$dynamicTitle=$dynamicTitle.' Medicare Advantage Plans'; ?>
2010 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
Geisinger Gold Reserve 3 (MSA) - H8468-003-0 Benefit Details |
Philadelphia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 14 members | ||||||
Aetna Medicare Basic Plan (HMO) - H3931-054-0 Benefit Details |
Philadelphia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Bravo Achieve (HMO) - H3949-024-0 Benefit Details |
Philadelphia | $0.00 | $0 | No Gap Coverage | Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Specialty: 33% Preferred Diabetic Drugs: $0.00 | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Bravo Classic (HMO) - H3949-002-0 Benefit Details |
Philadelphia | $0.00 | $0 | No Gap Coverage | Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Specialty: 33% | 18,994 members Browse Formulary | |||||
CIGNA Medicare Access Plan One (PFFS) - H2762-020-0 Benefit Details |
Philadelphia | $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 |
Philadelphia | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
FRESENIUS MEDICAL CARE HEALTH PLAN (PFFS) - H5606-001-0 Benefit Details |
Philadelphia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 117 members | ||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Philadelphia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Senior Partners Gold (HMO) - H3964-001-0 Benefit Details |
Philadelphia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,114 members | ||||||
Any, Any, Any MA Only (PFFS) - H5820-026-0 Benefit Details |
Philadelphia | $9.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 92 members | ||||||
Senior Partners Gold Rx (HMO) - H3964-003-0 Benefit Details |
Philadelphia | $25.00 | $185 | No Gap Coverage | Generic: $5.00 Preferred Brand: $40.00 Specialty: 28% | 5,924 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 Standard Plan (HMO) - H3931-065-0 Benefit Details |
Philadelphia | $29.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $39.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 6,908 members Browse Formulary | |||||
Any, Any, Any Gold (PFFS) - H5820-002-0 Benefit Details |
Philadelphia | $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 | |||||
Bravo Select (HMO) - H3949-009-0 Benefit Details |
Philadelphia | $ 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% | 6,412 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Bravo Traditions (HMO) - H3949-016-0 Benefit Details |
Philadelphia | $31.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 392 members Browse Formulary | |||||
Senior Partners Silver (HMO) - H3964-002-0 Benefit Details |
Philadelphia | $ 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 | 18,562 members Browse Formulary | |||||
Evercare Plan IP (PPO) - H3912-001-0 Benefit Details |
Philadelphia | $32.10 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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 | |||||||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-024-0 Benefit Details |
Philadelphia | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,787 members | ||||||
Keystone 65 Advantage Medical Only (HMO) - H3952-042-0 Benefit Details |
Philadelphia | $52.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,310 members | ||||||
SecurityChoice Classic (PFFS) - H0540-088-0 Benefit Details |
Philadelphia | $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 |
Philadelphia | $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 |
Philadelphia | $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 Basic Plus (PFFS) - H5006-018-2 Benefit Details |
Philadelphia | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
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 |
Philadelphia | $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 | |||||
Bravo Premier (HMO) - H3949-013-0 Benefit Details |
Philadelphia | $68.00 | $0 | No Gap Coverage | Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Specialty: 33% | 3,601 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) - H3333-138-0 Benefit Details |
Philadelphia | $75.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 191 members | ||||||
Keystone 65 Advantage Rx (HMO) - H3952-043-0 Benefit Details |
Philadelphia | $82.30 | $280 | No Gap Coverage | Generic: $3.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty: 25% | 5,973 members Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) - H2762-050-0 Benefit Details |
Philadelphia | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Keystone 65 Preferred Medical Only (HMO) - H3952-008-0 Benefit Details |
Philadelphia | $87.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,646 members | ||||||
Today's Options Value powered by CCRx (PFFS) - H3333-139-0 Benefit Details |
Philadelphia | $89.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 212 members Browse Formulary | |||||
Sterling Option I (PFFS) - H5006-014-2 Benefit Details |
Philadelphia | $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 | |||||||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Philadelphia | $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) - H5006-017-2 Benefit Details |
Philadelphia | $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 | |||||||||
Aetna Medicare Premier Plan (HMO) - H3931-058-0 Benefit Details |
Philadelphia | $118.50 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $5.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $40.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 33% | 2,699 members Browse Formulary | |||||
Today's Options Premier (PFFS) - H3333-136-0 Benefit Details |
Philadelphia | $119.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 341 members | ||||||
Sterling Option IV (PFFS) - H5006-016-2 Benefit Details |
Philadelphia | $120.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Keystone 65 Preferred Rx (HMO) - H3952-020-0 Benefit Details |
Philadelphia | $128.20 | $100 | Many Generics | Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $80.00 Specialty: 25% | 23,465 members Browse Formulary | |||||
Today's Options Premier powered by CCRx (PFFS) - H3333-137-0 Benefit Details |
Philadelphia | $160.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 221 members Browse Formulary | |||||
Humana Gold Choice H2944-075 (PFFS) - H2944-075-0 Benefit Details |
Philadelphia | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Personal Choice 65 Medical Only (PPO) - H3909-007-0 Benefit Details |
Philadelphia | $225.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 423 members | ||||||
Personal Choice 65 Rx (PPO) - H3909-001-0 Benefit Details |
Philadelphia | $261.20 | $275 | No Gap Coverage | Generic: $3.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty: 25% | 4,100 members Browse Formulary | |||||
|