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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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AARP MedicareComplete Choice (PPO) - H3812-001-0 Benefit Details |
Lane | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $39.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $74.00 Tier 4 Specialty: 33% | 6,498 members Browse Formulary | |||||
Health Net Violet Option 2 (PPO) - H5520-005-0 Benefit Details |
Lane | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic: $6.00 Tier 2 Preferred Brand: $38.00 Tier 3 Non-Preferred: $76.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 12,863 members Browse Formulary | |||||
Trillium Advantage Dual SNP (HMO) - H2174-001-0 Benefit Details |
Lane | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Preferred Generic: $0.00 Preferred Brand: $45.00 Specialty: 25% Non-Preferred: $95.00 | 2,447 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Evercare Plan MP (PPO) - H3812-007-0 Benefit Details |
Lane | $25.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $45.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $85.00 Tier 4 Specialty: 33% | n/a Browse Formulary | |||||
Health Net Aqua (PPO) - H5520-001-0 Benefit Details |
Lane | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,003 members | ||||||
Trillium Advantage ISNP (HMO) - H2174-003-0 Benefit Details |
Lane | $31.00 | $310 | No Gap Coverage | Tier 1: 25% | 31 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Providence Medicare Choice (HMO-POS) - H9047-035-0 Benefit Details |
Lane | $32.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 915 members | ||||||
Evercare Plan IP (PPO) - H3812-005-0 Benefit Details |
Lane | $35.60 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 237 members Browse Formulary | |||||
Trillium Advantage Community ISNP (HMO) - H2174-005-0 Benefit Details |
Lane | $35.60 | $310 | No Gap Coverage | Tier 1: 25% | < 10 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Sterling Basic Plus (PFFS) - H5006-018-1 Benefit Details |
Lane | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
AARP MedicareComplete (HMO) - H3805-007-0 Benefit Details |
Lane | $49.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $39.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $74.00 Tier 4 Specialty: 33% | 5,735 members Browse Formulary | |||||
Today's Options Value (PFFS) - H5421-056-0 Benefit Details |
Lane | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 869 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Providence Medicare Choice + RX (HMO-POS) - H9047-024-0 Benefit Details |
Lane | $58.00 | $0 | No Gap Coverage | Generic: $6.00 Brand: $45.00 Specialty: 33% | 7,086 members Browse Formulary | |||||
Sterling Option I (PFFS) - H5006-014-1 Benefit Details |
Lane | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
Trillium Advantage Flex (HMO) - H2174-004-0 Benefit Details |
Lane | $60.30 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 126 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 powered by CCRx (PFFS) - H5421-074-0 Benefit Details |
Lane | $68.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plan One (PFFS) - H2762-023-0 Benefit Details |
Lane | $85.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 183 members | ||||||
Health Net Violet Option 1 (PPO) - H5520-002-0 Benefit Details |
Lane | $89.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic: $6.00 Tier 2 Preferred Brand: $38.00 Tier 3 Non-Preferred: $76.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 11,873 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier (PFFS) - H5421-050-0 Benefit Details |
Lane | $89.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-048-0 Benefit Details |
Lane | $90.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
Providence Medicare Extra Plan 1 (HMO) - H9047-033-0 Benefit Details |
Lane | $92.00 | 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 | |||||||||
Sterling Option II (PFFS) - H5006-017-1 Benefit Details |
Lane | $99.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
Regence MedAdvantage (PPO) - H3817-001-0 Benefit Details |
Lane | $116.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 8,130 members | ||||||
Health Net Healthy Heart (PPO) - H5520-009-0 Benefit Details |
Lane | $117.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic: $5.00 Tier 2 Preferred Brand: $35.00 Tier 3 Non-Preferred: $70.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Providence Medicare Extra Plan 1 + RX (HMO) - H9047-001-0 Benefit Details |
Lane | $117.00 | $0 | No Gap Coverage | Generic: $6.00 Brand: $45.00 Specialty: 33% | 14,724 members Browse Formulary | |||||
Sterling Option IV (PFFS) - H5006-016-1 Benefit Details |
Lane | $119.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
Trillium Advantage (HMO) - H2174-002-0 Benefit Details |
Lane | $125.00 | $0 | Many Generics | Preferred Generic: $9.00 Preferred Brand: $30.00 Non-Preferred: $50.00 | 438 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Regence MedAdvantage + Rx Classic (PPO) - H3817-002-0 Benefit Details |
Lane | $126.00 | $200 | No Gap Coverage | Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $56.00 Miscellaneous Injectables: 27% Specialty: 27% | 23,022 members Browse Formulary | |||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Lane | $126.10 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 70 members | ||||||
Today's Options Premier powered by CCRx (PFFS) - H5421-068-0 Benefit Details |
Lane | $138.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 607 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-027-0 Benefit Details |
Lane | $140.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 78 members | ||||||
Regence MedAdvantage + Rx Enhanced (PPO) - H3817-003-0 Benefit Details |
Lane | $176.00 | $0 | Many Generics | Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $56.00 Miscellaneous Injectables: 30% Specialty: 30% | 22,389 members Browse Formulary | |||||
Trillium Advantage Deluxe Community ISNP (HMO) - H2174-006-0 Benefit Details |
Lane | $194.00 | $0 | No Gap Coverage | Preferred Generic: $9.00 Preferred Brand: $30.00 Non-Preferred: $50.00 | < 10 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
ODS Advantage PPORX Select (PPO) - H3813-003-0 Benefit Details |
Lane | $223.70 | $0 | All Generics | Tier 1: tbd | 248 members Browse Formulary | |||||
ODS Advantage PPORX (PPO) - H3813-002-0 Benefit Details |
Lane | $231.90 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% | 103 members Browse Formulary | |||||
Trillium Advantage Deluxe ISNP (HMO) - H2174-007-0 Benefit Details |
Lane | $244.00 | $0 | No Gap Coverage | Preferred Generic: $9.00 Preferred Brand: $30.00 Non-Preferred: $50.00 | < 10 members Browse Formulary | |||||
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