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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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Geisinger Gold Reserve 1 (MSA) - H8468-001-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 564 members | ||||||
AARP MedicareComplete Choice (PPO) - H3921-008-0 Benefit Details |
Erie | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $41.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $79.00 Tier 4 Specialty: 33% | 578 members Browse Formulary | |||||
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Advantra Elite (PPO) - H5522-009-0 Benefit Details |
Erie | $0.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $4.00 Tier 2 - Preferred Brand: $40.00 Tier 3 - Non-Preferred Generic/Non-Preferred Brand: $69.00 Tier 4 - Specialty Drugs: 33% | 2,208 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Advantra Silver (HMO) - H3959-011-0 Benefit Details |
Erie | $0.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generics: $6.00 Tier 2 - Preferred Brand: $32.00 Tier 3 - Non-Preferred Generic/Non-Preferred Brand: $64.00 Tier 4 - Specialty Drugs: 33% | 3,360 members Browse Formulary | |||||
Advantra Silver (PPO) - H5522-005-0 Benefit Details |
Erie | $0.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $4.00 Tier 2 - Preferred Brand: $41.00 Tier 3 - Non-Preferred Generic/Non-Preferred Brand: $66.00 Tier 4 - Specialty Drugs: 33% | 2,276 members Browse Formulary | |||||
CIGNA Medicare Access Plan One (PFFS) - H2762-020-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 13,290 members | ||||||
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) - H2762-042-0 Benefit Details |
Erie | $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 | |||||
FreedomBlue PPO HD Rx (PPO) - H3916-020-0 Benefit Details |
Erie | $0.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | 3,308 members Browse Formulary | |||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Erie | $0.00 | 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 | |||||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
SecureHorizons MedicareDirect Plan 1 (PFFS) - H5435-001-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 27,113 members | ||||||
Unison Advantage Basic (HMO) - H3920-007-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 278 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Unison Advantage Choice (HMO) - H3920-001-0 Benefit Details |
Erie | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $35.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $65.00 Tier 4 Specialty: 33% | 5,149 members Browse Formulary | |||||
UPMC for Life (HMO) - H3907-002-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 15,128 members | ||||||
UPMC for Life PPO High Deductible with Rx (PPO) - H5533-003-0 Benefit Details |
Erie | $0.00 | $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% | 363 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) - H5820-026-0 Benefit Details |
Erie | $9.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 92 members | ||||||
Today's Options Value (PFFS) - H3333-039-0 Benefit Details |
Erie | $10.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 956 members | ||||||
Today's Options Advantage 2 powered by CCRx (PPO) - H2775-090-0 Benefit Details |
Erie | $19.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 646 members Browse Formulary | |||||
new | new | new | |||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-102 (PFFS) - H2944-102-0 Benefit Details |
Erie | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 926 members | ||||||
HumanaChoice H6900-002 (PPO) - H6900-002-0 Benefit Details |
Erie | $20.00 | $0 | Few Generics, Few Brand | Preferred Generic: $7.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 393 members Browse Formulary | |||||
new | new | new | |||||||||
SecureHorizons MedicareDirect Rx Plan 51 (PFFS) - H5435-014-0 Benefit Details |
Erie | $20.00 | $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% | 61,945 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 H2944-101 (PFFS) - H2944-101-0 Benefit Details |
Erie | $22.00 | $0 | Few Generics, Few Brand | Preferred Generic: $9.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 24 members Browse Formulary | |||||
SecureHorizons MedicareDirect Plan 100 (PFFS) - H5435-020-0 Benefit Details |
Erie | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 4,121 members | ||||||
SecurityBlue Value (HMO) - H3957-025-0 Benefit Details |
Erie | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 655 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecurityBlue Care (HMO) - H3957-030-0 Benefit Details |
Erie | $ 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% | n/a Browse Formulary | |||||
Any, Any, Any Gold (PFFS) - H5820-002-0 Benefit Details |
Erie | $29.00 | $0 | No Gap Coverage | Value Generic: $4.00 Generic: $10.00 Preferred Brand: $35.00 Non Preferred Brand: $70.00 Speciality: 33% | 985 members Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H3333-057-0 Benefit Details |
Erie | $29.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 843 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 H2944-077 (PFFS) - H2944-077-0 Benefit Details |
Erie | $30.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 2,221 members Browse Formulary | |||||
Gateway Health Plan Medicare Assured (HMO) - H5932-001-0 Benefit Details |
Erie | $ 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: $94.75 Tier 4: 25% | 25,546 members Browse Formulary | |||||
Unison Advantage Plus (HMO) - H3920-003-0 Benefit Details |
Erie | $ 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% | 11,739 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
UPMC for Life Specialty Plan (HMO) - H3907-020-0 Benefit Details |
Erie | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Generics: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty: 33% | 15,487 members Browse Formulary | |||||
Sterling Basic Plus (PFFS) - H5006-018-1 Benefit Details |
Erie | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
SecurityBlue Basic (HMO) - H3957-032-0 Benefit Details |
Erie | $43.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 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 | |||||||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-024-0 Benefit Details |
Erie | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,787 members | ||||||
Today's Options Advantage 1 powered by CCRx (PPO) - H2775-078-0 Benefit Details |
Erie | $49.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 129 members Browse Formulary | |||||
new | new | new | |||||||||
Today's Options Premier (PFFS) - H3333-033-0 Benefit Details |
Erie | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,587 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Select (PPO) - H3916-024-0 Benefit Details |
Erie | $51.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty: 33% | 2,620 members Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) - H3907-029-0 Benefit Details |
Erie | $53.00 | $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% | 30,979 members Browse Formulary | |||||
SecurityChoice Classic (PFFS) - H0540-088-0 Benefit Details |
Erie | $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 |
Erie | $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 | |||||
Any, Any, Any Platinum (PFFS) - H5820-008-0 Benefit Details |
Erie | $59.00 | $0 | No Gap Coverage | Value Generic: $2.00 Generic: $7.00 Preferred Brand: $30.00 Non Preferred Brand: $60.00 Speciality: 33% | 75 members Browse Formulary | |||||
Sterling Option I (PFFS) - H5006-014-1 Benefit Details |
Erie | $59.00 | 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 | |||||||||
FreedomBlue PFFS Choice (PFFS) - H9793-002-0 Benefit Details |
Erie | $60.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 174 members | ||||||
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HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Erie | $67.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 590 members Browse Formulary | |||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Statewide | $67.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 590 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
FreedomBlue PFFS Choice Plus (PFFS) - H9793-001-0 Benefit Details |
Erie | $71.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | 464 members Browse Formulary | |||||
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Advantra Gold (HMO) - H3959-002-0 Benefit Details |
Erie | $76.00 | $0 | Many Generics | Tier 1 - Preferred Generics: $5.00 Tier 2 - Preferred Brand: $38.00 Tier 3 - Non-Preferred Generic/Non-Preferred Brand: $69.00 Tier 4 - Specialty Drugs: 33% | 9,478 members Browse Formulary | |||||
Today's Options Advantage 3 powered by CCRx (PPO) - H2775-084-0 Benefit Details |
Erie | $82.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 132 members Browse Formulary | |||||
new | new | new | |||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Advantra Gold (PPO) - H5522-003-0 Benefit Details |
Erie | $84.00 | $0 | Many Generics | Tier 1 - Preferred Generic: $6.00 Tier 2 - Preferred Brand: $37.00 Tier 3 - Non-Preferred Generic/Non-Preferred Brand: $70.00 Tier 4 - Specialty Drugs: 33% | 2,362 members Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) - H2762-050-0 Benefit Details |
Erie | $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 powered by CCRx (PFFS) - H3333-051-0 Benefit Details |
Erie | $92.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 598 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Erie | $95.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty: 33% | 2,986 members Browse Formulary | |||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Statewide | $95.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty: 33% | 2,986 members Browse Formulary | |||||
Sterling Option II (PFFS) - H5006-017-1 Benefit Details |
Erie | $99.00 | $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 | |||||||||
Sterling Option IV (PFFS) - H5006-016-1 Benefit Details |
Erie | $119.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
SecurityBlue Standard (HMO) - H3957-006-0 Benefit Details |
Erie | $120.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 7,172 members Browse Formulary | |||||
FreedomBlue PPO Classic (PPO) - H3916-002-0 Benefit Details |
Erie | $133.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 4,987 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
UPMC for Life HMO Rx Enhanced (HMO) - H3907-006-0 Benefit Details |
Erie | $141.00 | $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% | 8,673 members Browse Formulary | |||||
SecurityBlue Deluxe (HMO) - H3957-021-0 Benefit Details |
Erie | $151.00 | $0 | Many Generics | Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 9,092 members Browse Formulary | |||||
FreedomBlue PPO Platinum (PPO) - H3916-027-0 Benefit Details |
Erie | $179.00 | $0 | Many Generics | Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 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 | |||||||||
UPMC for Life PPO Rx Enhanced (PPO) - H5533-002-0 Benefit Details |
Erie | $211.50 | $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% | 777 members Browse Formulary | |||||
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