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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 Plan 1 (HMO) - H0151-001-0 Benefit Details |
Jefferson | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $4.00 Tier 2 Generic Preferred Brand: $42.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $79.00 Tier 4 Specialty: 33% | 18,200 members Browse Formulary | |||||
AARP MedicareComplete Plan 2 (HMO) - H0151-023-0 Benefit Details |
Jefferson | $0.00 | $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: $79.00 Tier 4 Specialty: 33% | 5,318 members Browse Formulary | |||||
Blue Advantage Value (PPO) - H0104-002-0 Benefit Details |
Jefferson | $0.00 | $0 | No Gap Coverage | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | 6,513 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HealthSpring HealthyAdvantage (HMO) - H0150-012-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 799 members | ||||||
HealthSpring HealthyAdvantage Plus (HMO) - H0150-001-0 Benefit Details |
Jefferson | $0.00 | $0 | Many Generics, Few Brand | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $70.00 Specialty: 33% | 12,106 members Browse Formulary | |||||
Humana Gold Plus H2012-002 (HMO) - H2012-002-0 Benefit Details |
Jefferson | $0.00 | $0 | Few Generics, Few Brand | Preferred Generic: $6.00 Non-Preferred Generic/Preferred Brand: $38.00 Non-Preferred Brand: $80.00 Specialty: 33% | 286 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-065 (Regional PPO) - R5826-065-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
HumanaChoice R5826-065 (Regional PPO) - R5826-065-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
VIVA Medicare Plus Rx (HMO) - H0154-001-0 Benefit Details |
Jefferson | $0.00 | $265 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $55.00 Tier 4: 26% | 17,855 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
VIVA Medicare Plus Select (HMO) - H0154-008-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Windsor Medicare Extra Emerald Plan (HMO) - H5698-150-0 Benefit Details |
Jefferson | $0.00 | $0 | Few Generics | Tier 1- Preferred Generic: $5.00 Tier 2 - Generic or Brand: $10.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - NonPreferred Brand/NonPreferred Generic: $60.00 Tier 5 - Specialty: 33% | 199 members Browse Formulary | |||||
Windsor Medicare Extra Silver Plan (HMO) - H5698-035-0 Benefit Details |
Jefferson | $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 | |||||||||
SecureHorizons MedicareComplete (HMO) - H0151-015-0 Benefit Details |
Jefferson | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 9,148 members Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) - H5698-151-0 Benefit Details |
Jefferson | $15.00 | $0 | Few Generics | Tier 1- Preferred Generic: $5.00 Tier 2 - Generic or Brand: $10.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - NonPreferred Brand/NonPreferred Generic: $60.00 Tier 5 - Specialty: 33% | 99 members Browse Formulary | |||||
HealthSpring TotalCare (HMO) - H0150-007-0 Benefit Details |
Jefferson | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 12,752 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Blue Advantage Special Needs Plan (PPO) - H0104-006-0 Benefit Details |
Jefferson | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | 5,978 members Browse Formulary | |||||
VIVA Medicare Plus Rx Extra Care (HMO) - H0154-010-0 Benefit Details |
Jefferson | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 6,405 members Browse Formulary | |||||
Windsor Medicare Extra Comprehensive Plan (HMO) - H5698-003-0 Benefit Details |
Jefferson | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | 2,088 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 |
Jefferson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
Blue Advantage Plus (PPO) - H0104-004-0 Benefit Details |
Jefferson | $41.00 | $0 | Few Generics | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | 31,134 members Browse Formulary | |||||
HumanaChoice H1681-002 (PPO) - H1681-002-0 Benefit Details |
Jefferson | $48.00 | $0 | Few Generics, Few Brand | Preferred Generic: $6.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 352 members Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecurityChoice Classic (PFFS) - H0540-088-0 Benefit Details |
Jefferson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
SecurityChoice Plus (PFFS) - H0540-089-0 Benefit Details |
Jefferson | $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 | |||||
HealthSpring HealthyLiving Premier (HMO) - H0150-021-0 Benefit Details |
Jefferson | $58.50 | $0 | Many Generics, Few Brand | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $60.00 Specialty: 33% | 2,489 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Sterling Option I (PFFS) - H5006-014-1 Benefit Details |
Jefferson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
HealthSpring OptimaCare (HMO) - H0150-019-0 Benefit Details |
Jefferson | $65.00 | $0 | No Gap Coverage | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: 33% Specialty: 33% | 858 members Browse Formulary | |||||
VIVA Medicare Plus Rx Premier (HMO) - H0154-011-0 Benefit Details |
Jefferson | $71.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $55.00 Tier 4: 33% | 2,513 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Fusion Plan (HMO) - H5698-123-0 Benefit Details |
Jefferson | $72.00 | $0 | No Gap Coverage | Tier 1- Preferred Generic or Brand: $5.00 Tier 2 - Generic or Brand: $10.00 Tier 3 - Preferred Brand: $25.00 Tier 4 - Non-Preferred Brand/Non-Preferred Generic: $45.00 Tier 5 - Specialty: 33% | < 10 members Browse Formulary | |||||
CIGNA Medicare Access Plan One (PFFS) - H2762-015-0 Benefit Details |
Jefferson | $80.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 150 members | ||||||
HumanaChoice R5826-001 (Regional PPO) - R5826-001-0 Benefit Details |
Jefferson | $80.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 3,238 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-001 (Regional PPO) - R5826-001-0 Benefit Details |
Statewide | $80.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 3,238 members Browse Formulary | |||||
Today's Options Value (PFFS) - H5421-173-0 Benefit Details |
Jefferson | $85.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-034-0 Benefit Details |
Jefferson | $95.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 627 members Browse Formulary | |||||
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 |
Jefferson | $99.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H5421-174-0 Benefit Details |
Jefferson | $99.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO) - H5698-153-0 Benefit Details |
Jefferson | $107.00 | $0 | No Gap Coverage | Tier 1- Preferred Generic or Brand: $5.00 Tier 2 - Generic or Brand: $10.00 Tier 3 - Preferred Brand: $25.00 Tier 4 - Non-Preferred Brand/Non-Preferred Generic: $45.00 Tier 5 - Specialty: 33% | < 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 Option IV (PFFS) - H5006-016-1 Benefit Details |
Jefferson | $119.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) - H5698-152-0 Benefit Details |
Jefferson | $122.00 | $0 | Few Generics | Tier 1- Preferred Generic: $5.00 Tier 2 - Generic or Brand: $10.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - NonPreferred Brand/NonPreferred Generic: $60.00 Tier 5 - Specialty: 33% | < 10 members Browse Formulary | |||||
Today's Options Premier (PFFS) - H5421-171-0 Benefit Details |
Jefferson | $124.00 | 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 | |||||||||
VIVA Medicare Plus Rx Gold (HMO) - H0154-013-0 Benefit Details |
Jefferson | $127.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $55.00 Tier 4: 33% | 2,767 members Browse Formulary | |||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-019-0 Benefit Details |
Jefferson | $135.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 57 members | ||||||
Blue Advantage Preferred (PPO) - H0104-008-0 Benefit Details |
Jefferson | $142.00 | $0 | Few Generics | Tier 1: $4.00 Tier 2: $7.00 Tier 3: $40.00 Tier 4: $60.00 Tier 5: 33% | 15,423 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 powered by CCRx (PFFS) - H5421-172-0 Benefit Details |
Jefferson | $186.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | n/a Browse Formulary | |||||
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