5,227 2014 Formulary | |||
2013 Freedom Blue PPO Classic (PPO) | $198.00 | $3,400 | $0 | Many Generics | H3916 -002 -0 | $8.00 | $42.00 | $90.00 | $90.00 | 5,246 2013 Formulary | ||
2014 Freedom Blue PPO Classic (PPO) | $194.00 | $6,700 | $0 | Many Generics | $8.00 | $42.00 | $90.00 | $90.00 | 5,227 2014 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Security Blue Deluxe (HMO) | $210.00 | $3,400 | $0 | Many Generics | H3957 -021 -0 | $8.00 | $42.00 | $90.00 | $90.00 | 5,246 2013 Formulary | ||
2014 Security Blue Deluxe (HMO) | $211.00 | $6,700 | $0 | Many Generics | $8.00 | $42.00 | $90.00 | $90.00 | 5,227 2014 Formulary | |||
2013 UPMC for Life HMO Rx Enhanced (HMO) | $195.50 | $3,200 | $0 | No additional gap coverage, only the Donut Hole Discount | H3907 -006 -0 | $8.00 | $44.00 | $95.00 | $95.00 | 3,359 2013 Formulary | ||
2014 UPMC for Life HMO Rx Enhanced (HMO) | $224.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $95.00 | $95.00 | 3,300 2014 Formulary | |||
2013 UPMC for Life PPO Rx (PPO) | $88.50 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5533 -004 -0 | $8.00 | $44.00 | $95.00 | $95.00 | 3,359 2013 Formulary | ||
-- Members will be assigned to UPMC for Life PPO High Deductible with Rx (PPO) H5533-003 -- | ||||||||||||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2013 Geisinger Gold Secure 3 (HMO SNP) | $123.00 | n/a | $0 | Few Generics | H3954 -135 -0 | $3.00 | $7.00 | $39.00 | $39.00 | 3,253 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 UnitedHealthcare Dual Complete (HMO SNP) | $30.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H3920 -009 -0 | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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