2011 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Bedford | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
![]() |
![]() |
![]() |
|||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Blair | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
![]() |
![]() |
![]() |
|||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Cameron | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 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 | |||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Clarion | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
![]() |
![]() |
![]() |
|||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Clearfield | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
![]() |
![]() |
![]() |
|||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Crawford | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 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 | |||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Elk | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
![]() |
![]() |
![]() |
|||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Erie | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
![]() |
![]() |
![]() |
|||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Forest | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 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 | |||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Huntingdon | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
![]() |
![]() |
![]() |
|||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Jefferson | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
![]() |
![]() |
![]() |
|||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
McKean | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 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 | |||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Mercer | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
![]() |
![]() |
![]() |
|||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Potter | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
![]() |
![]() |
![]() |
|||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Somerset | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 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 | |||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Venango | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
![]() |
![]() |
![]() |
|||||||||
SecurityBlue Deluxe (HMO) in PA - H3957-021-0 Benefit Details ![]() ![]() ![]() ![]() |
Warren | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
![]() |
![]() |
![]() |
|