There are 58 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. | |
|
-- This plan not offered in 2014 --
|
H3959 -041 -0 | | | | | |
-- |
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2015 Advantra Basic Medical (HMO)
| $0.00 |
$6,700 |
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 -011 -0 | $6.00 | $19.00 | $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 | $12.00 | $45.00 | $45.00 | 3,463 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 Silver (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5522 -004 -0 | $6.00 | $20.00 | $35.00 | $35.00 | 3,225
2014 Formulary |
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|
|
2015 Advantra Silver (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $13.00 | $45.00 | $45.00 | 3,463 2015 Formulary |
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-- This plan not offered in 2014 --
|
H3954 -158 -4 | | | | | |
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2015 Geisinger Gold Classic Complete Rx (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $6.00 | $20.00 | $39.00 | $39.00 | 3,379 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H3924 -060 -4 | | | | | |
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2015 Geisinger Gold Preferred Complete Rx (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $6.00 | $20.00 | $39.00 | $39.00 | 3,379 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 Humana Gold Plus H6859-003 (HMO)
| $0.00 |
$6,700 |
$0 | Few Generics, Few Brands |
H6859 -003 -0 | $6.00 | $18.00 | $45.00 | $45.00 | 3,711
2014 Formulary |
-- |
-- |
-- |
|
2015 Humana Gold Plus H6859-003 (HMO)
| $0.00 |
$6,700 |
$320 | 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. | |
|
|
|
|
2015 HumanaChoice R5826-062 (Regional PPO)
| $0.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 SeniorBlue - Option 3 (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3962 -007 -0 | $5.00 | $15.00 | $40.00 | $40.00 | 3,025
2014 Formulary |
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2015 SeniorBlue - Option 3 (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $38.00 | $38.00 | tbd |
|
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 Basic Plan (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3931 -054 -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 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 |
-- |
-- |
|
|
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 |
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-- This plan not offered in 2014 --
|
H5522 -017 -0 | | | | | |
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2015 AdvantraOne (PPO)
| $29.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $19.00 | $45.00 | $45.00 | 3,221 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 Geisinger Gold Preferred 3 $0 Deductible Rx (PPO)
| $148.00 |
$3,400 |
$0 | Few Generics |
H3924 -054 -0 | $3.00 | $10.00 | $39.00 | $39.00 | 3,207
2014 Formulary |
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2015 Geisinger Gold Preferred Essential Rx (PPO)
| $31.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $6.00 | $20.00 | $39.00 | $39.00 | 3,379 2015 Formulary |
|
2014 Advantra Cares (HMO SNP)
| $35.50 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3959 -036 -0 | 15% | 15% | 15% | 15% | 3,177
2014 Formulary |
-- |
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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 AmeriHealth VIP Care (HMO SNP)
| $35.50 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H4227 -002 -0 | | | | | n/a |
-- |
-- |
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2015 AmeriHealth VIP Care (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 |
|
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 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 |
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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 Geisinger Gold Secure 1 (HMO SNP)
| $35.50 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3954 -097 -0 | 15% | | | | 3,207
2014 Formulary |
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|
|
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2015 Geisinger Gold Secure Rx (HMO SNP)
| $33.90 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,379 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 AARP MedicareComplete Choice Plan 1 (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3921 -008 -0 | $4.00 | $8.00 | $45.00 | $45.00 | 3,604
2014 Formulary |
-- |
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|
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2015 AARP MedicareComplete Choice Plan 1 (PPO)
| $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 |
|
2014 HumanaChoice H5525-007 (PPO)
| $41.00 |
$6,700 |
$0 | Few Generics, Few Brands |
H5525 -007 -0 | $7.00 | $18.00 | $45.00 | $45.00 | 3,711
2014 Formulary |
-- |
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|
|
2015 HumanaChoice H5525-007 (PPO)
| $45.00 |
$6,700 |
$320 | Yes, some additional gap coverage. | $6.00 | $18.00 | $45.00 | $45.00 | 3,630 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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|
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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 |
|
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 --
|
H3959 -039 -0 | | | | | |
-- |
|
|
|
2015 Advantra Silver Plus (HMO)
| $49.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $22.00 | $45.00 | $45.00 | 3,463 2015 Formulary |
|
2014 Aetna Medicare Standard Plan (HMO)
| $61.00 |
$6,700 |
$0 | Few Generics |
H3931 -070 -0 | $7.00 | $45.00 | $95.00 | $95.00 | 3,134
2014 Formulary |
|
|
|
|
2015 Aetna Medicare Standard Plan (HMO)
| $49.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $45.00 | $45.00 | 3,112 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H3954 -156 -4 | | | | | |
|
|
|
|
2015 Geisinger Gold Classic Advantage (HMO)
| $50.00 |
$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 |
2014 AARP MedicareComplete Choice Plan 2 (PPO)
| $40.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3921 -009 -0 | $4.00 | $8.00 | $45.00 | $45.00 | 3,604
2014 Formulary |
-- |
|
|
|
2015 AARP MedicareComplete Choice Plan 2 (PPO)
| $59.00 |
$5,500 |
$210 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $45.00 | $45.00 | 3,649 2015 Formulary |
|
2014 Advantra Silver Plus (PPO)
| $49.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5522 -013 -0 | $6.00 | $20.00 | $35.00 | $35.00 | 3,225
2014 Formulary |
|
|
|
|
2015 Advantra Silver Plus (PPO)
| $67.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $9.00 | $45.00 | $45.00 | 3,463 2015 Formulary |
|
2014 Freedom Blue PPO HD Rx (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -025 -0 | $5.00 | $20.00 | $40.00 | $40.00 | 4,342
2014 Formulary |
|
|
|
|
2015 Freedom Blue PPO HD Rx (PPO)
| $70.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $45.00 | $45.00 | 4,522 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 SeniorBlue - Option 2 (PPO)
| $78.60 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3923 -013 -0 | $5.00 | $17.00 | $38.00 | $38.00 | 4,967
2014 Formulary |
|
|
|
|
2015 SeniorBlue - Option 2 (PPO)
| $72.40 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $17.00 | $38.00 | $38.00 | tbd |
|
-- This plan not offered in 2014 --
|
H3924 -059 -4 | | | | | |
|
|
|
|
2015 Geisinger Gold Preferred Advantage Rx (PPO)
| $75.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $3.00 | $18.00 | $39.00 | $39.00 | 3,379 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 Freedom Blue PPO Value (PPO)
| $30.00 |
$6,700 |
No Rx Coverage |
H3916 -012 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2015 Freedom Blue PPO Value (PPO)
| $95.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 Freedom Blue PPO ValueRx (PPO)
| $31.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -018 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 5,227
2014 Formulary |
|
|
|
|
2015 Freedom Blue PPO ValueRx (PPO)
| $95.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $45.00 | $45.00 | 4,522 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 |
|
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)
| $99.00 |
$6,500 |
$0 | Some Generics |
H5522 -002 -0 | $2.00 | $15.00 | $40.00 | $40.00 | 3,225
2014 Formulary |
|
|
|
|
2015 Advantra Gold (PPO)
| $116.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $2.00 | $8.00 | $45.00 | $45.00 | 3,463 2015 Formulary |
|
2014 SeniorBlue - Option 2 (HMO)
| $135.40 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3962 -004 -0 | $4.00 | $12.00 | $38.00 | $38.00 | 4,967
2014 Formulary |
|
|
|
|
2015 SeniorBlue - Option 2 (HMO)
| $117.50 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $38.00 | $38.00 | tbd |
|
-- This plan not offered in 2014 --
|
H3954 -157 -4 | | | | | |
|
|
|
|
2015 Geisinger Gold Classic Advantage Rx (HMO)
| $119.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $3.00 | $18.00 | $39.00 | $39.00 | 3,379 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 Aetna Medicare Premier Plan (PPO)
| $141.00 |
$6,700 |
$0 | Few Generics |
H5521 -012 -0 | $7.00 | $45.00 | $95.00 | $95.00 | 3,134
2014 Formulary |
|
|
|
|
2015 Aetna Medicare Premier Plan (PPO)
| $124.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $45.00 | $45.00 | 3,112 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H5521 -052 -0 | | | | | |
|
|
|
|
2015 Aetna Medicare Select Plus Plan (PPO)
| $139.00 |
$3,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $45.00 | $45.00 | 3,112 2015 Formulary |
|
2014 SeniorBlue - Option 1 (HMO)
| $182.40 |
$3,400 |
$0 | Many Generics |
H3962 -001 -0 | $3.00 | $9.00 | $38.00 | $38.00 | 4,967
2014 Formulary |
|
|
|
|
2015 SeniorBlue - Option 1 (HMO)
| $167.50 |
$3,400 |
$0 | Yes, some additional gap coverage. | $3.00 | $9.00 | $38.00 | $38.00 | tbd |
|
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 SeniorBlue - Option 1 (PPO)
| $193.40 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3923 -017 -0 | $4.00 | $10.00 | $38.00 | $38.00 | 4,967
2014 Formulary |
|
|
|
|
2015 SeniorBlue - Option 1 (PPO)
| $191.90 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $38.00 | $38.00 | tbd |
|
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 Freedom Blue PPO Standard (PPO)
| $172.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -015 -0 | $8.00 | $45.00 | $90.00 | $90.00 | 5,227
2014 Formulary |
|
|
|
|
2015 Freedom Blue PPO Standard (PPO)
| $246.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $45.00 | $45.00 | 5,455 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 Freedom Blue PPO Deluxe (PPO)
| $219.00 |
$6,700 |
$0 | Many Generics |
H3916 -005 -0 | $8.00 | $42.00 | $90.00 | $90.00 | 5,227
2014 Formulary |
|
|
|
|
2015 Freedom Blue PPO Deluxe (PPO)
| $296.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $4.00 | $12.00 | $45.00 | $45.00 | 5,455 2015 Formulary |
|
2014 Advantra Elite (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5522 -008 -0 | $5.00 | $19.00 | $37.00 | $37.00 | 3,225
2014 Formulary |
|
|
|
|
-- Members will be assigned to Advantra Silver (PPO) H5522-004 --
| | | | | |
|
2014 Geisinger Gold Classic 1 (HMO)
| $50.00 |
$2,800 |
No Rx Coverage |
H3954 -136 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- Members will be assigned to Geisinger Gold Classic Advantage (HMO) H3954-156 --
| | | | | |
|
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 Geisinger Gold Classic 4 (HMO)
| $0.00 |
$2,250 |
No Rx Coverage |
H3954 -138 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- Members will be assigned to Geisinger Gold Classic Advantage (HMO) H3954-156 --
| | | | | |
|
2014 Geisinger Gold Classic Plus (HMO-POS)
| $60.00 |
$4,300 |
No Rx Coverage |
H3954 -154 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- Members will be assigned to Geisinger Gold Classic Advantage (HMO) H3954-156 --
| | | | | |
|
2014 Geisinger Gold Classic 1 $0 Deductible Rx (HMO)
| $88.00 |
$2,800 |
$0 | Few Generics |
H3954 -137 -0 | $3.00 | $7.00 | $39.00 | $39.00 | 3,207
2014 Formulary |
|
|
|
|
-- Members will be assigned to Geisinger Gold Classic Advantage Rx (HMO) H3954-157 --
| | | | | |
|
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 Geisinger Gold Classic 4 $0 Deductible Rx (HMO)
| $45.00 |
$2,250 |
$0 | Few Generics |
H3954 -139 -0 | $3.00 | $10.00 | $39.00 | $39.00 | 3,207
2014 Formulary |
|
|
|
|
-- Members will be assigned to Geisinger Gold Classic Advantage Rx (HMO) H3954-157 --
| | | | | |
|
2014 Geisinger Gold Classic Plus $0 Deductible Rx (HMO-POS)
| $100.00 |
$4,300 |
$0 | Few Generics |
H3954 -155 -0 | $3.00 | $7.00 | $39.00 | $39.00 | 3,207
2014 Formulary |
|
|
|
|
-- Members will be assigned to Geisinger Gold Classic Advantage Rx (HMO) H3954-157 --
| | | | | |
|
2014 Geisinger Gold Preferred 2 $0 Deductible Rx (PPO)
| $66.00 |
$3,900 |
$0 | Few Generics |
H3924 -052 -0 | $3.00 | $10.00 | $39.00 | $39.00 | 3,207
2014 Formulary |
|
|
|
|
-- Members will be assigned to Geisinger Gold Preferred Essential Rx (PPO) H3924-054 --
| | | | | |
|
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 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 Premier 200 (PFFS)
| $110.00 |
n/a |
No Rx Coverage |
H2816 -026 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
-- Members will be assigned to Today's Options Premier 100 (PFFS) H2816-002 --
| | | | | |
|
2014 Today's Options Premier 900 (PFFS)
| $59.00 |
n/a |
No Rx Coverage |
H2816 -010 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
-- Members will be assigned to Today's Options Premier 200 (PFFS) H2816-008 --
| | | | | |
|
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 Plus 350A (PFFS)
| $162.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2816 -028 -0 | $2.00 | $7.00 | $40.00 | $40.00 | 2,885
2014 Formulary |
-- |
|
|
|
-- Members will be assigned to Today's Options Premier Plus 150A (PFFS) H2816-027 --
| | | | | |
|
2014 Today's Options Premier Plus 950F (PFFS)
| $105.00 |
n/a |
$120 | No additional gap coverage, only the Donut Hole Discount |
H2816 -022 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 2,885
2014 Formulary |
-- |
|
|
|
-- Members will be assigned to Today's Options Premier Plus 350B (PFFS) H2816-021 --
| | | | | |
|
2014 Geisinger Gold Preferred 2 (PPO)
| $31.00 |
$3,900 |
No Rx Coverage |
H3924 -051 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- 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 Geisinger Gold Preferred 3 (PPO)
| $96.00 |
$3,400 |
No Rx Coverage |
H3924 -053 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|