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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 |
Jefferson | $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 |
Jefferson | $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 MedicareDirect Plan 2 (PFFS) - H5435-002-0 Benefit Details |
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 16,559 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx Plan 55 (PFFS) - H5435-024-0 Benefit Details |
Jefferson | $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 | |||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-024-0 Benefit Details |
Jefferson | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,787 members | ||||||
SecurityChoice Classic (PFFS) - H0540-088-0 Benefit Details |
Jefferson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecurityChoice Plus (PFFS) - H0540-089-0 Benefit Details |
Jefferson | $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 |
Jefferson | $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 | |||||
Today's Options Value (PFFS) - H5421-165-0 Benefit Details |
Jefferson | $65.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,006 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 powered by CCRx (PFFS) - H5421-166-0 Benefit Details |
Jefferson | $76.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 3,797 members Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) - H2762-050-0 Benefit Details |
Jefferson | $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 | |||||
Today's Options Premier (PFFS) - H5421-163-0 Benefit Details |
Jefferson | $104.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 6,062 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Value Plan (HMO) - H3864-002-0 Benefit Details |
Jefferson | $124.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 535 members | ||||||
ODS Advantage PPO (PPO) - H3813-001-0 Benefit Details |
Jefferson | $126.10 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 70 members | ||||||
Traditional Plan (HMO-POS) - H3864-001-0 Benefit Details |
Jefferson | $140.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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 |
Jefferson | $151.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 2,969 members Browse Formulary | |||||
Value + Rx Plan (HMO) - H3864-006-0 Benefit Details |
Jefferson | $153.00 | $125 | No Gap Coverage | Preferred Generic: $10.00 Preferred Brand: $31.00 Specialty: 25% | 2,822 members Browse Formulary | |||||
Traditional + Rx Plan (HMO-POS) - H3864-007-0 Benefit Details |
Jefferson | $186.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $55.00 Specialty: 25% | 3,500 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 PPORX Select (PPO) - H3813-003-0 Benefit Details |
Jefferson | $223.70 | $0 | All Generics | Tier 1: tbd | 248 members Browse Formulary | |||||
ODS Advantage PPORX (PPO) - H3813-002-0 Benefit Details |
Jefferson | $231.90 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% | 103 members Browse Formulary | |||||
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