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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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Anthem Senior Advantage Basic (HMO) - H3655-013-0 Benefit Details |
Jefferson | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 69,004 members Browse Formulary | |||||
Anthem Senior Advantage Value (HMO) - H3655-031-0 Benefit Details |
Jefferson | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $0.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Blue Medicare Access Classic (Regional PPO) - R5941-007-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 995 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Blue Medicare Access Classic (Regional PPO) - R5941-007-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 995 members | ||||||
Blue Medicare Access Value (Regional PPO) - R5941-008-0 Benefit Details |
Jefferson | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 14,988 members Browse Formulary | |||||
Blue Medicare Access Value (Regional PPO) - R5941-008-0 Benefit Details |
Statewide | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 14,988 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Health Plan SecureCare (HMO) - H5151-004-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 738 members | ||||||
HumanaChoice R5826-021 (Regional PPO) - R5826-021-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,037 members | ||||||
HumanaChoice R5826-021 (Regional PPO) - R5826-021-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,037 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
PrimeTime Health Plan Basic - MA Only (HMO-POS) - H3664-014-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Anthem Senior Advantage Plus (HMO) - H3655-030-0 Benefit Details |
Jefferson | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | 7,719 members Browse Formulary | |||||
Anthem Medicare Preferred Standard (PPO) - H5529-001-0 Benefit Details |
Jefferson | $28.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 8,307 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Blue Medicare Access Standard (Regional PPO) - R5941-001-0 Benefit Details |
Jefferson | $30.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 14,803 members Browse Formulary | |||||
Blue Medicare Access Standard (Regional PPO) - R5941-001-0 Benefit Details |
Statewide | $30.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 14,803 members Browse Formulary | |||||
SecureChoice (PPO) - H8604-004-0 Benefit Details |
Jefferson | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 20 members | ||||||
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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) - H2762-013-0 Benefit Details |
Jefferson | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 337 members | ||||||
Anthem Medicare Preferred Select (PPO) - H5529-004-0 Benefit Details |
Jefferson | $49.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | 4,701 members Browse Formulary | |||||
Aetna Medicare Open Basic Plan (PFFS) - H5736-020-0 Benefit Details |
Jefferson | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 296 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
PrimeTime Health Plan Plus (HMO-POS) - H3664-017-0 Benefit Details |
Jefferson | $53.00 | $295 | No Gap Coverage | Generic: $4.00 Preferred Brand: $25.00 Non-Preferred Brand: $45.00 Specialty: 25% | 11,282 members Browse Formulary | |||||
Advantage Plan Securex (HMO-POS) - H9313-007-0 Benefit Details |
Jefferson | $58.00 | $0 | No Gap Coverage | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $50.00 Non-Preferred Brand: $90.00 Specialty: 33% | 911 members Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-030-0 Benefit Details |
Jefferson | $60.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 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 | |||||||||
HumanaChoice R5826-080 (Regional PPO) - R5826-080-0 Benefit Details |
Jefferson | $61.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 181 members Browse Formulary | |||||
HumanaChoice R5826-080 (Regional PPO) - R5826-080-0 Benefit Details |
Statewide | $61.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 181 members Browse Formulary | |||||
HumanaChoice R5826-007 (Regional PPO) - R5826-007-0 Benefit Details |
Jefferson | $69.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $82.00 Specialty: 33% | 7,690 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-007 (Regional PPO) - R5826-007-0 Benefit Details |
Statewide | $69.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $82.00 Specialty: 33% | 7,690 members Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) - H5736-025-0 Benefit Details |
Jefferson | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 931 members Browse Formulary | |||||
Health Plan SecureCare (HMO) - H5151-002-0 Benefit Details |
Jefferson | $99.00 | $0 | All Generics | Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: 50% Specialty: 20% | 7,109 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 Plan Three (PFFS) - H2762-017-0 Benefit Details |
Jefferson | $100.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 165 members | ||||||
Today's Options Value (PFFS) - H5421-181-0 Benefit Details |
Jefferson | $100.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 962 members | ||||||
UPMC for Life Ohio (HMO) - H2169-001-0 Benefit Details |
Jefferson | $107.60 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | < 10 members | ||||||
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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 Value powered by CCRx (PFFS) - H5421-182-0 Benefit Details |
Jefferson | $114.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
SecureChoice (PPO) - H8604-003-0 Benefit Details |
Jefferson | $119.00 | $0 | All Generics | Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: 50% Specialty: 20% | 201 members Browse Formulary | |||||
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UPMC for Life PPO High Deductible with Rx Ohio (PPO) - H9670-003-0 Benefit Details |
Jefferson | $125.60 | $0 | No Gap Coverage | Tier 1 - Generic: $5.00 Tier 2 - Preferred Brand: $32.00 Tier 3 - Non-Preferred Brand: $80.00 Tier 4 - Specialty: 33% | < 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 | |||||||||
PrimeTime Health Plan Premier (HMO-POS) - H3664-012-0 Benefit Details |
Jefferson | $128.00 | $0 | All Generics | Generic: $4.00 Preferred Brand: $25.00 Non-Preferred Brand: $45.00 Specialty: 25% | 442 members Browse Formulary | |||||
Today's Options Premier (PFFS) - H5421-179-0 Benefit Details |
Jefferson | $134.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) - H2762-038-0 Benefit Details |
Jefferson | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 442 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
PrimeTime Health Plan Prime PPO (PPO) - H3620-001-0 Benefit Details |
Jefferson | $140.00 | $295 | No Gap Coverage | Generic: $4.00 Preferred Brand: $25.00 Non-Preferred Brand: $45.00 Specialty: 25% | 276 members Browse Formulary | |||||
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UPMC for Life HMO Rx Ohio (HMO) - H2169-002-0 Benefit Details |
Jefferson | $141.50 | $0 | No Gap Coverage | Tier 1 - Generic: $5.00 Tier 2 - Preferred Brand: $32.00 Tier 3 - Non-Preferred Brand: $80.00 Tier 4 - Specialty: 33% | 18 members Browse Formulary | |||||
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UPMC for Life HMO Rx Enhanced Ohio (HMO) - H2169-003-0 Benefit Details |
Jefferson | $157.70 | $0 | No Gap Coverage | Tier 1 - Generic: $5.00 Tier 2 - Preferred Brand: $32.00 Tier 3 - Non-Preferred Brand: $80.00 Tier 4 - Specialty: 33% | 26 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 | |||||||||
Advantage Plan Optimumx (HMO-POS) - H9313-012-1 Benefit Details |
Jefferson | $170.00 | $0 | Many Generics | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $50.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | 319 members Browse Formulary | |||||
Today's Options Premier powered by CCRx (PFFS) - H5421-180-0 Benefit Details |
Jefferson | $203.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 735 members Browse Formulary | |||||
UPMC for Life PPO Rx Enhanced Ohio (PPO) - H9670-001-0 Benefit Details |
Jefferson | $223.50 | $0 | Many Generics | Tier 1 - Generic: $5.00 Tier 2 - Preferred Brand: $30.00 Tier 3 - Non-Preferred Brand: $85.00 Tier 4 - Specialty: 33% | < 10 members Browse Formulary | |||||
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