There are 49 Medicare Advantage plans meeting your criteria.
2014 / 2015 Medicare Advantage Plan Information
Click here to jump to the Chart Legend |
Plan Name |
Monthly Premium |
Part A&B Maximum Out-Of Pocket |
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 |
2014 Geisinger Gold Reserve (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H8468 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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2015 Geisinger Gold Reserve (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 Advantra Silver (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3959 -033 -0 | $6.00 | $20.00 | $35.00 | $35.00 | 3,225
2014 Formulary |
-- |
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2015 Advantra Silver (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $15.00 | $45.00 | $45.00 | 3,221 2015 Formulary |
|
2014 Cigna-HealthSpring Advantage (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3949 -026 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
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2015 Cigna-HealthSpring Advantage (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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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 2014 --
|
H3949 -028 -0 | | | | | |
-- |
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|
|
2015 Cigna-HealthSpring PreventiveCare (HMO)
| $0.00 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 3,087 2015 Formulary |
|
2014 Humana Gold Plus H6859-004 (HMO)
| $22.00 |
$6,700 |
$175 | Few Generics, Few Brands |
H6859 -004 -0 | $6.00 | $18.00 | $45.00 | $45.00 | 3,711
2014 Formulary |
-- |
-- |
-- |
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2015 Humana Gold Plus H6859-004 (HMO)
| $0.00 |
$6,700 |
$200 | Yes, some additional gap coverage. | $6.00 | $18.00 | $45.00 | $45.00 | 3,630 2015 Formulary |
|
2014 HumanaChoice R5826-062 (Regional PPO)
| $0.00 |
$3,400 |
No Rx Coverage |
R5826 -062 -0 | This plan does NOT include Prescription Drug coverage. | |
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2015 HumanaChoice R5826-062 (Regional PPO)
| $0.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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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 2014 --
|
H3952 -052 -0 | | | | | |
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2015 Keystone 65 Basic Rx (HMO)
| $0.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 3,735 2015 Formulary |
|
2014 Keystone 65 Select Medical Only (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3952 -048 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
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2015 Keystone 65 Select Medical Only (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2014 Erickson Advantage Guardian (HMO-POS SNP)
| $26.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -003 -0 | $0.00 | $4.00 | $40.00 | $40.00 | 3,604
2014 Formulary |
-- |
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2015 Erickson Advantage Guardian (HMO-POS SNP)
| $2.90 |
$500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $32.00 | $32.00 | 3,649 2015 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 2014 --
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H3949 -029 -1 | | | | | |
-- |
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|
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2015 Cigna-HealthSpring Preferred (HMO)
| $20.00 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 3,087 2015 Formulary |
|
2014 Aetna Medicare Basic Plan (HMO)
| $25.00 |
$6,700 |
No Rx Coverage |
H3931 -055 -0 | This plan does NOT include Prescription Drug coverage. | |
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2015 Aetna Medicare Basic Plan (HMO)
| $25.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 Keystone 65 Select Rx (HMO)
| $0.00 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount |
H3952 -049 -0 | $3.00 | $8.00 | $45.00 | $45.00 | 3,833
2014 Formulary |
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2015 Keystone 65 Select Rx (HMO)
| $25.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 3,735 2015 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 |
2014 Cigna-HealthSpring TotalCare (HMO SNP)
| $30.40 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3949 -009 -0 | 15% | | | | 2,946
2014 Formulary |
-- |
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|
|
2015 Cigna-HealthSpring TotalCare (HMO SNP)
| $25.40 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,087 2015 Formulary |
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2014 UnitedHealthcare Nursing Home Plan (PPO SNP)
| $29.50 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3912 -001 -0 | 25% | 25% | 25% | 25% | 3,604
2014 Formulary |
-- |
-- |
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2015 UnitedHealthcare Nursing Home Plan (PPO SNP)
| $27.80 |
$3,500 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,649 2015 Formulary |
|
2014 Cigna-HealthSpring Achieve (HMO SNP)
| $20.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3949 -024 -0 | $4.00 | $10.00 | $40.00 | $40.00 | 2,946
2014 Formulary |
-- |
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2015 Cigna-HealthSpring Achieve (HMO SNP)
| $28.50 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 3,087 2015 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 |
2014 Advantra Cares (HMO SNP)
| $35.50 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3959 -035 -0 | 15% | 15% | 15% | 15% | 3,177
2014 Formulary |
-- |
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|
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2015 Advantra Cares (HMO SNP)
| $33.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,221 2015 Formulary |
|
2014 Cigna-HealthSpring Traditions (HMO SNP)
| $33.60 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3949 -016 -0 | 25% | | | | 2,946
2014 Formulary |
-- |
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2015 Cigna-HealthSpring Traditions (HMO SNP)
| $33.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,087 2015 Formulary |
|
2014 Gateway Health Medicare Assured Diamond (HMO SNP)
| $35.50 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5932 -001 -0 | 0% | | | | 2,610
2014 Formulary |
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2015 Gateway Health Medicare Assured Diamond (HMO SNP)
| $33.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,634 2015 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 |
2014 Gateway Health Medicare Assured Ruby (HMO SNP)
| $32.70 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5932 -009 -0 | 15% | | | | 2,610
2014 Formulary |
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2015 Gateway Health Medicare Assured Ruby (HMO SNP)
| $33.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,634 2015 Formulary |
|
2014 Keystone VIP Choice (HMO SNP)
| $35.50 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H4227 -001 -0 | | | | | n/a |
-- |
-- |
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2015 Keystone VIP Choice (HMO SNP)
| $33.90 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,163 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H4102 -030 -0 | | | | | |
-- |
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2015 AARP MedicareComplete (HMO)
| $39.00 |
$6,700 |
$230 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $45.00 | $45.00 | 3,649 2015 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 |
2014 Cigna-HealthSpring Premier (HMO-POS)
| $34.00 |
$6,700 |
$180 | No additional gap coverage, only the Donut Hole Discount |
H3949 -027 -0 | $7.00 | $10.00 | $40.00 | $40.00 | 2,946
2014 Formulary |
-- |
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|
|
2015 Cigna-HealthSpring Premier (HMO-POS)
| $39.50 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $10.00 | $40.00 | $40.00 | 3,087 2015 Formulary |
|
2014 Gateway Health Medicare Assured Gold (HMO SNP)
| $34.20 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5932 -007 -0 | $4.00 | $10.00 | $45.00 | $45.00 | 2,610
2014 Formulary |
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|
|
|
2015 Gateway Health Medicare Assured Gold (HMO SNP)
| $46.30 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 2,634 2015 Formulary |
|
2014 Erickson Advantage Freedom (HMO-POS)
| $48.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -006 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 3,604
2014 Formulary |
-- |
|
|
|
2015 Erickson Advantage Freedom (HMO-POS)
| $48.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $45.00 | $45.00 | 3,649 2015 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 |
2014 HumanaChoice H5525-005 (PPO)
| $67.00 |
$6,700 |
$0 | Few Generics, Few Brands |
H5525 -005 -0 | $7.00 | $18.00 | $45.00 | $45.00 | 3,711
2014 Formulary |
-- |
|
|
|
2015 HumanaChoice H5525-005 (PPO)
| $65.00 |
$6,700 |
$320 | Yes, some additional gap coverage. | $7.00 | $18.00 | $45.00 | $45.00 | 3,630 2015 Formulary |
|
2014 Aetna Medicare Standard Plan (HMO)
| $71.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount |
H3931 -064 -0 | $7.00 | $43.00 | $95.00 | $95.00 | 3,134
2014 Formulary |
|
|
|
|
2015 Aetna Medicare Standard Plan (HMO)
| $70.00 |
$6,700 |
$115 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,112 2015 Formulary |
|
2014 Gateway Health Medicare Assured Platinum (HMO SNP)
| $56.40 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5932 -008 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 2,610
2014 Formulary |
|
|
|
|
2015 Gateway Health Medicare Assured Platinum (HMO SNP)
| $77.80 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 2,634 2015 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 |
2014 Advantra Gold (PPO)
| $72.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5522 -015 -0 | $6.00 | $20.00 | $38.00 | $38.00 | 3,225
2014 Formulary |
|
|
|
|
2015 Advantra Gold (PPO)
| $92.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $15.00 | $45.00 | $45.00 | 3,463 2015 Formulary |
|
2014 HumanaChoice R5826-002 (Regional PPO)
| $88.00 |
$5,900 |
$0 | Few Generics, Few Brands |
R5826 -002 -0 | $7.00 | $18.00 | $45.00 | $45.00 | 3,711
2014 Formulary |
|
|
|
|
2015 HumanaChoice R5826-002 (Regional PPO)
| $97.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $18.00 | $45.00 | $45.00 | tbd |
|
2014 Keystone 65 Preferred Medical Only (HMO)
| $125.40 |
$6,700 |
No Rx Coverage |
H3952 -008 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2015 Keystone 65 Preferred Medical Only (HMO)
| $135.00 |
$5,000 |
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 |
2014 Cigna-HealthSpring Preferred Plus (HMO)
| $106.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3949 -013 -0 | $4.00 | $8.00 | $35.00 | $35.00 | 2,946
2014 Formulary |
-- |
|
|
|
2015 Cigna-HealthSpring Preferred Plus (HMO)
| $140.50 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $8.00 | $40.00 | $40.00 | 3,087 2015 Formulary |
|
2014 Erickson Advantage Signature without Drugs (HMO-POS)
| $149.00 |
$5,000 |
No Rx Coverage |
H5652 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
2015 Erickson Advantage Signature without Drugs (HMO-POS)
| $149.00 |
$5,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 Personal Choice 65 Medical Only (PPO)
| $145.00 |
$6,700 |
No Rx Coverage |
H3909 -007 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2015 Personal Choice 65 Medical Only (PPO)
| $155.00 |
$6,700 |
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 |
2014 Aetna Medicare Premier Plan (HMO)
| $166.00 |
$6,700 |
$0 | Few Generics |
H3931 -004 -0 | $7.00 | $45.00 | $95.00 | $95.00 | 3,134
2014 Formulary |
|
|
|
|
2015 Aetna Medicare Premier Plan (HMO)
| $185.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,112 2015 Formulary |
|
2014 Erickson Advantage Champion (HMO-POS SNP)
| $189.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -004 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,604
2014 Formulary |
-- |
|
|
|
2015 Erickson Advantage Champion (HMO-POS SNP)
| $189.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,649 2015 Formulary |
|
2014 Erickson Advantage Signature with Drugs (HMO-POS)
| $189.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -001 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 3,604
2014 Formulary |
-- |
|
|
|
2015 Erickson Advantage Signature with Drugs (HMO-POS)
| $189.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $45.00 | $45.00 | 3,649 2015 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 |
2014 Keystone 65 Preferred Rx (HMO)
| $182.60 |
$6,700 |
$100 | Many Generics |
H3952 -020 -0 | $4.00 | $40.00 | $80.00 | $80.00 | 5,236
2014 Formulary |
|
|
|
|
2015 Keystone 65 Preferred Rx (HMO)
| $190.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $8.00 | $45.00 | $45.00 | 3,735 2015 Formulary |
|
2014 Humana Gold Choice H8145-053 (PFFS)
| $197.00 |
n/a |
$0 | Few Generics, Few Brands |
H8145 -053 -0 | $6.00 | $18.00 | $45.00 | $45.00 | 3,711
2014 Formulary |
|
|
|
|
2015 Humana Gold Choice H8145-053 (PFFS)
| $195.00 |
n/a |
$0 | Yes, some additional gap coverage. | $6.00 | $18.00 | $45.00 | $45.00 | 3,630 2015 Formulary |
|
2014 Personal Choice 65 Rx (PPO)
| $222.50 |
$6,700 |
$285 | No additional gap coverage, only the Donut Hole Discount |
H3909 -001 -0 | $5.00 | $40.00 | $80.00 | $80.00 | 5,236
2014 Formulary |
|
|
|
|
2015 Personal Choice 65 Rx (PPO)
| $240.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $9.00 | $45.00 | $45.00 | 3,735 2015 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 |
2014 Cigna-HealthSpring Preferred (HMO)
| $20.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3949 -002 -0 | $4.00 | $10.00 | $40.00 | $40.00 | 2,946
2014 Formulary |
-- |
|
|
|
-- Members will be assigned to Cigna-HealthSpring Preferred (HMO) H3949-029 --
| | | | | |
|
2014 HumanaChoice R5826-081 (Regional PPO)
| $78.00 |
$6,700 |
$310 | No additional gap coverage, only the Donut Hole Discount |
R5826 -081 -0 | 25% | 25% | 25% | 25% | 3,711
2014 Formulary |
|
|
|
|
-- Members will be assigned to HumanaChoice R5826-002 (Regional PPO) R5826-002 --
| | | | | |
|
2014 Today's Options Advantage 900 (PPO)
| $20.00 |
$6,700 |
No Rx Coverage |
H2775 -096 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
-- Members will be assigned to Today's Options Advantage 200 (PPO) H2775-095 --
| | | | | |
|
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 |
2014 Today's Options Advantage Plus 350A (PPO)
| $121.00 |
$3,250 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2775 -098 -0 | $2.00 | $7.00 | $40.00 | $40.00 | 2,885
2014 Formulary |
-- |
|
|
|
-- Members will be assigned to Today's Options Advantage Plus 150A (PPO) H2775-083 --
| | | | | |
|
2014 Today's Options Advantage Plus 950B (PPO)
| $56.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2775 -084 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 2,885
2014 Formulary |
-- |
|
|
|
-- Members will be assigned to Today's Options Advantage Plus 350B (PPO) H2775-089 --
| | | | | |
|
2014 Today's Options Premier 200 (PFFS)
| $70.00 |
n/a |
No Rx Coverage |
H2816 -025 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
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-- Members will be assigned to Today's Options Premier 100 (PFFS) H2816-002 --
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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 |
2014 Today's Options Premier 900 (PFFS)
| $30.00 |
n/a |
No Rx Coverage |
H2816 -009 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
|
-- Members will be assigned to Today's Options Premier 200 (PFFS) H2816-008 --
| | | | | |
|
2014 Today's Options Premier Plus 950B (PFFS)
| $76.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2816 -021 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 2,885
2014 Formulary |
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|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|
2014 Today's Options Premier Plus 350A (PFFS)
| $112.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2816 -027 -0 | $2.00 | $7.00 | $40.00 | $40.00 | 2,885
2014 Formulary |
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|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|
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 |
2014 Humana Gold Plus H6859-006 (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H6859 -006 -0 | This plan does NOT include Prescription Drug coverage. | |
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-- |
-- |
|
-- This plan not offered in 2015 --
|
| | | | |
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