2010 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Adams | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Berks | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Bradford | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Carbon | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Centre | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Clinton | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Columbia | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Cumberland | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Dauphin | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Franklin | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Fulton | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Juniata | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Lackawanna | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Lancaster | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Lebanon | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Lehigh | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Luzerne | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Lycoming | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Mifflin | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Monroe | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Montour | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Northampton | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Northumberland | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Perry | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Pike | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Schuylkill | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Snyder | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Sullivan | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Susquehanna | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Tioga | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Union | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Wayne | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
Wyoming | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Basic Rx (PPO) in PA - H3916-018-0 Benefit Details |
York | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | n/a Browse Formulary | |||||
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