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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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CIGNA Medicare Access Plan One (PFFS) - H2762-020-0 Benefit Details |
Lewis | $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 |
Lewis | $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 | |||||
SecureHorizons MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Lewis | $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% | 13,222 members 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) - R5342-001-0 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% | 13,222 members Browse Formulary | |||||
SecureHorizons MedicareComplete Choice Essential (Regional PPO) - R5342-002-0 Benefit Details |
Lewis | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 748 members | ||||||
SecureHorizons MedicareComplete Choice Essential (Regional PPO) - R5342-002-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 748 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 (PFFS) - H3333-038-0 Benefit Details |
Lewis | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Medicare Blue PPO Plan FOUR (PPO) - H3335-043-0 Benefit Details |
Lewis | $5.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 176 members | ||||||
Medicare Blue PPO Plan ONE (PPO) - H3335-038-0 Benefit Details |
Lewis | $5.50 | $150 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $75.00 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 | |||||||||
Today's Options Value powered by CCRx (PFFS) - H3333-056-0 Benefit Details |
Lewis | $19.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | n/a Browse Formulary | |||||
Evercare Plan RDP (Regional PPO) - R5342-003-0 Benefit Details |
Lewis | $ 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% | 4,933 members Browse Formulary | |||||
Evercare Plan RDP (Regional PPO) - R5342-003-0 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% | 4,933 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) - R5342-004-0 Benefit Details |
Lewis | $25.00 | $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% | n/a Browse Formulary | |||||
Evercare Plan RMP (Regional PPO) - R5342-004-0 Benefit Details |
Statewide | $25.00 | $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% | n/a Browse Formulary | |||||
Today's Options Premier (PFFS) - H3333-032-0 Benefit Details |
Lewis | $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 | |||||||||
Independent Health Medicare Anywhere Basic (PFFS) - H9519-003-0 Benefit Details |
Lewis | $33.30 | $0 | Few Generics, Few Brand | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $75.00 Specialty Tier 4: 33% | 79 members Browse Formulary | |||||
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Humana Gold Choice H4774-002 (PFFS) - H4774-002-0 Benefit Details |
Lewis | $40.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty: 33% | 716 members Browse Formulary | |||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-024-0 Benefit Details |
Lewis | $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 | |||||||||
Humana Gold Choice H4774-005 (PFFS) - H4774-005-0 Benefit Details |
Lewis | $52.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 943 members Browse Formulary | |||||
SecurityChoice Classic (PFFS) - H0540-088-0 Benefit Details |
Lewis | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
SecurityChoice Plus (PFFS) - H0540-089-0 Benefit Details |
Lewis | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Medicare Blue PPO - TWO (PPO) - H3335-014-0 Benefit Details |
Lewis | $63.00 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $75.00 Tier 4: 33% | 3,281 members Browse Formulary | |||||
Today's Options Premier powered by CCRx (PFFS) - H3333-050-0 Benefit Details |
Lewis | $69.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | n/a Browse Formulary | |||||
Humana Gold Choice H4774-001 (PFFS) - H4774-001-0 Benefit Details |
Lewis | $72.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 2,202 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Medicare Blue PPO - THREE (PPO) - H3335-015-0 Benefit Details |
Lewis | $78.00 | $0 | No Gap Coverage | Tier 1: $5.00 Tier 2: $30.00 Tier 3: $75.00 Tier 4: 33% | 3,179 members Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) - H2762-050-0 Benefit Details |
Lewis | $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 | |||||
Sterling Basic Plus (PFFS) - H5006-018-3 Benefit Details |
Lewis | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Independent Health Medicare Anywhere (PFFS) - H9519-001-0 Benefit Details |
Lewis | $135.00 | $0 | Few Generics, Few Brand | Tier 1: $8.00 Tier 2: $40.00 Tier 3: $70.00 Specialty Tier 4: 33% | 156 members Browse Formulary | |||||
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Sterling Option II (PFFS) - H5006-017-3 Benefit Details |
Lewis | $170.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
Sterling Option I (PFFS) - H5006-014-3 Benefit Details |
Lewis | $183.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Sterling Option IV (PFFS) - H5006-016-3 Benefit Details |
Lewis | $196.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
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