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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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AARP MedicareComplete Essential (HMO) - H0609-015-0 Benefit Details |
Fremont | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 739 members | ||||||
AARP MedicareComplete Plan 3 (HMO) - H0609-020-0 Benefit Details |
Fremont | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $39.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $74.00 Tier 4 Specialty: 33% | 7,810 members Browse Formulary | |||||
Evercare Plan MH (HMO) - H0624-005-0 Benefit Details |
Fremont | $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% | 2,407 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Green Plan (Cost) - H0602-042-0 Benefit Details |
Fremont | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 184 members | ||||||
HumanaChoice H0623-006 (PPO) - H0623-006-0 Benefit Details |
Fremont | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 420 members | ||||||
Kaiser Permanente Senior Advantage Core (HMO) - H0630-017-0 Benefit Details |
Fremont | $0.00 | $0 | All Generics | Generic Drugs: $9.00 Brand Drugs: $35.00 Specialty Drugs: 25% | 861 members 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 2 (PFFS) - H5435-002-0 Benefit Details |
Fremont | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 16,559 members | ||||||
SecureHorizons MedicareDirect Rx Plan 55 (PFFS) - H5435-024-0 Benefit Details |
Fremont | $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: $80.00 Tier 4 Specialty: 33% | 54,374 members Browse Formulary | |||||
SmartValue Classic (PFFS) - H0540-090-0 Benefit Details |
Fremont | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 11,362 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Evercare Plan DH (HMO) - H0624-001-0 Benefit Details |
Fremont | $ 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% | 2,186 members Browse Formulary | |||||
AB Basic Plan (Cost) - H0602-026-0 Benefit Details |
Fremont | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Evercare Plan IH-POS (HMO-POS) - H0624-004-0 Benefit Details |
Fremont | $28.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 19 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Thrifty Plan (Cost) - H0602-028-0 Benefit Details |
Fremont | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 87 members | ||||||
Green Plan + Rx (Cost) - H0602-043-0 Benefit Details |
Fremont | $31.60 | $120 | No Gap Coverage | Generic Drugs: $12.00 Preferred Brand Drugs: $36.00 Non-Preferred Drugs: $56.00 Specialty Drugs: 30% | 435 members Browse Formulary | |||||
Kaiser Permanente Senior Advantage Silver (HMO) - H0630-018-0 Benefit Details |
Fremont | $39.00 | $0 | All Generics | Generic Drugs: $8.00 Brand Drugs: $35.00 Specialty Drugs: 25% | 391 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) - H0540-091-0 Benefit Details |
Fremont | $40.00 | $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% | 12,629 members Browse Formulary | |||||
Standard Plan (Cost) - H0602-007-0 Benefit Details |
Fremont | $46.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 443 members | ||||||
HumanaChoice H0623-005 (PPO) - H0623-005-0 Benefit Details |
Fremont | $50.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 3,805 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) - H5421-157-0 Benefit Details |
Fremont | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 344 members | ||||||
CIGNA Medicare Access Plan One (PFFS) - H2762-014-0 Benefit Details |
Fremont | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 215 members | ||||||
Humana Gold Choice H2944-006 (PFFS) - H2944-006-0 Benefit Details |
Fremont | $56.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 7,929 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 powered by CCRx (PFFS) - H5421-158-0 Benefit Details |
Fremont | $63.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 559 members Browse Formulary | |||||
Thrifty Plan + Rx (Cost) - H0602-038-0 Benefit Details |
Fremont | $67.70 | $115 | No Gap Coverage | Generic Drugs: $12.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $60.00 Specialty Drugs: 30% | 102 members Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-032-0 Benefit Details |
Fremont | $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 | |||||||||
Today's Options Premier (PFFS) - H5421-155-0 Benefit Details |
Fremont | $84.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 703 members | ||||||
Standard Plan + Rx (Cost) - H0602-020-0 Benefit Details |
Fremont | $92.90 | $0 | No Gap Coverage | Generic Drugs: $10.00 Preferred Brand Drugs: $40.00 Non-Preferred Drugs: $60.00 Specialty Drugs: 33% | 2,155 members Browse Formulary | |||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-018-0 Benefit Details |
Fremont | $110.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 151 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 Four (PFFS) - H2762-040-0 Benefit Details |
Fremont | $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 | |||||
Today's Options Premier powered by CCRx (PFFS) - H5421-156-0 Benefit Details |
Fremont | $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 H2944-007 (PFFS) - H2944-007-0 Benefit Details |
Fremont | $152.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 963 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Gold Plan (Cost) - H0602-002-0 Benefit Details |
Fremont | $156.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | < 10 members | ||||||
Gold Plan + Rx (Cost) - H0602-018-0 Benefit Details |
Fremont | $242.80 | $0 | All Generics | Generic Drugs: $8.50 Preferred Brand: $38.00 Non-Preferred Brand: $58.00 Specialty Drugs: 33% | 257 members Browse Formulary | |||||
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