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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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Health Net Violet Option 2 (PPO) - H5520-006-0 Benefit Details |
Douglas | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic: $6.00 Tier 2 Preferred Brand: $38.00 Tier 3 Non-Preferred: $76.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 2,126 members Browse Formulary | |||||
SecureHorizons MedicareDirect Plan 2 (PFFS) - H5435-002-0 Benefit Details |
Douglas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 16,559 members | ||||||
SecureHorizons MedicareDirect Rx Plan 55 (PFFS) - H5435-024-0 Benefit Details |
Douglas | $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: $80.00 Tier 4 Specialty: 33% | 54,374 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
CareSource Silver (HMO) - H3810-006-0 Benefit Details |
Douglas | $23.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 107 members | ||||||
Health Net Aqua (PPO) - H5520-003-0 Benefit Details |
Douglas | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
ATRIO MyAdvantage Active (HMO) - H3814-011-0 Benefit Details |
Douglas | $26.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 175 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) - H5421-055-0 Benefit Details |
Douglas | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 5,383 members | ||||||
ATRIO MyAdvantage SNP (HMO) - H3814-007-0 Benefit Details |
Douglas | $ 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% | n/a Browse Formulary | |||||
CareSource - SNP (HMO) - H3810-002-0 Benefit Details |
Douglas | $ 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% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
ATRIO MyAdvantage Active Rx (HMO) - H3814-012-0 Benefit Details |
Douglas | $48.00 | $310 | No Gap Coverage | TIER 1 - GENERICS: $4.00 TIER 2 - PREFERRED BRAND: $31.00 TIER 3 - NON-PREFERRED BRAND: $50.00 TIER 4 - SPECIALTY: 25% | 423 members Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H5421-073-0 Benefit Details |
Douglas | $51.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 10,805 members Browse Formulary | |||||
CareSource Silver Plus Rx (HMO) - H3810-007-0 Benefit Details |
Douglas | $54.60 | $0 | No Gap Coverage | Generic: $5.00 Brand: $39.00 Non-preferred Brand: $69.00 Specialty: 3,300% | 290 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecurityChoice Classic (PFFS) - H0540-088-0 Benefit Details |
Douglas | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
SecurityChoice Plus (PFFS) - H0540-089-0 Benefit Details |
Douglas | $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 | |||||
Humana Gold Choice H2944-054 (PFFS) - H2944-054-0 Benefit Details |
Douglas | $58.00 | $0 | Few Generics, Few Brand | Preferred Generic: $6.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 3,011 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
CareSource Gold (HMO) - H3810-001-0 Benefit Details |
Douglas | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 429 members | ||||||
Sterling Basic Plus (PFFS) - H5006-018-2 Benefit Details |
Douglas | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
Today's Options Premier (PFFS) - H5421-049-0 Benefit Details |
Douglas | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 8,597 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Health Net Violet Option 1 (PPO) - H5520-004-0 Benefit Details |
Douglas | $75.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic: $6.00 Tier 2 Preferred Brand: $38.00 Tier 3 Non-Preferred: $76.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | 3,542 members Browse Formulary | |||||
CIGNA Medicare Access Plan One (PFFS) - H2762-023-0 Benefit Details |
Douglas | $85.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 183 members | ||||||
ATRIO MyAdvantage Choice Rx (HMO-POS) - H3814-026-0 Benefit Details |
Douglas | $88.00 | $0 | No Gap Coverage | TIER 1 - GENERICS: $4.00 TIER 2 - PREFERRED BRAND: $31.00 TIER 3 - NON-PREFERRED BRAND: $50.00 TIER 4 - SPECIALTY: 25% | 181 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) - H2762-048-0 Benefit Details |
Douglas | $90.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CareSource Diamond (PPO) - H2481-003-0 Benefit Details |
Douglas | $91.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 13 members | ||||||
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Sterling Option I (PFFS) - H5006-014-2 Benefit Details |
Douglas | $94.00 | 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 | |||||||||
ATRIO MyAdvantage II (HMO) - H3814-005-0 Benefit Details |
Douglas | $99.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 178 members | ||||||
Health Net Healthy Heart (PPO) - H5520-010-0 Benefit Details |
Douglas | $101.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic: $5.00 Tier 2 Preferred Brand: $35.00 Tier 3 Non-Preferred: $70.00 Tier 4 Injectable: 33% Tier 5 Specialty: 33% | n/a Browse Formulary | |||||
Sterling Option II (PFFS) - H5006-017-2 Benefit Details |
Douglas | $107.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 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) - H5421-067-0 Benefit Details |
Douglas | $112.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 4,339 members Browse Formulary | |||||
CareSource Platinum (HMO-POS) - H3810-004-0 Benefit Details |
Douglas | $113.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 41 members | ||||||
CareSource Gold Plus Rx (HMO) - H3810-003-0 Benefit Details |
Douglas | $114.60 | $0 | No Gap Coverage | Generic: $5.00 Brand: $39.00 Non-preferred Brand: $69.00 Specialty: 3,300% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Regence MedAdvantage (PPO) - H3817-001-0 Benefit Details |
Douglas | $116.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 8,130 members | ||||||
Sterling Option IV (PFFS) - H5006-016-2 Benefit Details |
Douglas | $120.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
Regence MedAdvantage + Rx Classic (PPO) - H3817-002-0 Benefit Details |
Douglas | $126.00 | $200 | No Gap Coverage | Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $56.00 Miscellaneous Injectables: 27% Specialty: 27% | 23,022 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Douglas | $126.10 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 70 members | ||||||
ATRIO MyAdvantage II Rx (HMO) - H3814-006-0 Benefit Details |
Douglas | $133.00 | $310 | No Gap Coverage | TIER 1 - GENERICS: $4.00 TIER 2 - PREFERRED BRAND: $31.00 TIER 3 - NON-PREFERRED BRAND: $50.00 TIER 4 - SPECIALTY: 25% | 868 members Browse Formulary | |||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-027-0 Benefit Details |
Douglas | $140.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 78 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
CareSource Diamond Plus Rx (PPO) - H2481-004-0 Benefit Details |
Douglas | $142.60 | $0 | No Gap Coverage | Generic: $5.00 Brand: $39.00 Non-preferred Brand: $69.00 Specialty: 3,300% | 54 members Browse Formulary | |||||
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ATRIO MyAdvantage Elite Rx (HMO-POS) - H3814-015-0 Benefit Details |
Douglas | $148.00 | $0 | No Gap Coverage | TIER 1 - GENERICS: $4.00 TIER 2 - PREFERRED BRAND: $25.00 TIER 3 - NON-PREFERRED BRAND: $50.00 TIER 4 - SPECIALTY: 25% | 359 members Browse Formulary | |||||
CareSource Platinum Plus Rx (HMO-POS) - H3810-005-0 Benefit Details |
Douglas | $150.70 | $0 | No Gap Coverage | Generic: $5.00 Brand: $39.00 Non-preferred Brand: $69.00 Specialty: 3,300% | 300 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Regence MedAdvantage + Rx Enhanced (PPO) - H3817-003-0 Benefit Details |
Douglas | $176.00 | $0 | Many Generics | Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $56.00 Miscellaneous Injectables: 30% Specialty: 30% | 22,389 members Browse Formulary | |||||
ODS Advantage PPORX Select (PPO) - H3813-003-0 Benefit Details |
Douglas | $223.70 | $0 | All Generics | Tier 1: tbd | 248 members Browse Formulary | |||||
ODS Advantage PPORX (PPO) - H3813-002-0 Benefit Details |
Douglas | $231.90 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% | 103 members Browse Formulary | |||||
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