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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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SecureHorizons MedicareDirect Plan 1 (PFFS) - H5435-001-0 Benefit Details |
Sullivan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 27,113 members | ||||||
Today's Options Value (PFFS) - H3333-038-0 Benefit Details |
Sullivan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
SmartValue Classic (PFFS) - H1689-012-0 Benefit Details |
Sullivan | $15.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,461 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) - H3333-056-0 Benefit Details |
Sullivan | $19.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | n/a Browse Formulary | |||||
SecureHorizons MedicareDirect Rx Plan 51 (PFFS) - H5435-014-0 Benefit Details |
Sullivan | $20.00 | $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% | 61,945 members Browse Formulary | |||||
Today's Options Premier (PFFS) - H3333-032-0 Benefit Details |
Sullivan | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 7,958 members | ||||||
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 |
Sullivan | $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 | |||||
First Seniority Freedom - No Drug (PFFS) - H7226-015-0 Benefit Details |
Sullivan | $68.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 242 members | ||||||
Today's Options Premier powered by CCRx (PFFS) - H3333-050-0 Benefit Details |
Sullivan | $69.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 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 | |||||||||
CIGNA Medicare Access Plan One (PFFS) - H2762-015-0 Benefit Details |
Sullivan | $80.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 150 members | ||||||
Humana Gold Choice H2944-073 (PFFS) - H2944-073-0 Benefit Details |
Sullivan | $80.00 | $0 | Few Generics, Few Brand | Preferred Generic: $7.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 204 members Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-034-0 Benefit Details |
Sullivan | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
First Seniority Freedom - Drug (PFFS) - H7226-013-0 Benefit Details |
Sullivan | $103.90 | $0 | No Gap Coverage | Tier 1: $10.00 Tier 2: $35.00 Tier 3: $70.00 | 294 members Browse Formulary | |||||
Humana Gold Choice H2944-106 (PFFS) - H2944-106-0 Benefit Details |
Sullivan | $105.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 501 members Browse Formulary | |||||
First Seniority Freedom Plus - Drug (PFFS) - H7226-011-0 Benefit Details |
Sullivan | $127.00 | $0 | All Generics | Tier 1: $10.00 Tier 2: $30.00 Tier 3: $60.00 | n/a 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 Three (PFFS) - H2762-019-0 Benefit Details |
Sullivan | $135.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 57 members | ||||||
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