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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. |
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AARP MedicareComplete Choice (PPO) - H5532-001-0 Benefit Details |
Charlotte | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $42.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $79.00 Tier 4 Specialty: 33% | 946 members Browse Formulary | |||||
AARP MedicareComplete Choice Essential (Regional PPO) - R5287-002-0 Benefit Details |
Charlotte | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,293 members | ||||||
AARP MedicareComplete Choice Essential (Regional PPO) - R5287-002-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,293 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
AARP MedicareComplete Choice Plan 2 (Regional PPO) - R5287-001-0 Benefit Details |
Charlotte | $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% | 105,115 members Browse Formulary | |||||
AARP MedicareComplete Choice Plan 2 (Regional PPO) - R5287-001-0 Benefit Details |
Statewide | $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% | 105,115 members Browse Formulary | |||||
AARP MedicareComplete Plus Plan 1 (HMO-POS) - H1080-004-0 Benefit Details |
Charlotte | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $42.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $79.00 Tier 4 Specialty: 33% | 17,367 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Advantage (HMO) - H5402-039-0 Benefit Details |
Charlotte | $0.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $15.00 Brand: $45.00 Non-Preferred Brand: 25% Specialty: 33% | 3,997 members Browse Formulary | |||||
Advantage Health Florida (HMO) - H5402-035-0 Benefit Details |
Charlotte | $0.00 | $0 | No Gap Coverage | Generic: $0.00 Preferred Brand: $15.00 Brand: $45.00 Non-Preferred Brand: 25% Specialty: 33% | n/a Browse Formulary | |||||
Advantage Silver (HMO) - H5402-007-0 Benefit Details |
Charlotte | $0.00 | $0 | Many Generics, Few Brand | Generic: $0.00 Preferred Brand: $15.00 Brand: $45.00 Non-Preferred Brand: 25% Specialty: 33% | 3,678 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Advantage Value FL (HMO) - H5402-040-0 Benefit Details |
Charlotte | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 165 members | ||||||
CareOne (HMO) - H1019-044-0 Benefit Details |
Charlotte | $0.00 | $0 | Few Generics, Few Brand | Preferred Generic: $6.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | < 10 members Browse Formulary | |||||
Evercare Plan MP (PPO) - H5417-005-0 Benefit Details |
Charlotte | $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% | 16,897 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Freedom Medicare Plan Rx (HMO) - H5427-059-0 Benefit Details |
Charlotte | $0.00 | $0 | No Gap Coverage | Tier 1: $0.00 Tier2: $20.00 Tier 3: $60.00 Tier 4: 33% | n/a Browse Formulary | |||||
Freedom Savings Plan (HMO) - H5427-052-0 Benefit Details |
Charlotte | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Freedom Savings Plan Rx (HMO) - H5427-053-0 Benefit Details |
Charlotte | $0.00 | $0 | No Gap Coverage | Tier 1: $0.00 Tier2: $20.00 Tier 3: $60.00 Tier 4: 33% | 6,734 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Freedom VIP Care (HMO) - H5427-080-0 Benefit Details |
Charlotte | $0.00 | $0 | No Gap Coverage | Tier 1: $0.00 Tier2: $20.00 Tier 3: $60.00 Tier 4: 33% | 96 members Browse Formulary | |||||
Freedom VIP Care COPD (HMO) - H5427-081-0 Benefit Details |
Charlotte | $0.00 | $0 | No Gap Coverage | Tier 1: $0.00 Tier2: $20.00 Tier 3: $60.00 Tier 4: 33% | 24 members Browse Formulary | |||||
Freedom VIP Plus (HMO) - H5427-082-0 Benefit Details |
Charlotte | $0.00 | $0 | No Gap Coverage | Tier 1: $0.00 Tier2: $20.00 Tier 3: $60.00 Tier 4: 33% | 908 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Freedom VIP Plus COPD (HMO) - H5427-083-0 Benefit Details |
Charlotte | $0.00 | $0 | No Gap Coverage | Tier 1: $0.00 Tier2: $20.00 Tier 3: $60.00 Tier 4: 33% | 217 members Browse Formulary | |||||
Humana Gold Plus H5426-008 (HMO-POS) - H5426-008-0 Benefit Details |
Charlotte | $0.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | n/a Browse Formulary | |||||
Humana Gold Plus H5426-019 (HMO) - H5426-019-0 Benefit Details |
Charlotte | $0.00 | $0 | Few Generics, Few Brand | Preferred Generic: $6.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 41 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-018 (Regional PPO) - R5826-018-0 Benefit Details |
Charlotte | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 5,816 members | ||||||
HumanaChoice R5826-018 (Regional PPO) - R5826-018-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 5,816 members | ||||||
Medicare Masterpiece (HMO) - H5404-025-0 Benefit Details |
Charlotte | $0.00 | $0 | No Gap Coverage | Value Generic: $0.00 Generic: $5.00 Preferred Brand: $30.00 Non Preferred Brand: $60.00 Speciality: 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 | |||||||||
Medicare Masterpiece MA Only (HMO) - H5404-123-0 Benefit Details |
Charlotte | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 22 members | ||||||
Medicare Masterpiece MA Only (PPO) - H5429-053-0 Benefit Details |
Charlotte | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 72 members | ||||||
Optimum Gold Plan (HMO) - H5594-018-0 Benefit Details |
Charlotte | $0.00 | $0 | No Gap Coverage | Tier 1: $0.00 Tier2: $39.00 Tier 3: $69.00 Tier 4: 33% | 344 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Optimum Platinum Plan (HMO) - H5594-019-0 Benefit Details |
Charlotte | $0.00 | $0 | No Gap Coverage | Tier 1: $0.00 Tier2: $39.00 Tier 3: $69.00 Tier 4: 33% | 97 members Browse Formulary | |||||
Value One Florida (HMO) - H5402-041-0 Benefit Details |
Charlotte | $ 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: $15.00 Brand: $45.00 Non-Preferred Brand: 25% Specialty: 33% | n/a Browse Formulary | |||||
Humana Gold Plus H5426-002 (HMO-POS) - H5426-002-0 Benefit Details |
Charlotte | $16.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 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 | |||||||||
Evercare Plan RDP (Regional PPO) - R5287-003-0 Benefit Details |
Charlotte | $ 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% | 12,354 members Browse Formulary | |||||
Evercare Plan RDP (Regional PPO) - R5287-003-0 Benefit Details |
Statewide | $ 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% | 12,354 members Browse Formulary | |||||
Aetna Medicare Value Plan (HMO) - H5414-009-0 Benefit Details |
Charlotte | $21.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $37.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 920 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Evercare Plan DH (HMO) - H1080-036-0 Benefit Details |
Charlotte | $ 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% | 582 members Browse Formulary | |||||
Evercare Plan IP (PPO) - H5417-001-0 Benefit Details |
Charlotte | $27.50 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Medicare Masterpiece (PPO) - H5429-020-0 Benefit Details |
Charlotte | $29.00 | $0 | No Gap Coverage | Value Generic: $3.00 Generic: $10.00 Preferred Brand: $35.00 Non Preferred Brand: $70.00 Speciality: 33% | 174 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Medicare Masterpiece Plus (HMO-POS) - H5404-086-0 Benefit Details |
Charlotte | $29.00 | $0 | No Gap Coverage | Value Generic: $3.00 Generic: $10.00 Preferred Brand: $35.00 Non Preferred Brand: $70.00 Speciality: 33% | 3,158 members Browse Formulary | |||||
BlueMedicare Regional PPO (Regional PPO) - R3332-001-0 Benefit Details |
Charlotte | $45.00 | $90 | No Gap Coverage | Tier 1 - Covered Generic: $4.00 Tier 2 - Covered Preferred Brand: $45.00 Tier 3 - Covered Brand: $95.00 Tier S - Covered Specialty: 25% | 10,845 members Browse Formulary | |||||
BlueMedicare Regional PPO (Regional PPO) - R3332-001-0 Benefit Details |
Statewide | $45.00 | $90 | No Gap Coverage | Tier 1 - Covered Generic: $4.00 Tier 2 - Covered Preferred Brand: $45.00 Tier 3 - Covered Brand: $95.00 Tier S - Covered Specialty: 25% | 10,845 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) - H5820-029-0 Benefit Details |
Charlotte | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 872 members | ||||||
Any, Any, Any Gold (PFFS) - H5820-011-0 Benefit Details |
Charlotte | $59.00 | $0 | No Gap Coverage | Value Generic: $4.00 Generic: $10.00 Preferred Brand: $35.00 Non Preferred Brand: $70.00 Speciality: 33% | 15,561 members Browse Formulary | |||||
HumanaChoice R5826-074 (Regional PPO) - R5826-074-0 Benefit Details |
Charlotte | $84.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 475 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-074 (Regional PPO) - R5826-074-0 Benefit Details |
Statewide | $84.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 475 members Browse Formulary | |||||
Any, Any, Any Platinum (PFFS) - H5820-013-0 Benefit Details |
Charlotte | $89.00 | $0 | No Gap Coverage | Value Generic: $2.00 Generic: $7.00 Preferred Brand: $30.00 Non Preferred Brand: $60.00 Speciality: 33% | 612 members Browse Formulary | |||||
HumanaChoice R5826-005 (Regional PPO) - R5826-005-0 Benefit Details |
Charlotte | $95.00 | $0 | Few Generics, Few Brand | Preferred Generic: $7.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 20,502 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-005 (Regional PPO) - R5826-005-0 Benefit Details |
Statewide | $95.00 | $0 | Few Generics, Few Brand | Preferred Generic: $7.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 20,502 members Browse Formulary | |||||
Aetna Medicare Premier Plan (HMO) - H5414-002-0 Benefit Details |
Charlotte | $98.00 | $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% | 252 members Browse Formulary | |||||
Humana Gold Choice H2944-141 (PFFS) - H2944-141-0 Benefit Details |
Charlotte | $100.00 | $0 | Few Generics, Few Brand | Preferred Generic: $9.00 Non-Preferred Generic/Preferred Brand: $38.00 Non-Preferred Brand: $80.00 Specialty: 33% | 427 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) - H5421-181-0 Benefit Details |
Charlotte | $100.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 962 members | ||||||
Aetna Medicare Standard Plan (PPO) - H5521-029-0 Benefit Details |
Charlotte | $108.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $5.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $40.00 Tier 4 - Non-Preferred Brand: $82.00 Tier 5 - Specialty: 25% | 211 members Browse Formulary | |||||
BlueMedicare PPO (PPO) - H5434-002-0 Benefit Details |
Charlotte | $112.00 | $90 | No Gap Coverage | Tier 1 - Covered Generic: $4.00 Tier 2 - Covered Preferred Brand: $45.00 Tier 3 - Covered Brand: $95.00 Tier S - Covered Specialty: 25% | 4,483 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
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Today's Options Value powered by CCRx (PFFS) - H5421-182-0 Benefit Details |
Charlotte | $114.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Today's Options Premier (PFFS) - H5421-179-0 Benefit Details |
Charlotte | $134.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Aetna Medicare Premier Plan (PPO) - H5521-032-0 Benefit Details |
Charlotte | $143.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $5.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $37.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 200 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
BlueMedicare PFFS (PFFS) - H3518-001-0 Benefit Details |
Charlotte | $151.00 | $145 | No Gap Coverage | Tier 1 - Covered Generic: $4.00 Tier 2 - Covered Preferred Brand: $45.00 Tier 3 - Covered Brand: $95.00 Tier S - Covered Specialty: 25% | n/a Browse Formulary | |||||
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Today's Options Premier powered by CCRx (PFFS) - H5421-180-0 Benefit Details |
Charlotte | $203.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 735 members Browse Formulary | |||||
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