2011 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) Additional 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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UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Allegheny | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Armstrong | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Beaver | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Bedford | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Blair | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Butler | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Cambria | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Cameron | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Clarion | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Clearfield | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Crawford | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Elk | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Erie | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Fayette | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Forest | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Greene | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Indiana | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Jefferson | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Lawrence | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
McKean | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Mercer | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Somerset | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Venango | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Washington | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UPMC for Life HMO Rx (HMO) in PA - H3907-029-0 Benefit Details |
Westmoreland | $59.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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