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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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65C Plus Saver Option (Cost) - H1251-010-0 Benefit Details |
Honolulu | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 91 members | ||||||
AARP MedicareComplete Choice (PPO) - H5424-001-0 Benefit Details |
Honolulu | $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% | 5,793 members Browse Formulary | |||||
AARP MedicareComplete Choice Essential (PPO) - H5424-003-0 Benefit Details |
Honolulu | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 683 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
AlohaCare Advantage (HMO) - H5969-001-0 Benefit Details |
Honolulu | $0.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plan One (PFFS) - H2762-020-0 Benefit Details |
Honolulu | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 13,290 members | ||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-042-0 Benefit Details |
Honolulu | $0.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 40,257 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 RMP (Regional PPO) - R3175-004-0 Benefit Details |
Honolulu | $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% | 300 members Browse Formulary | |||||
Evercare Plan RMP (Regional PPO) - R3175-004-0 Benefit Details |
Statewide | $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% | 300 members Browse Formulary | |||||
HumanaChoice H0248-001 (PPO) - H0248-001-0 Benefit Details |
Honolulu | $0.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 3,175 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 | |||||||||
HumanaChoice H0248-003 (PPO) - H0248-003-0 Benefit Details |
Honolulu | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 91 members | ||||||
new | new | new | |||||||||
Kaiser Permanente Senior Advantage Basic (HMO) - H1230-003-0 Benefit Details |
Honolulu | $0.00 | $0 | All Generics | Generic: $10.00 Brand: $40.00 Specialty: 25% | n/a Browse Formulary | |||||
SecureHorizons MedicareComplete Choice (Regional PPO) - R3175-001-0 Benefit Details |
Honolulu | $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% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareComplete Choice (Regional PPO) - R3175-001-0 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% | n/a Browse Formulary | |||||
SecureHorizons MedicareComplete Choice Essential (Regional PPO) - R3175-002-0 Benefit Details |
Honolulu | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 207 members | ||||||
SecureHorizons MedicareComplete Choice Essential (Regional PPO) - R3175-002-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 207 members | ||||||
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) - H3333-104-0 Benefit Details |
Honolulu | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 247 members | ||||||
Today's Options Value (PFFS) - H3333-106-0 Benefit Details |
Honolulu | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | < 10 members | ||||||
Humana Gold Choice H2944-035 (PFFS) - H2944-035-0 Benefit Details |
Honolulu | $16.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $42.00 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) - R3175-003-0 Benefit Details |
Honolulu | $ 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% | n/a Browse Formulary | |||||
Evercare Plan RDP (Regional PPO) - R3175-003-0 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% | n/a Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H3333-107-0 Benefit Details |
Honolulu | $25.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 19 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
AlohaCare Advantage Plus (HMO) - H5969-002-0 Benefit Details |
Honolulu | $ 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% | 507 members Browse Formulary | |||||
Evercare Plan DP (PPO) - H5424-005-0 Benefit Details |
Honolulu | $ 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% | 5,199 members Browse Formulary | |||||
65C Plus Saver Option BRx (Cost) - H1251-011-0 Benefit Details |
Honolulu | $33.10 | $310 | No Gap Coverage | Generic: $3.00 Preferred Brand: $35.00 Other Brand: $65.00 Injectables: 25% Specialty Drugs: 25% | 151 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) - H3333-105-0 Benefit Details |
Honolulu | $44.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 173 members Browse Formulary | |||||
65C Plus Basic Option (Cost) - H1251-001-0 Benefit Details |
Honolulu | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 286 members | ||||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-024-0 Benefit Details |
Honolulu | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,787 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecurityChoice Classic (PFFS) - H0540-088-0 Benefit Details |
Honolulu | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
SecurityChoice Plus (PFFS) - H0540-089-0 Benefit Details |
Honolulu | $56.00 | $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% | n/a Browse Formulary | |||||
65C Plus Basic Option BRx (Cost) - H1251-003-0 Benefit Details |
Honolulu | $78.10 | $310 | No Gap Coverage | Generic: $3.00 Preferred Brand: $35.00 Other Brand: $65.00 Injectables: 25% Specialty Drugs: 25% | 849 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 Plus RX Plan Four (PFFS) - H2762-050-0 Benefit Details |
Honolulu | $85.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 9,959 members Browse Formulary | |||||
65C Plus High Option (Cost) - H1251-002-0 Benefit Details |
Honolulu | $89.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 6,950 members | ||||||
Kaiser Permanente Senior Advantage Enhanced (HMO) - H1230-001-0 Benefit Details |
Honolulu | $116.00 | $0 | All Generics | Generic: $10.00 Brand: $40.00 Specialty: 25% | 8,430 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H0248-002 (PPO) - H0248-002-0 Benefit Details |
Honolulu | $120.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | < 10 members Browse Formulary | |||||
new | new | new | |||||||||
65C Plus High Option SRx (Cost) - H1251-004-0 Benefit Details |
Honolulu | $126.60 | $310 | No Gap Coverage | Generic: $3.00 Preferred Brand: $25.00 Other Brand: $65.00 Injectables: 25% Specialty Drugs: 25% | 23,346 members Browse Formulary | |||||
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