$dynamicTitle=$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) - H0609-018-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
AARP MedicareComplete Plan 3 (HMO) - H0609-012-0 Benefit Details |
Jefferson | $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% | 22,075 members Browse Formulary | |||||
Aetna Medicare Value Plan (HMO) - H6923-001-0 Benefit Details |
Jefferson | $0.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $6.00 Tier 2 - Non-Preferred Generic: $34.00 Tier 3 - Preferred Brand: $36.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 761 members Browse Formulary | |||||
new | new | new | |||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
CO Access Advantage - Plan F (HMO) - H0621-007-0 Benefit Details |
Jefferson | $0.00 | $0 | Many Generics | Tier 1: $1.00 Tier 2: $38.00 Tier 3: $78.00 Tier 4: 33% | 322 members Browse Formulary | |||||
Evercare Plan MH (HMO) - H0624-005-0 Benefit Details |
Jefferson | $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 | |||||
Green Plan (Cost) - H0602-042-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 184 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Kaiser Permanente Senior Advantage Core (HMO) - H0630-013-0 Benefit Details |
Jefferson | $0.00 | $0 | All Generics | Generic Drugs: $10.00 Brand Drugs: $35.00 Specialty Drugs: 25% | 5,500 members Browse Formulary | |||||
SecureHorizons MedicareDirect Plan 2 (PFFS) - H5435-002-0 Benefit Details |
Jefferson | $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 |
Jefferson | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SureValue Basic (HMO) - H5679-001-0 Benefit Details |
Jefferson | $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% | 458 members Browse Formulary | |||||
-- | |||||||||||
Senior Advantage Medicare Medicaid Plan (HMO) - H0630-014-0 Benefit Details |
Jefferson | $ 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% | 2,496 members Browse Formulary | |||||
Thrifty Plan (Cost) - H0602-029-0 Benefit Details |
Jefferson | $14.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 261 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H5291-001 (HMO) - H5291-001-0 Benefit Details |
Jefferson | $20.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 2,860 members Browse Formulary | |||||
-- | |||||||||||
SmartValue Classic (PFFS) - H0540-090-0 Benefit Details |
Jefferson | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 11,362 members | ||||||
Evercare Plan DH (HMO) - H0624-001-0 Benefit Details |
Jefferson | $ 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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H0623-009 (PPO) - H0623-009-0 Benefit Details |
Jefferson | $23.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 159 members | ||||||
AB Basic Plan (Cost) - H0602-026-0 Benefit Details |
Jefferson | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Evercare Plan IP (PPO) - H0620-002-0 Benefit Details |
Jefferson | $28.30 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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 | |||||||||
CO Access Advantage - Plan E (HMO) - H0621-006-0 Benefit Details |
Jefferson | $31.00 | $310 | No Gap Coverage | Tier 1: $0.00 Tier 2: 37% Tier 3: 60% Tier 4: 25% | 543 members Browse Formulary | |||||
Colorado Access Advantage - Plan D (HMO) - H0621-001-0 Benefit Details |
Jefferson | $ 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% | 2,088 members Browse Formulary | |||||
Green Plan + Rx (Cost) - H0602-043-0 Benefit Details |
Jefferson | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Kaiser Permanente Senior Advantage Silver (HMO) - H0630-015-0 Benefit Details |
Jefferson | $39.00 | $0 | All Generics | Generic Drugs: $10.00 Brand Drugs: $35.00 Specialty Drugs: 25% | 27,506 members Browse Formulary | |||||
SmartValue Plus (PFFS) - H0540-091-0 Benefit Details |
Jefferson | $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 | |||||
SureValue Enhanced (HMO) - H5679-002-0 Benefit Details |
Jefferson | $49.00 | $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% | 109 members Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
AARP MedicareComplete Plan 1 (HMO) - H0609-007-0 Benefit Details |
Jefferson | $50.00 | $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% | 14,219 members Browse Formulary | |||||
Thrifty Plan + Rx (Cost) - H0602-036-0 Benefit Details |
Jefferson | $52.70 | $115 | No Gap Coverage | Generic Drugs: $12.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $60.00 Specialty Drugs: 30% | 380 members Browse Formulary | |||||
Aetna Medicare Standard Plan (PPO) - H5521-028-0 Benefit Details |
Jefferson | $55.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $5.00 Tier 2 - Non-Preferred Generic: $25.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - Non-Preferred Brand: $82.00 Tier 5 - Specialty: 25% | 388 members 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 H2944-006 (PFFS) - H2944-006-0 Benefit Details |
Jefferson | $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 | |||||
Aetna Medicare Premier Plan (HMO) - H6923-003-0 Benefit Details |
Jefferson | $60.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $7.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 441 members Browse Formulary | |||||
new | new | new | |||||||||
Standard Plan (Cost) - H0602-009-0 Benefit Details |
Jefferson | $64.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 354 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 (PFFS) - H5421-165-0 Benefit Details |
Jefferson | $65.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,006 members | ||||||
Today's Options Value powered by CCRx (PFFS) - H5421-166-0 Benefit Details |
Jefferson | $76.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 3,797 members Browse Formulary | |||||
Kaiser Permanente Senior Advantage Plus Choice (HMO-POS) - H0630-019-0 Benefit Details |
Jefferson | $79.00 | $0 | All Generics | Generic Drugs: $10.00 Brand Drugs: $35.00 Specialty Drugs: 25% | 191 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) - H2762-015-0 Benefit Details |
Jefferson | $80.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 150 members | ||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-034-0 Benefit Details |
Jefferson | $95.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 627 members Browse Formulary | |||||
AARP MedicareComplete Plan 2 (HMO) - H0609-006-0 Benefit Details |
Jefferson | $97.00 | $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% | 6,081 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) - H5421-163-0 Benefit Details |
Jefferson | $104.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 6,062 members | ||||||
Sterling Basic Plus (PFFS) - H5006-018-3 Benefit Details |
Jefferson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
Aetna Medicare Premier Plan (PPO) - H5521-045-0 Benefit Details |
Jefferson | $110.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $7.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 118 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Standard Plan + Rx (Cost) - H0602-022-0 Benefit Details |
Jefferson | $118.20 | $0 | No Gap Coverage | Generic Drugs: $10.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $60.00 Specialty Drugs: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-019-0 Benefit Details |
Jefferson | $135.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 57 members | ||||||
HumanaChoice H0623-001 (PPO) - H0623-001-0 Benefit Details |
Jefferson | $150.00 | $0 | Few Generics, Few Brand | Preferred Generic: $7.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 739 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 powered by CCRx (PFFS) - H5421-164-0 Benefit Details |
Jefferson | $151.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 2,969 members Browse Formulary | |||||
Colorado Access Advantage - Plan B (HMO) - H0621-004-0 Benefit Details |
Jefferson | $152.00 | $0 | No Gap Coverage | Tier 1: $3.00 Tier 2: $38.00 Tier 3: $78.00 Tier 4: 33% | 32 members Browse Formulary | |||||
Humana Gold Choice H2944-007 (PFFS) - H2944-007-0 Benefit Details |
Jefferson | $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) - H0602-008-0 Benefit Details |
Jefferson | $156.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | < 10 members | ||||||
Kaiser Permanente Senior Advantage Gold (HMO) - H0630-016-0 Benefit Details |
Jefferson | $164.00 | $0 | All Generics | Generic Drugs: $8.00 Brand Drugs: $30.00 Specialty Drugs: 25% | 4,898 members Browse Formulary | |||||
Sterling Option II (PFFS) - H5006-017-3 Benefit Details |
Jefferson | $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 |
Jefferson | $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 |
Jefferson | $196.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
Colorado Access Advantage - Plan C (HMO) - H0621-005-0 Benefit Details |
Jefferson | $227.00 | $0 | No Gap Coverage | Tier 1: $3.00 Tier 2: $38.00 Tier 3: $78.00 Tier 4: 33% | < 10 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 + Rx (Cost) - H0602-021-0 Benefit Details |
Jefferson | $250.30 | $0 | All Generics | Generic: $8.50 Preferred Brand: $38.00 Non-Preferred Drugs: $58.00 Specialty Drugs: 33% | 382 members Browse Formulary | |||||
|