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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. |
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AARP MedicareComplete Essential (HMO) - H3659-054-0 Benefit Details |
Summit | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 984 members | ||||||
AARP MedicareComplete Plan 1 (HMO) - H3659-003-0 Benefit Details |
Summit | $0.00 | $0 | Many Generics | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $40.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $75.00 Tier 4 Specialty: 33% | 15,733 members Browse Formulary | |||||
AARP MedicareComplete Plan 2 (HMO) - H3659-031-0 Benefit Details |
Summit | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $38.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $72.00 Tier 4 Specialty: 33% | 37,565 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 Value Plan (HMO) - H3623-004-0 Benefit Details |
Summit | $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% | n/a Browse Formulary | |||||
Anthem Senior Advantage Basic (HMO) - H3655-013-0 Benefit Details |
Summit | $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 | |||||
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 | ||||||
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 |
Summit | $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 |
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 | |||||
Blue Medicare Access Value (Regional PPO) - R5941-008-0 Benefit Details |
Summit | $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) - H3672-014-0 Benefit Details |
Summit | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 914 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 | ||||||
HumanaChoice R5826-021 (Regional PPO) - R5826-021-0 Benefit Details |
Summit | $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 | |||||||||
Kaiser Permanente Medicare Plus Basic III (Cost) - H6360-008-0 Benefit Details |
Summit | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 286 members | ||||||
Kaiser Permanente Medicare Plus III (Cost) - H6360-006-0 Benefit Details |
Summit | $0.00 | $0 | No Gap Coverage | Generic: $12.00 Brand: $46.00 Specialty: 25% | n/a Browse Formulary | |||||
SummaCare Secure Classic Medical Only (HMO-POS) - H3660-043-0 Benefit Details |
Summit | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 51 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SummaCare Secure Silver Plus (HMO-POS) - H3660-029-0 Benefit Details |
Summit | $0.00 | $0 | All Generics | Tier 1: $3.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 33% | 10,618 members Browse Formulary | |||||
Evercare Plan DH (HMO) - H3659-056-0 Benefit Details |
Summit | $ 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% | 6,538 members Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) - H3655-030-0 Benefit Details |
Summit | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Evercare Plan MH (HMO) - H3659-059-0 Benefit Details |
Summit | $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% | 3,110 members Browse Formulary | |||||
Anthem Medicare Preferred Standard (PPO) - H5529-001-0 Benefit Details |
Summit | $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 | |||||
Kaiser Permanente Medicare Plus Basic II (Cost) - H6360-007-0 Benefit Details |
Summit | $28.30 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 73 members | ||||||
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 |
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 | |||||
Blue Medicare Access Standard (Regional PPO) - R5941-001-0 Benefit Details |
Summit | $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 | |||||
Buckeye Community Health Plan (HMO) - H0908-001-0 Benefit Details |
Summit | $ 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: $45.00 Non-Preferred Brand: $95.00 Injectables: $95.00 | 233 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 | |||||||||
SecureChoice (PPO) - H8604-002-0 Benefit Details |
Summit | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 14 members | ||||||
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CareSource Advantage (HMO) - H6178-001-0 Benefit Details |
Summit | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: $0.00 Tier 2: $45.00 Tier 3: 25% Tier 4: $98.00 | 654 members Browse Formulary | |||||
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Evercare Plan IP (PPO) - H2406-001-0 Benefit Details |
Summit | $30.50 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 2,031 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 | |||||||||
Anthem Medicare Preferred Select (PPO) - H5529-004-0 Benefit Details |
Summit | $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 | |||||
Kaiser Permanente Medicare Plus II (Cost) - H6360-002-0 Benefit Details |
Summit | $49.90 | $0 | All Generics | Generic: $10.00 Brand: $45.00 Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Basic Plan (PFFS) - H5736-020-0 Benefit Details |
Summit | $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 | |||||||||
CIGNA Medicare Access Plan One (PFFS) - H2762-014-0 Benefit Details |
Summit | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 215 members | ||||||
Advantage Plan Securex (HMO-POS) - H9313-007-0 Benefit Details |
Summit | $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 | |||||
HumanaChoice H3619-004 (PPO) - H3619-004-0 Benefit Details |
Summit | $60.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 2,091 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-080 (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 R5826-080 (Regional PPO) - R5826-080-0 Benefit Details |
Summit | $61.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 181 members Browse Formulary | |||||
Aetna Medicare Standard Plan (PPO) - H5521-021-0 Benefit Details |
Summit | $65.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $36.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 200 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 Value (PFFS) - H5421-165-0 Benefit Details |
Summit | $65.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,006 members | ||||||
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 | |||||
HumanaChoice R5826-007 (Regional PPO) - R5826-007-0 Benefit Details |
Summit | $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 | |||||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-032-0 Benefit Details |
Summit | $70.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 942 members Browse Formulary | |||||
Aetna Medicare Premier Plan (HMO) - H3623-006-0 Benefit Details |
Summit | $73.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $40.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 433 members Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H5421-166-0 Benefit Details |
Summit | $76.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 3,797 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 Open Value Plan w/Rx (PFFS) - H5736-025-0 Benefit Details |
Summit | $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 | |||||
SummaCare Secure Gold Plus (HMO-POS) - H3660-028-0 Benefit Details |
Summit | $80.00 | $0 | All Generics | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $60.00 Tier 4: 33% | 7,381 members Browse Formulary | |||||
Health Plan SecureCare (HMO) - H3672-013-0 Benefit Details |
Summit | $99.00 | $0 | All Generics | Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: 50% Specialty: 20% | 4,069 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 (PFFS) - H5421-163-0 Benefit Details |
Summit | $104.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 6,062 members | ||||||
Kaiser Permanente Medicare Plus Basic I (Cost) - H6360-004-0 Benefit Details |
Summit | $106.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,850 members | ||||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-018-0 Benefit Details |
Summit | $110.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 151 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecureChoice (PPO) - H8604-001-0 Benefit Details |
Summit | $119.00 | $0 | All Generics | Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: 50% Specialty: 20% | 74 members Browse Formulary | |||||
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Kaiser Permanente Medicare Plus I (Cost) - H6360-001-0 Benefit Details |
Summit | $132.90 | $0 | All Generics | Generic: $7.00 Brand: $40.00 Specialty: 25% | 8,471 members Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) - H2762-040-0 Benefit Details |
Summit | $145.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 254 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) - H5421-164-0 Benefit Details |
Summit | $151.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 2,969 members Browse Formulary | |||||
Advantage Plan Optimumx (HMO-POS) - H9313-012-1 Benefit Details |
Summit | $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 | |||||
SummaCare Secure Platinum (HMO-POS) - H3660-032-0 Benefit Details |
Summit | $180.00 | $0 | All Generics | Tier 1: $3.00 Tier 2: $35.00 Tier 3: $70.00 Tier 4: 33% | 917 members Browse Formulary | |||||
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