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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) |
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(Donut Hole) Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
Members In This Plan ID | |||||
Cust. Service Rating |
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Aetna Medicare Value Plan (HMO) - H3312-048-0 Benefit Details |
Onondaga | $0.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $78.00 Tier 5 - Specialty: 25% | 2,016 members Browse Formulary | |||||
CIGNA Medicare Access Plan One (PFFS) - H2762-020-0 Benefit Details |
Onondaga | $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 |
Onondaga | $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 | |||||||||
Fidelis Medicare Advantage (HMO-POS) - H3328-012-0 Benefit Details |
Onondaga | $0.00 | $310 | Many Generics | Generic: $4.00 Preferred Brand: 40% Non-Preferred Brand: 60% Specialty: 25% | n/a Browse Formulary | |||||
Fidelis Medicare Advantage Part B Reduction (HMO-POS) - H3328-014-0 Benefit Details |
Onondaga | $0.00 | $310 | No Gap Coverage | Generic: $5.00 Preferred Brand: $45.00 Non-preferred Brand: $95.00 Specialty: 25% | 56 members Browse Formulary | |||||
Fidelis Medicare Advantage without Rx (HMO-POS) - H3328-001-0 Benefit Details |
Onondaga | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 228 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
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Northeast Community Care - Plus (HMO) - H3533-001-0 Benefit Details |
Onondaga | $0.00 | $0 | Some Generics | Tier 1 - Preferred Generic: $0.00 Tier 2 - Non-Preferred Generic: $5.00 Tier 3 - Preferred Brand: $39.00 Tier 4 - Non-Preferred Brand: $69.00 Tier 5 - Specialty: Lesser of $300 or 33%: -200% | 937 members Browse Formulary | |||||
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SecureHorizons MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Onondaga | $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 (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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareComplete Choice Essential (Regional PPO) - R5342-002-0 Benefit Details |
Onondaga | $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 | ||||||
Today's Options Advantage 1 powered by CCRx (PPO) - H2775-076-0 Benefit Details |
Onondaga | $0.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 2,073 members Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
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Service | Exper. | Cost Info | |||||||||
Today's Options Premier (PFFS) - H3333-031-0 Benefit Details |
Onondaga | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 17,821 members | ||||||
Today's Options Value (PFFS) - H3333-037-0 Benefit Details |
Onondaga | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 683 members | ||||||
Touchstone Health Medicare Clear (HMO-POS) - H3327-022-0 Benefit Details |
Onondaga | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 799 members | ||||||
Plan Name | County | Monthly Prem. |
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Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
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Touchstone Health Medicare Power (HMO) - H3327-021-0 Benefit Details |
Onondaga | $0.00 | $310 | No Gap Coverage | Generic: $6.00 Preferred Brand: $25.00 Non-Preferred Brand: $55.00 Biological and Specialty Injectables: 25% | n/a Browse Formulary | |||||
Medicare Blue PPO Plan FOUR (PPO) - H3335-043-0 Benefit Details |
Onondaga | $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 |
Onondaga | $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 Advantage 2 powered by CCRx (PPO) - H2775-088-0 Benefit Details |
Onondaga | $9.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 383 members Browse Formulary | |||||
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Today's Options Value powered by CCRx (PFFS) - H3333-055-0 Benefit Details |
Onondaga | $19.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 930 members Browse Formulary | |||||
HumanaChoice H5970-002 (PPO) - H5970-002-0 Benefit Details |
Onondaga | $20.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 520 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Preferred Gold (HMO) - H9859-001-0 Benefit Details |
Onondaga | $20.30 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 794 members | ||||||
Humana Gold Choice H4774-004 (PFFS) - H4774-004-0 Benefit Details |
Onondaga | $22.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | < 10 members Browse Formulary | |||||
Evercare Plan RDP (Regional PPO) - R5342-003-0 Benefit Details |
Onondaga | $ 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 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 | |||||
Evercare Plan RMP (Regional PPO) - R5342-004-0 Benefit Details |
Onondaga | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Evercare Plan IH (HMO) - H3379-022-0 Benefit Details |
Onondaga | $33.30 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Fidelis Dual Advantage (HMO) - H3328-002-0 Benefit Details |
Onondaga | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Generic: 0% Preferred Brand: 37% Non-preferred Brand: 50% Specialty: 25% | 378 members Browse Formulary | |||||
Fidelis Dual Advantage Flex Plan (HMO) - H3328-013-0 Benefit Details |
Onondaga | $ 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: 10% Non-Preferred Brand: 55% Specialty: 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 | |||||||||
Fidelis Medicare Advantage Flex Plan (HMO-POS) - H3328-003-0 Benefit Details |
Onondaga | $33.30 | $310 | No Gap Coverage | Generic: $6.00 Preferred Brand: $35.00 Non-preferred Brand: $55.00 Specialty: 25% | 3,840 members Browse Formulary | |||||
Independent Health Medicare Anywhere Basic (PFFS) - H9519-003-0 Benefit Details |
Onondaga | $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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Northeast Community Care - Enhanced (HMO) - H3533-003-0 Benefit Details |
Onondaga | $33.30 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | < 10 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 | |||||||||
Today's Options Advantage 3 powered by CCRx (PPO) - H2775-082-0 Benefit Details |
Onondaga | $34.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 2,944 members Browse Formulary | |||||
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Humana Gold Choice H4774-003 (PFFS) - H4774-003-0 Benefit Details |
Onondaga | $41.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 122 members Browse Formulary | |||||
Touchstone Health Medicare Freedom (HMO-POS) - H3327-023-0 Benefit Details |
Onondaga | $42.00 | $0 | Many Generics | Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Biological and Specialty Injectables: 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 Premier powered by CCRx (PFFS) - H3333-049-0 Benefit Details |
Onondaga | $44.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 4,486 members Browse Formulary | |||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-024-0 Benefit Details |
Onondaga | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,787 members | ||||||
Aetna Medicare Standard Plan (PPO) - H5521-039-0 Benefit Details |
Onondaga | $47.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $5.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 277 members Browse Formulary | |||||
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 |
Onondaga | $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 |
Onondaga | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
SecurityChoice Plus (PFFS) - H0540-089-0 Benefit Details |
Onondaga | $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 | |||||||||
Preferred Gold Rx (HMO) - H9859-002-0 Benefit Details |
Onondaga | $58.50 | $0 | No Gap Coverage | Tier 1: $10.00 Tier 2: $35.00 Tier 3: $90.00 Tier 4: 33% Tier 5: 8,000% | n/a Browse Formulary | |||||
Sterling Basic Plus (PFFS) - H5006-018-2 Benefit Details |
Onondaga | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
Medicare Blue PPO - TWO (PPO) - H3335-014-0 Benefit Details |
Onondaga | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Aetna Medicare Premier Plan (HMO) - H3312-055-0 Benefit Details |
Onondaga | $67.00 | $0 | Many Generics | Tier 1 - Preferred Generic: $5.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 33% | 100 members Browse Formulary | |||||
Medicare Blue PPO - THREE (PPO) - H3335-015-0 Benefit Details |
Onondaga | $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 | |||||
GoldAnywhere Rx (PPO) - H9615-002-0 Benefit Details |
Onondaga | $82.00 | $0 | Many Generics | Tier 1: $9.00 Tier 2: $30.00 Tier 3: $85.00 Tier 4: 33% Tier 5: 8,000% | 2,544 members Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
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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 |
Onondaga | $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 Option I (PFFS) - H5006-014-2 Benefit Details |
Onondaga | $94.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
Sterling Option II (PFFS) - H5006-017-2 Benefit Details |
Onondaga | $107.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
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Service | Exper. | Cost Info | |||||||||
Sterling Option IV (PFFS) - H5006-016-2 Benefit Details |
Onondaga | $120.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
Independent Health Medicare Anywhere (PFFS) - H9519-001-0 Benefit Details |
Onondaga | $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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