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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 |
Members In This Plan ID | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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CIGNA Medicare Access Plan One (PFFS) - H2762-012-0 Benefit Details |
Upshur | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,544 members | ||||||
Health Plan SecureCare (HMO) - H5151-004-0 Benefit Details |
Upshur | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 738 members | ||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Upshur | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
SecureHorizons MedicareDirect Plan 3 (PFFS) - H5435-003-0 Benefit Details |
Upshur | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 24,942 members | ||||||
Today's Options Premier (PFFS) - H3333-104-0 Benefit Details |
Upshur | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 247 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Today's Options Value (PFFS) - H3333-106-0 Benefit Details |
Upshur | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | < 10 members | ||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-028-0 Benefit Details |
Upshur | $20.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 7,225 members Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H3333-107-0 Benefit Details |
Upshur | $25.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 19 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Value (PPO) - H5106-017-0 Benefit Details |
Upshur | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 235 members | ||||||
HumanaChoice H5041-001 (PPO) - H5041-001-0 Benefit Details |
Upshur | $30.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 3,978 members Browse Formulary | |||||
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SecureChoice (PPO) - H8604-004-0 Benefit Details |
Upshur | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 20 members | ||||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-094 (PFFS) - H2944-094-0 Benefit Details |
Upshur | $40.00 | $0 | No Gap Coverage | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 748 members Browse Formulary | |||||
Today's Options Premier powered by CCRx (PFFS) - H3333-105-0 Benefit Details |
Upshur | $44.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 173 members Browse Formulary | |||||
SecurityChoice Classic (PFFS) - H0540-088-0 Benefit Details |
Upshur | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecurityChoice Plus (PFFS) - H0540-089-0 Benefit Details |
Upshur | $56.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $8.00 Tier 2 Preferred Brand Certain Generic Drugs: $44.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-016-0 Benefit Details |
Upshur | $60.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 608 members | ||||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Statewide | $67.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 590 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Upshur | $67.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 590 members Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) - H5106-013-0 Benefit Details |
Upshur | $70.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-080 (PFFS) - H2944-080-0 Benefit Details |
Upshur | $70.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 3,502 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
FreedomBlue PFFS Choice Plus (PFFS) - H1643-001-0 Benefit Details |
Upshur | $82.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | 224 members Browse Formulary | |||||
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FreedomBlue PFFS Choice (PFFS) - H1643-002-0 Benefit Details |
Upshur | $85.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 29 members | ||||||
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CIGNA Medicare Access Plus RX Plan Four (PFFS) - H2762-036-0 Benefit Details |
Upshur | $90.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 2,420 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Statewide | $95.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty: 33% | 2,986 members Browse Formulary | |||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Upshur | $95.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty: 33% | 2,986 members Browse Formulary | |||||
Health Plan SecureCare (HMO) - H5151-002-0 Benefit Details |
Upshur | $99.00 | $0 | All Generics | Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: 50% Specialty: 20% | 7,109 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecureChoice (PPO) - H8604-003-0 Benefit Details |
Upshur | $119.00 | $0 | All Generics | Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: 50% Specialty: 20% | 201 members Browse Formulary | |||||
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FreedomBlue PPO Deluxe (PPO) - H5106-014-0 Benefit Details |
Upshur | $123.00 | $0 | Many Generics | Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 3,107 members Browse Formulary | |||||
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