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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 |
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 | |||||||||
AARP MedicareComplete Choice (Regional PPO) - R7444-001-0 Benefit Details |
Windham | $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 |
Windham | $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 |
Windham | $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 |
Windham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 78 members | ||||||
Health Net Green (HMO) - H0755-023-0 Benefit Details |
Windham | $5.00 | 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 | |||||||||
Health Net Ruby Option 2 (HMO) - H0755-022-0 Benefit Details |
Windham | $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 | |||||
SmartValue Classic (PFFS) - H1689-012-0 Benefit Details |
Windham | $15.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,461 members | ||||||
Evercare Plan DP (PPO) - H0710-002-0 Benefit Details |
Windham | $ 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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) - H1689-013-0 Benefit Details |
Windham | $34.50 | $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% | 8,845 members Browse Formulary | |||||
Evercare Plan IP (PPO) - H0710-001-0 Benefit Details |
Windham | $34.60 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
ConnectiCare VIP Prime 2 (HMO) - H3528-005-0 Benefit Details |
Windham | $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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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Health Net Ruby Option 3 (HMO) - H0755-028-0 Benefit Details |
Windham | $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 | |||||
Health Net Navy 2 (HMO-POS) - H0755-029-0 Benefit Details |
Windham | $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 (PFFS) - H3333-146-0 Benefit Details |
Windham | $90.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 304 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 powered by CCRx (PFFS) - H3333-147-0 Benefit Details |
Windham | $104.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 372 members Browse Formulary | |||||
ConnectiCare VIP Option 2 (HMO-POS) - H3528-007-0 Benefit Details |
Windham | $119.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 63 members | ||||||
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Health Net Ruby Option 1 (HMO) - H0755-001-0 Benefit Details |
Windham | $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 | |||||||||
ConnectiCare VIP Prime 3 (HMO) - H3528-002-0 Benefit Details |
Windham | $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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Today's Options Premier (PFFS) - H3333-144-0 Benefit Details |
Windham | $134.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 587 members | ||||||
Health Net Navy 1 (HMO-POS) - H0755-020-0 Benefit Details |
Windham | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
ConnectiCare VIP Option 1 (HMO-POS) - H3528-006-0 Benefit Details |
Windham | $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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Today's Options Premier powered by CCRx (PFFS) - H3333-145-0 Benefit Details |
Windham | $175.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 402 members Browse Formulary | |||||
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