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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) - H2762-020-0 Benefit Details |
Calaveras | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 13,290 members | ||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-042-0 Benefit Details |
Calaveras | $0.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 40,257 members Browse Formulary | |||||
Freedom Blue Classic (Regional PPO) - R9943-004-0 Benefit Details |
Calaveras | $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 | |||||||||
Freedom Blue Classic (Regional PPO) - R9943-004-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Freedom Blue Plan I (Regional PPO) - R9943-001-0 Benefit Details |
Calaveras | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 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 | |||||
Freedom Blue Plan I (Regional PPO) - R9943-001-0 Benefit Details |
Statewide | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Plan 3 (PFFS) - H5435-003-0 Benefit Details |
Calaveras | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 24,942 members | ||||||
Today's Options Value (PFFS) - H5421-055-0 Benefit Details |
Calaveras | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 5,383 members | ||||||
Freedom Blue Plus (Regional PPO) - R9943-003-0 Benefit Details |
Calaveras | $31.00 | $0 | Many Generics | Preferred Generic Drugs: $7.00 Preferred Brand Certain Generic Drugs: $43.00 Non-Preferred Brand Certain Generic Drugs: $85.00 Non-Specialty Injectable Drugs: 33% Specialty Drugs: 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 | |||||||||
Freedom Blue Plus (Regional PPO) - R9943-003-0 Benefit Details |
Statewide | $31.00 | $0 | Many Generics | Preferred Generic Drugs: $7.00 Preferred Brand Certain Generic Drugs: $43.00 Non-Preferred Brand Certain Generic Drugs: $85.00 Non-Specialty Injectable Drugs: 33% Specialty Drugs: 33% | n/a Browse Formulary | |||||
SmartValue Classic (PFFS) - H5419-001-0 Benefit Details |
Calaveras | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-024-0 Benefit Details |
Calaveras | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,787 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) - H5421-073-0 Benefit Details |
Calaveras | $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 | |||||
Today's Options Premier (PFFS) - H5421-049-0 Benefit Details |
Calaveras | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 8,597 members | ||||||
SmartValue Plus (PFFS) - H5419-004-0 Benefit Details |
Calaveras | $78.00 | $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% | 2,559 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) - H2762-050-0 Benefit Details |
Calaveras | $85.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 9,959 members Browse Formulary | |||||
Sterling Basic Plus (PFFS) - H5006-018-3 Benefit Details |
Calaveras | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
Today's Options Premier powered by CCRx (PFFS) - H5421-067-0 Benefit Details |
Calaveras | $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 | |||||||||
Sterling Option II (PFFS) - H5006-017-3 Benefit Details |
Calaveras | $170.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
Sterling Option I (PFFS) - H5006-014-3 Benefit Details |
Calaveras | $183.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
Sterling Option IV (PFFS) - H5006-016-3 Benefit Details |
Calaveras | $196.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
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