2013 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 You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Allegheny | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Armstrong | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Beaver | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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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 You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Bedford | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Blair | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Butler | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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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 You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Cambria | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Cameron | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Clarion | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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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 You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Clearfield | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Crawford | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Elk | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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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 You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Erie | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Fayette | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Forest | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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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 You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Greene | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Huntingdon | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Indiana | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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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 You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Jefferson | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Lawrence | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
McKean | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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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 You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Mercer | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Potter | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Somerset | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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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 You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Venango | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Warren | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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UPMC for You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Washington | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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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 You Advantage (HMO SNP) in PA - H4279-001-0 Benefit Details |
Westmoreland | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Brand: $75.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
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