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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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AR Blue Cross - Medi-Pak Advantage MA (PFFS) - H4213-002-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 784 members | ||||||
Care Improvement Plus Gold Rx (Regional PPO) - R3444-009-0 Benefit Details |
Jefferson | $0.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 4,700 members Browse Formulary | |||||
Care Improvement Plus Gold Rx (Regional PPO) - R3444-009-0 Benefit Details |
Statewide | $0.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 4,700 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-067 (Regional PPO) - R5826-067-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
HumanaChoice R5826-067 (Regional PPO) - R5826-067-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Physicians Health Choice Basic (HMO) - H7252-001-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 44 members | ||||||
new | new | new | |||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Physicians Health Choice Standard (HMO) - H7252-002-0 Benefit Details |
Jefferson | $0.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $30.00 Tier 3: $70.00 Tier 4: 20% | 795 members Browse Formulary | |||||
new | new | new | |||||||||
SecureHorizons MedicareDirect Plan 1 (PFFS) - H5435-001-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 27,113 members | ||||||
SecurityChoice Classic (PFFS) - H0540-001-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 22,271 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) - R3444-010-0 Benefit Details |
Jefferson | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) - R3444-010-0 Benefit Details |
Statewide | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (PPO) - H6528-001-0 Benefit Details |
Jefferson | $17.00 | $0 | No Gap Coverage | Formulary Generic: $9.00 Formulary Preferred Brand: $36.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 296 members Browse Formulary | |||||
new | new | new | |||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx Plan 51 (PFFS) - H5435-014-0 Benefit Details |
Jefferson | $20.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $42.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $80.00 Tier 4 Specialty: 33% | 61,945 members Browse Formulary | |||||
SecurityChoice Plus (PFFS) - H0540-020-0 Benefit Details |
Jefferson | $23.00 | $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% | 15,526 members Browse Formulary | |||||
Today's Options Value (PFFS) - H5421-055-0 Benefit Details |
Jefferson | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 5,383 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Silver Rx (Regional PPO) - R3444-008-0 Benefit Details |
Jefferson | $33.20 | $0 | No Gap Coverage | Formulary Generic: $0.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 4,445 members Browse Formulary | |||||
Care Improvement Plus Silver Rx (Regional PPO) - R3444-008-0 Benefit Details |
Statewide | $33.20 | $0 | No Gap Coverage | Formulary Generic: $0.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 4,445 members Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (Regional PPO) - R3444-012-0 Benefit Details |
Jefferson | $37.00 | $0 | No Gap Coverage | Formulary Generic: $9.00 Formulary Preferred Brand: $36.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 774 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Medicare Advantage (Regional PPO) - R3444-012-0 Benefit Details |
Statewide | $37.00 | $0 | No Gap Coverage | Formulary Generic: $9.00 Formulary Preferred Brand: $36.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 774 members Browse Formulary | |||||
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 | ||||||
AR Blue Cross - Medi-Pak Advantage MA-PD Option 1 (PFFS) - H4213-005-0 Benefit Details |
Jefferson | $44.90 | $150 | No Gap Coverage | Generic: $7.00 Preferred Brand: $36.00 Non-Preferred Brand: $76.00 Specialty: 25% | 721 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H7188-003 (PPO) - H7188-003-0 Benefit Details |
Jefferson | $47.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 5,004 members Browse Formulary | |||||
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Humana Gold Choice H2944-010 (PFFS) - H2944-010-0 Benefit Details |
Jefferson | $50.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 9,336 members Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H5421-073-0 Benefit Details |
Jefferson | $51.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 10,805 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Physicians Health Choice Extra (HMO) - H7252-003-0 Benefit Details |
Jefferson | $53.00 | $0 | Many Generics | Tier 1: $0.00 Tier 2: $30.00 Tier 3: $70.00 Tier 4: 20% | 340 members Browse Formulary | |||||
new | new | new | |||||||||
CIGNA Medicare Access Plan One (PFFS) - H2762-014-0 Benefit Details |
Jefferson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 215 members | ||||||
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 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
AR Blue Cross - Medi-Pak Advantage MA-PD Option 2 (PFFS) - H4213-008-0 Benefit Details |
Jefferson | $67.10 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $36.00 Non-Preferred Brand: $76.00 Specialty: 25% | 244 members Browse Formulary | |||||
Today's Options Premier (PFFS) - H5421-049-0 Benefit Details |
Jefferson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 8,597 members | ||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-032-0 Benefit Details |
Jefferson | $70.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 942 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 | |||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-018-0 Benefit Details |
Jefferson | $110.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 151 members | ||||||
Today's Options Premier powered by CCRx (PFFS) - H5421-067-0 Benefit Details |
Jefferson | $112.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 4,339 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-010 (Regional PPO) - R5826-010-0 Benefit Details |
Jefferson | $113.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 797 members Browse Formulary | |||||
HumanaChoice R5826-010 (Regional PPO) - R5826-010-0 Benefit Details |
Statewide | $113.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 797 members Browse Formulary | |||||
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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) - H2762-040-0 Benefit Details |
Jefferson | $145.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 254 members Browse Formulary | |||||
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