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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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Freedom Blue Classic (Regional PPO) - R9943-004-0 Benefit Details |
Contra Costa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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 |
Contra Costa | $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 | |||||||||
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 | |||||
Fresenius Medical Care Health Plan (PFFS) - H5301-003-0 Benefit Details |
Contra Costa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 143 members | ||||||
SelectCare (HMO) - H5895-001-0 Benefit Details |
Contra Costa | $ 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% | 138 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 | |||||||||
Senior Advantage Medicare Medi-Cal Plan North (HMO) - H0524-030-0 Benefit Details |
Contra Costa | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Generic: $13.00 Brand: $45.00 Specialty: 25% | 28,501 members Browse Formulary | |||||
SCAN Health Plan (HMO) - H5425-022-0 Benefit Details |
Contra Costa | $29.00 | $0 | No Gap Coverage | Select Generic: $0.00 Generic: $10.00 Brand: $40.00 Additional Brand: $70.00 Specialty: 33% | n/a Browse Formulary | |||||
Health Net Seniority Plus Amber II (HMO) - H0562-070-0 Benefit Details |
Contra Costa | $ 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% | 12,528 members 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 |
Contra Costa | $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 | |||||
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 |
Contra Costa | $35.00 | 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 | |||||||||
SCAN Health Plan (HMO) - H5425-018-0 Benefit Details |
Contra Costa | $39.00 | $0 | All Generics | Select Generic: $0.00 Generic: $10.00 Brand: $30.00 Additional Brand: $50.00 Specialty: 33% | 514 members Browse Formulary | |||||
Today's Options Value (PFFS) - H5421-157-0 Benefit Details |
Contra Costa | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 344 members | ||||||
Today's Options Value powered by CCRx (PFFS) - H5421-158-0 Benefit Details |
Contra Costa | $63.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 559 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 MH (HMO) - H0543-136-0 Benefit Details |
Contra Costa | $70.00 | $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% | 238 members Browse Formulary | |||||
AARP MedicareComplete (HMO) - H0543-070-0 Benefit Details |
Contra Costa | $75.00 | $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: $79.00 Tier 4 Specialty: 33% | 6,513 members Browse Formulary | |||||
SmartValue Plus (PFFS) - H5419-004-0 Benefit Details |
Contra Costa | $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 | |||||||||
Health Net Healthy Heart (HMO) - H0562-011-0 Benefit Details |
Contra Costa | $79.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic: $7.00 Tier 2 Preferred Brand: $42.00 Tier 3 Non-Preferred: $84.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 5,439 members Browse Formulary | |||||
Health Net Seniority Plus Green (HMO) - H0562-045-0 Benefit Details |
Contra Costa | $79.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 584 members | ||||||
Humana Gold Choice H2944-032 (PFFS) - H2944-032-0 Benefit Details |
Contra Costa | $83.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 3,921 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) - H5421-155-0 Benefit Details |
Contra Costa | $84.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 703 members | ||||||
CIGNA Medicare Access Plan One (PFFS) - H2762-023-0 Benefit Details |
Contra Costa | $85.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 183 members | ||||||
Kaiser Permanente Senior Advantage Contra Costa (HMO) - H0524-033-0 Benefit Details |
Contra Costa | $86.00 | $0 | All Generics | Generic: $10.00 Brand: $45.00 Specialty: 25% | 21,964 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 Two (PFFS) - H2762-048-0 Benefit Details |
Contra Costa | $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 | |||||
Sterling Basic Plus (PFFS) - H5006-018-3 Benefit Details |
Contra Costa | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-027-0 Benefit Details |
Contra Costa | $140.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 78 members | ||||||
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) - H5421-156-0 Benefit Details |
Contra Costa | $146.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 225 members Browse Formulary | |||||
Humana Gold Choice H2944-072 (PFFS) - H2944-072-0 Benefit Details |
Contra Costa | $164.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 705 members Browse Formulary | |||||
Sterling Option II (PFFS) - H5006-017-3 Benefit Details |
Contra Costa | $170.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 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) - H5006-014-3 Benefit Details |
Contra Costa | $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 |
Contra Costa | $196.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
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