$dynamicTitle=$dynamicTitle.' Medicare Advantage Plans'; ?>
2010 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
AARP MedicareComplete Essential (HMO) - H0543-121-0 Benefit Details |
San Bernardino | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,534 members | ||||||
AARP MedicareComplete Plan 1 (HMO) - H0543-007-0 Benefit Details |
San Bernardino | $0.00 | $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% | 21,897 members Browse Formulary | |||||
AARP MedicareComplete Plan 3 (HMO) - H0543-127-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $45.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $85.00 Tier 4 Specialty: 33% | 17,895 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Advantage I MAPD (HMO) - H7731-001-0 Benefit Details |
San Bernardino | $0.00 | $0 | All Generics, All Brand | Tier 1: $0.00 Tier 2: $15.00 Tier 3: $50.00 Tier 4: 25% | 10,747 members Browse Formulary | |||||
-- | |||||||||||
Advantage Select MA (HMO) - H7731-007-0 Benefit Details |
San Bernardino | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 127 members | ||||||
-- | |||||||||||
Aetna Medicare Select Plan (HMO) - H0523-022-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Tier 1 - Preferred Generic: $5.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $40.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 33% | 18,980 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Blue Cross Senior Secure Plan I (HMO) - H0564-047-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic: $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% | 9,326 members Browse Formulary | |||||
Blue Shield 65 Plus (HMO) - H0504-017-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Formulary Generic: $5.00 Formulary Brand: $35.00 Non-Preferred Brand: $68.00 Injectables: 33% Formulary Specialty (Unique High Cost Drugs): 33% | 2,038 members Browse Formulary | |||||
Care1st Medicare Advantage Plan (HMO) - H5928-008-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Generic: $5.00 Brand: $30.00 Other Non-Preferred: $50.00 Specialty: 25% | 384 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
CareMore Breathe (HMO) - H0544-019-0 Benefit Details |
San Bernardino | $0.00 | $0 | No Gap Coverage | Preferred Generic Drugs: $0.00 Generic Drugs: $5.00 Enhanced Care Brand Drugs: $0.00 Preferred Brand Drugs: $29.00 Brand Drugs: $60.00 Specialty Drugs: 33% | 202 members Browse Formulary | |||||
CareMore Connect (HMO) - H0544-009-0 Benefit Details |
San Bernardino | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Preferred Generic Drugs: $0.00 Generic Drugs: $0.00 Enhanced Care Brand Drugs: 25% Preferred Brand Drugs: 25% Brand Drugs: 25% Specialty Drugs: 25% | 16 members Browse Formulary | |||||
CareMore Diabetes (HMO) - H0544-010-0 Benefit Details |
San Bernardino | $0.00 | $0 | No Gap Coverage | Preferred Generic Drugs: $0.00 Generic Drugs: $5.00 Enhanced Care Brand Drugs: $0.00 Preferred Brand Drugs: $29.00 Brand Drugs: $60.00 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 | |||||||||
CareMore ESRD (HMO) - H0544-020-0 Benefit Details |
San Bernardino | $0.00 | $0 | No Gap Coverage | Preferred Generic Drugs: $0.00 Generic Drugs: $5.00 Enhanced Care Brand Drugs: $0.00 Preferred Brand Drugs: $29.00 Brand Drugs: $60.00 Specialty Drugs: 33% | 50 members Browse Formulary | |||||
CareMore Value Plus (HMO) - H0544-008-0 Benefit Details |
San Bernardino | $0.00 | $0 | All Generics | Preferred Generic Drugs: $0.00 Generic Drugs: $5.00 Enhanced Care Brand Drugs: $0.00 Preferred Brand Drugs: $29.00 Brand Drugs: $60.00 Specialty Drugs: 33% | 609 members Browse Formulary | |||||
Central Health Medicare Plan (HMO) - H5649-001-0 Benefit Details |
San Bernardino | $0.00 | $0 | All Generics, All Brand | Generic: $0.00 Preferred Brand: $20.00 Brand: $40.00 Specialty Drugs: 33% | 4,598 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Central Health Medicare Value Plan (HMO) - H5649-003-0 Benefit Details |
San Bernardino | $0.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | < 10 members Browse Formulary | |||||
Citizens Choice Healthplan (HMO) - H3815-005-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Formulary Generic Tier 1: $0.00 Formulary Preferred Brand Tier 2: $20.00 Formulary Non-Preferred Brand Tier 3: $40.00 Injectable Drugs Tier 4: 33% Specialty Drugs Tier 5: 33% | 298 members Browse Formulary | |||||
Evercare Plan MH (HMO) - H0543-135-0 Benefit Details |
San Bernardino | $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: $85.00 Tier 4 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 | |||||||||
Freedom Blue Classic (Regional PPO) - R9943-004-0 Benefit Details |
San Bernardino | $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 |
San Bernardino | $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 | |||||
Health Net Healthy Heart Plan 1 (HMO) - H0562-082-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic: $5.00 Tier 2 Preferred Brand: $42.00 Tier 3 Non-Preferred: $84.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 25,075 members Browse Formulary | |||||
Health Net Seniority Plus Amber CHF (HMO) - H0562-081-0 Benefit Details |
San Bernardino | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic: $5.00 Tier 2 Preferred Brand: $42.00 Tier 3 Non-Preferred: $84.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 164 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 Seniority Plus Green (HMO) - H0562-044-0 Benefit Details |
San Bernardino | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 298 members | ||||||
Health Net Seniority Plus Ruby Plan 1 (HMO) - H0562-083-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic: $5.00 Tier 2 Preferred Brand: $42.00 Tier 3 Non-Preferred: $84.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 7,948 members Browse Formulary | |||||
Humana Gold Plus H0108-005 (HMO) - H0108-005-0 Benefit Details |
San Bernardino | $0.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 220 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Inter Valley Health Plan Focus SNP (HMO) - H0545-009-0 Benefit Details |
San Bernardino | $0.00 | $0 | No Gap Coverage | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Other Special Needs: $18.00 Preferred Brand: $29.00 Non-Preferred Brand: $55.00 Injectables: 10% | 634 members Browse Formulary | |||||
Inter Valley Health Plan Service To Seniors (HMO) - H0545-001-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $12.00 Preferred Brand: $29.00 Non-Preferred Brand: $60.00 Injectables: 10% Specialty Drugs: 25% | 10,926 members Browse Formulary | |||||
Inter Valley Health Plan Total Fit (HMO) - H0545-011-0 Benefit Details |
San Bernardino | $0.00 | $0 | No Gap Coverage | Preferred Generic: $10.00 Non-Preferred Generic: $14.00 Preferred Brand: $39.50 Non-Preferred Brand: $49.00 Injectables: 10% 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 | |||||||||
Kaiser Permanente Senior Advantage Inland Empire (HMO) - H0524-015-0 Benefit Details |
San Bernardino | $0.00 | $0 | All Generics | Generic: $10.00 Brand: $45.00 Specialty: 25% | 30,530 members Browse Formulary | |||||
Molina Medicare Options (HMO) - H5810-002-0 Benefit Details |
San Bernardino | $0.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $20.00 Non-Preferred Brand: $50.00 Specialty Drug: 33% | 234 members Browse Formulary | |||||
-- | |||||||||||
Salud Con Health Net Medicare Advantage (HMO) - H0562-085-0 Benefit Details |
San Bernardino | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic: $5.00 Tier 2 Preferred Brand: $42.00 Tier 3 Non-Preferred: $84.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 381 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SCAN Health Plan (HMO) - H9104-009-0 Benefit Details |
San Bernardino | $0.00 | $0 | No Gap Coverage | Select Generic: $0.00 Generic: $10.00 Brand: $35.00 Additional Brand: $60.00 Specialty: 25% | 5,140 members Browse Formulary | |||||
SCAN Health Plan (HMO) - H5425-009-0 Benefit Details |
San Bernardino | $0.00 | $0 | All Generics | Select Generic: $0.00 Generic: $10.00 Brand: $35.00 Additional Brand: $60.00 Specialty: 25% | n/a Browse Formulary | |||||
SCAN Health Plan (HMO) - H5425-016-0 Benefit Details |
San Bernardino | $0.00 | $0 | All Generics | Select Generic: $0.00 Generic: $10.00 Brand: $40.00 Additional Brand: $70.00 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 | |||||||||
StartSmart with CareMore (HMO) - H0544-016-0 Benefit Details |
San Bernardino | $0.00 | $0 | No Gap Coverage | Preferred Generic Drugs: $5.00 Generic Drugs: $10.00 Enhanced Care Brand Drugs: $15.00 Preferred Brand Drugs: $40.00 Brand Drugs: $75.00 Specialty Drugs: 33% | < 10 members Browse Formulary | |||||
SCAN Health Plan (HMO) - H9104-015-0 Benefit Details |
San Bernardino | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Select Generic: $0.00 Generic: $0.00 Brand: $35.00 Additional Brand: $93.00 Specialty: 25% | 125 members Browse Formulary | |||||
Care1st Dual Plus Plan (HMO) - H5928-007-0 Benefit Details |
San Bernardino | $ 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% | 194 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Molina Medicare Options Plus (HMO) - H5810-001-0 Benefit Details |
San Bernardino | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty: 25% | 2,130 members Browse Formulary | |||||
-- | |||||||||||
Evercare Plan DH (HMO) - H0543-081-0 Benefit Details |
San Bernardino | $ 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% | 2,018 members Browse Formulary | |||||
Senior Advantage Medicare Medi-Cal Plan South (HMO) - H0524-029-0 Benefit Details |
San Bernardino | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Generic: $12.00 Brand: $43.00 Specialty: 25% | 29,811 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Central Health Medi-Medi Plan (HMO) - H5649-002-0 Benefit Details |
San Bernardino | $ 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% | n/a Browse Formulary | |||||
Brand New Day (HMO) - H0838-020-0 Benefit Details |
San Bernardino | $29.00 | $310 | No Gap Coverage | Tier 1: 25% | n/a Browse Formulary | |||||
-- | |||||||||||
VillageHealth (HMO-POS) - H5943-001-0 Benefit Details |
San Bernardino | $29.00 | $0 | No Gap Coverage | Select Generic: $0.00 Generic: $6.00 Brand: $30.00 Additional Brand: $55.00 Specialty: 25% | 432 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 Seniority Plus Amber I (HMO) - H0562-055-0 Benefit Details |
San Bernardino | $ 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 | |||||
Health Net Seniority Plus Amber II (HMO) - H0562-070-0 Benefit Details |
San Bernardino | $ 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 | |||||
Freedom Blue Plus (Regional PPO) - R9943-003-0 Benefit Details |
San Bernardino | $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 |
San Bernardino | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Health Net Healthy Heart Plan 2 (HMO) - H0562-071-0 Benefit Details |
San Bernardino | $39.00 | $0 | Many Generics | Tier 1 Preferred Generic: $5.00 Tier 2 Preferred Brand: $42.00 Tier 3 Non-Preferred: $84.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 415 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 Seniority Plus Ruby Plan 2 (HMO) - H0562-002-0 Benefit Details |
San Bernardino | $39.00 | $0 | Many Generics | Tier 1 Preferred Generic: $5.00 Tier 2 Preferred Brand: $42.00 Tier 3 Non-Preferred: $84.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 481 members Browse Formulary | |||||
My Choice (HMO-POS) - H5425-027-0 Benefit Details |
San Bernardino | $40.00 | $0 | All Generics | Select Generic: $0.00 Generic: $5.00 Brand: $32.00 Additional Brand: $60.00 Specialty: 33% | < 10 members Browse Formulary | |||||
Humana Gold Plus H0108-006 (HMO-POS) - H0108-006-0 Benefit Details |
San Bernardino | $49.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 44 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) - H5421-165-0 Benefit Details |
San Bernardino | $65.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,006 members | ||||||
Humana Gold Choice H2944-033 (PFFS) - H2944-033-0 Benefit Details |
San Bernardino | $73.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 2,762 members Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H5421-166-0 Benefit Details |
San Bernardino | $76.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 3,797 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) - H5419-004-0 Benefit Details |
San Bernardino | $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 | |||||
CIGNA Medicare Access Plan One (PFFS) - H2762-023-0 Benefit Details |
San Bernardino | $85.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 183 members | ||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-048-0 Benefit Details |
San Bernardino | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-034 (PFFS) - H2944-034-0 Benefit Details |
San Bernardino | $101.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 955 members Browse Formulary | |||||
Today's Options Premier (PFFS) - H5421-163-0 Benefit Details |
San Bernardino | $104.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 6,062 members | ||||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-027-0 Benefit Details |
San Bernardino | $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) - H5421-164-0 Benefit Details |
San Bernardino | $151.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 2,969 members Browse Formulary | |||||
|