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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 3 (MSA) - H8468-003-0 Benefit Details |
Fulton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 14 members | ||||||
FreedomBlue PPO HD Rx (PPO) - H3916-025-0 Benefit Details |
Fulton | $0.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | 7,170 members Browse Formulary | |||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Fulton | $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 | ||||||
FreedomBlue PPO Basic Rx (PPO) - H3916-018-0 Benefit Details |
Fulton | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | 5,847 members Browse Formulary | |||||
SeniorBlue - Option 3 (PPO) - H3923-021-0 Benefit Details |
Fulton | $38.60 | $0 | No Gap Coverage | Generic Drugs: $9.00 Formulary Brand Drugs: $45.00 Specialty Drugs: 33% | 352 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Sterling Basic Plus (PFFS) - H5006-018-1 Benefit Details |
Fulton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
FreedomBlue PPO Value (PPO) - H3916-012-0 Benefit Details |
Fulton | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) - H5820-029-0 Benefit Details |
Fulton | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 872 members | ||||||
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 |
Fulton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
SecurityChoice Plus (PFFS) - H0540-089-0 Benefit Details |
Fulton | $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 Gold (PFFS) - H5820-011-0 Benefit Details |
Fulton | $59.00 | $0 | No Gap Coverage | Value Generic: $4.00 Generic: $10.00 Preferred Brand: $35.00 Non Preferred Brand: $70.00 Speciality: 33% | 15,561 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 I (PFFS) - H5006-014-1 Benefit Details |
Fulton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
FreedomBlue PFFS Choice (PFFS) - H9793-002-0 Benefit Details |
Fulton | $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 |
Fulton | $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 | |||||||||
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 | |||||
FreedomBlue PFFS Choice Plus (PFFS) - H9793-001-0 Benefit Details |
Fulton | $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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Today's Options Value (PFFS) - H3333-138-0 Benefit Details |
Fulton | $75.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 191 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any Platinum (PFFS) - H5820-013-0 Benefit Details |
Fulton | $89.00 | $0 | No Gap Coverage | Value Generic: $2.00 Generic: $7.00 Preferred Brand: $30.00 Non Preferred Brand: $60.00 Speciality: 33% | 612 members Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H3333-139-0 Benefit Details |
Fulton | $89.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 212 members Browse Formulary | |||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Fulton | $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 | |||||
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 |
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 | |||||
SeniorBlue - Option 2 (PPO) - H3923-013-0 Benefit Details |
Fulton | $96.70 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $90.00 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Sterling Option II (PFFS) - H5006-017-1 Benefit Details |
Fulton | $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 | |||||||||
FreedomBlue PPO Standard (PPO) - H3916-015-0 Benefit Details |
Fulton | $102.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 7,736 members Browse Formulary | |||||
Sterling Option IV (PFFS) - H5006-016-1 Benefit Details |
Fulton | $119.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
Today's Options Premier (PFFS) - H3333-136-0 Benefit Details |
Fulton | $119.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 341 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Deluxe (PPO) - H3916-005-0 Benefit Details |
Fulton | $138.00 | $0 | Many Generics | Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 17,715 members Browse Formulary | |||||
SeniorBlue - Option 1 (PPO) - H3923-017-0 Benefit Details |
Fulton | $143.60 | $0 | Many Generics | Generic Drugs: $6.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $90.00 Specialty Drugs: 33% | 5,232 members Browse Formulary | |||||
Today's Options Premier powered by CCRx (PFFS) - H3333-137-0 Benefit Details |
Fulton | $160.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 221 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 H2944-075 (PFFS) - H2944-075-0 Benefit Details |
Fulton | $182.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 291 members Browse Formulary | |||||
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