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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 Choice (Regional PPO) - R7444-001-0 Benefit Details |
Hartford | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $41.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $79.00 Tier 4 Specialty: 33% | 20,637 members Browse Formulary | |||||
new | new | new | |||||||||
AARP MedicareComplete Choice (Regional PPO) - R7444-001-0 Benefit Details |
Statewide | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $41.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $79.00 Tier 4 Specialty: 33% | 20,637 members Browse Formulary | |||||
new | new | new | |||||||||
ConnectiCare VIP Prime 1 (HMO) - H3528-001-0 Benefit Details |
Hartford | $0.00 | $150 | No Gap Coverage | Tier 1: $10.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 25% | 4,798 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 | |||||||||
ConnectiCare VIP Prime 4 (HMO) - H3528-003-0 Benefit Details |
Hartford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 703 members | ||||||
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Fresenius Medical Care Health Plan (PFFS) - H5909-001-0 Benefit Details |
Hartford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 78 members | ||||||
MediBlue Essential (HMO) - H5854-004-0 Benefit Details |
Hartford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 165 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
MediBlue Value (HMO) - H5854-005-0 Benefit Details |
Hartford | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $42.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $80.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 749 members Browse Formulary | |||||
Health Net Green (HMO) - H0755-023-0 Benefit Details |
Hartford | $5.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Health Net Ruby Option 2 (HMO) - H0755-022-0 Benefit Details |
Hartford | $12.00 | $0 | No Gap Coverage | Tier 1 Preferred Genericá: $8.00 Tier 2 Preferred Brand: $38.00 Tier 3 Non-Preferred: $76.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 9,553 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Aetna Medicare Value Plan (HMO) - H5793-001-0 Benefit Details |
Hartford | $24.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $33.00 Tier 3 - Preferred Brand: $34.00 Tier 4 - Non-Preferred Brand: $74.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
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Evercare Plan DP (PPO) - H0710-002-0 Benefit Details |
Hartford | $ 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% | 2,731 members Browse Formulary | |||||
Evercare Plan IP (PPO) - H0710-001-0 Benefit Details |
Hartford | $34.60 | $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 | |||||||||
Aetna Medicare Standard Plan (HMO) - H5793-008-0 Benefit Details |
Hartford | $58.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $6.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $33.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
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ConnectiCare VIP Prime 2 (HMO) - H3528-005-0 Benefit Details |
Hartford | $68.00 | $0 | No Gap Coverage | Tier 1: $10.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | n/a Browse Formulary | |||||
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Health Net Ruby Option 3 (HMO) - H0755-028-0 Benefit Details |
Hartford | $71.00 | $0 | No Gap Coverage | Tier 1 Preferred Genericá: $8.00 Tier 2 Preferred Brand: $38.00 Tier 3 Non-Preferred: $76.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 6,571 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
MediBlue Plus (HMO) - H5854-002-0 Benefit Details |
Hartford | $72.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $42.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $80.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 647 members Browse Formulary | |||||
Today's Options Value (PFFS) - H3333-138-0 Benefit Details |
Hartford | $75.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 191 members | ||||||
Aetna Medicare Standard Plan (PPO) - H5521-013-0 Benefit Details |
Hartford | $82.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $7.00 Tier 2 - Non-Preferred Generic: $25.00 Tier 3 - Preferred Brand: $30.00 Tier 4 - Non-Preferred Brand: $72.00 Tier 5 - Specialty: 25% | 266 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 Navy 2 (HMO-POS) - H0755-029-0 Benefit Details |
Hartford | $89.00 | $0 | No Gap Coverage | Tier 1 Preferred Genericá: $8.00 Tier 2 Preferred Brand: $38.00 Tier 3 Non-Preferred: $76.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | n/a Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H3333-139-0 Benefit Details |
Hartford | $89.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 212 members Browse Formulary | |||||
Aetna Medicare Premier Plan (HMO) - H5793-003-0 Benefit Details |
Hartford | $98.00 | $0 | Many Generics | Tier 1 - Preferred Generic: $5.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 33% | n/a 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 | |||||||||
ConnectiCare VIP Option 2 (HMO-POS) - H3528-007-0 Benefit Details |
Hartford | $119.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 63 members | ||||||
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Today's Options Premier (PFFS) - H3333-136-0 Benefit Details |
Hartford | $119.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 341 members | ||||||
Health Net Ruby Option 1 (HMO) - H0755-001-0 Benefit Details |
Hartford | $122.00 | $0 | Many Generics | Tier 1 Preferred Genericá: $8.00 Tier 2 Preferred Brand: $38.00 Tier 3 Non-Preferred: $76.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 28,917 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
MediBlue Select (HMO) - H5854-003-0 Benefit Details |
Hartford | $122.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $42.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $80.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 771 members Browse Formulary | |||||
ConnectiCare VIP Prime 3 (HMO) - H3528-002-0 Benefit Details |
Hartford | $129.00 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | 5,841 members Browse Formulary | |||||
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Aetna Medicare Premier Plan (PPO) - H5521-014-0 Benefit Details |
Hartford | $143.00 | $0 | Many Generics | Tier 1 - Preferred Generic: $5.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 33% | 296 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) - H3333-137-0 Benefit Details |
Hartford | $160.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 221 members Browse Formulary | |||||
Health Net Navy 1 (HMO-POS) - H0755-020-0 Benefit Details |
Hartford | $162.00 | $0 | Many Generics | Tier 1 Preferred Genericá: $8.00 Tier 2 Preferred Brand: $38.00 Tier 3 Non-Preferred: $76.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | n/a Browse Formulary | |||||
ConnectiCare VIP Option 1 (HMO-POS) - H3528-006-0 Benefit Details |
Hartford | $168.00 | $0 | Many Generics | Tier 1: $10.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33% | 968 members Browse Formulary | |||||
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