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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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Arkansas Community Care - Plus (HMO) - H5700-027-0 Benefit Details |
Saline | $0.00 | $0 | Some Generics | Tier 1 - Preferred Generic: $7.50 Tier 2 - Non-Preferred Generic: $15.00 Tier 3 - Preferred Brand: $44.00 Tier 4 - Non-Preferred Brand: $79.00 Tier 5 - Specialty: Lesser of $300 or 33%: -200% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx (Regional PPO) - R3444-009-0 Benefit Details |
Saline | $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 |
Saline | $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 |
Saline | $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 |
Saline | $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 | |||||||||
Windsor Medicare Extra Emerald Plan (HMO) - H5698-063-0 Benefit Details |
Saline | $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% | n/a Browse Formulary | |||||
Windsor Medicare Extra Silver Plan (HMO) - H5698-035-0 Benefit Details |
Saline | $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 | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) - R3444-010-0 Benefit Details |
Saline | $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 | |||||
Windsor Medicare Extra Gold Plan (HMO) - H5698-020-0 Benefit Details |
Saline | $25.00 | $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% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Arkansas Community Care - Enhanced (HMO) - H5700-029-0 Benefit Details |
Saline | $28.50 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | < 10 members Browse Formulary | |||||
Care Improvement Plus Silver Rx (Regional PPO) - R3444-008-0 Benefit Details |
Saline | $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 | |||||
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 |
Saline | $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 | |||||
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 | |||||
Windsor Medicare Extra Comprehensive Plan (HMO) - H5698-022-0 Benefit Details |
Saline | $ 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% | n/a 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 |
Saline | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
AR Blue Cross - Medi-Pak Advantage MA (PFFS) - H4213-003-0 Benefit Details |
Saline | $40.60 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 181 members | ||||||
Windsor Medicare Extra Fusion Plan (HMO) - H5698-129-0 Benefit Details |
Saline | $41.00 | $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% | 238 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 One (PFFS) - H2762-013-0 Benefit Details |
Saline | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 337 members | ||||||
HumanaChoice H7188-003 (PPO) - H7188-003-0 Benefit Details |
Saline | $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 |
Saline | $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 | |||||
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) - H5421-056-0 Benefit Details |
Saline | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 869 members | ||||||
Physicians Health Choice Extra (HMO) - H7252-003-0 Benefit Details |
Saline | $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 | |||||||||
Sterling Option I (PFFS) - H5006-014-1 Benefit Details |
Saline | $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 | |||||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-030-0 Benefit Details |
Saline | $60.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H5421-074-0 Benefit Details |
Saline | $68.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | n/a Browse Formulary | |||||
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) - H4213-006-0 Benefit Details |
Saline | $75.80 | $170 | No Gap Coverage | Generic: $7.00 Preferred Brand: $36.00 Non-Preferred Brand: $76.00 Specialty: 25% | 348 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 |
Saline | $89.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Sterling Option II (PFFS) - H5006-017-1 Benefit Details |
Saline | $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) - H2762-017-0 Benefit Details |
Saline | $100.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 165 members | ||||||
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 |
Saline | $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 |
Saline | $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) - H2762-038-0 Benefit Details |
Saline | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 442 members Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO) - H5698-154-0 Benefit Details |
Saline | $135.00 | $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% | 67 members Browse Formulary | |||||
Today's Options Premier powered by CCRx (PFFS) - H5421-068-0 Benefit Details |
Saline | $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 | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) - H5698-069-0 Benefit Details |
Saline | $145.00 | $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% | 479 members Browse Formulary | |||||
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