$dynamicTitle=$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 2 (MSA) - H8468-002-0 Benefit Details |
Potter | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 19 members | ||||||
FreedomBlue PPO HD Rx (PPO) - H3916-020-0 Benefit Details |
Potter | $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 | |||||
Geisinger Gold Classic 3 (HMO) - H3954-098-0 Benefit Details |
Potter | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 438 members | ||||||
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 |
Potter | $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 | ||||||
SecureHorizons MedicareDirect Plan 1 (PFFS) - H5435-001-0 Benefit Details |
Potter | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 27,113 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) - H3333-038-0 Benefit Details |
Potter | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Today's Options Value powered by CCRx (PFFS) - H3333-056-0 Benefit Details |
Potter | $19.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-102 (PFFS) - H2944-102-0 Benefit Details |
Potter | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 926 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6900-001 (PPO) - H6900-001-0 Benefit Details |
Potter | $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% | n/a Browse Formulary | |||||
new | new | new | |||||||||
SecureHorizons MedicareDirect Rx Plan 51 (PFFS) - H5435-014-0 Benefit Details |
Potter | $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 | |||||
Humana Gold Choice H2944-099 (PFFS) - H2944-099-0 Benefit Details |
Potter | $22.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/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 | |||||||||
SecureHorizons MedicareDirect Plan 100 (PFFS) - H5435-020-0 Benefit Details |
Potter | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 4,121 members | ||||||
Geisinger Gold Classic 3 Standard Rx (HMO) - H3954-099-0 Benefit Details |
Potter | $29.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 338 members Browse Formulary | |||||
Today's Options Premier (PFFS) - H3333-032-0 Benefit Details |
Potter | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 7,958 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Geisinger Gold Classic 3 $0 Deductible Rx (HMO) - H3954-100-0 Benefit Details |
Potter | $33.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plan One (PFFS) - H2762-021-0 Benefit Details |
Potter | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 550 members | ||||||
Sterling Basic Plus (PFFS) - H5006-018-1 Benefit Details |
Potter | $39.00 | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-044-0 Benefit Details |
Potter | $40.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 3,276 members Browse Formulary | |||||
Geisinger Gold Classic 2 (HMO) - H3954-009-0 Benefit Details |
Potter | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 199 members | ||||||
Humana Gold Choice H2944-074 (PFFS) - H2944-074-0 Benefit Details |
Potter | $41.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 13,285 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) - H5820-028-0 Benefit Details |
Potter | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 122 members | ||||||
FreedomBlue PPO Select (PPO) - H3916-024-0 Benefit Details |
Potter | $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 | |||||
SecurityChoice Classic (PFFS) - H0540-088-0 Benefit Details |
Potter | $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 |
Potter | $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 | |||||
Geisinger Gold Open 3 (PFFS) - H5812-058-0 Benefit Details |
Potter | $58.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 55 members | ||||||
-- | |||||||||||
Any, Any, Any Gold (PFFS) - H5820-004-0 Benefit Details |
Potter | $59.00 | $0 | No Gap Coverage | Value Generic: $4.00 Generic: $10.00 Preferred Brand: $35.00 Non Preferred Brand: $70.00 Speciality: 33% | 2,337 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 |
Potter | $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 |
Potter | $60.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 174 members | ||||||
-- | |||||||||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Potter | $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 | |||||
Geisinger Gold Classic 2 Standard Rx (HMO) - H3954-038-0 Benefit Details |
Potter | $69.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 121 members Browse Formulary | |||||
Today's Options Premier powered by CCRx (PFFS) - H3333-050-0 Benefit Details |
Potter | $69.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 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 | |||||||||
FreedomBlue PFFS Choice Plus (PFFS) - H9793-001-0 Benefit Details |
Potter | $71.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | 464 members Browse Formulary | |||||
-- | |||||||||||
Geisinger Gold Classic 2 $0 Deductible Rx (HMO) - H3954-039-0 Benefit Details |
Potter | $73.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | 264 members Browse Formulary | |||||
Geisinger Gold Preferred (PPO) - H3924-001-0 Benefit Details |
Potter | $79.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 55 members | ||||||
-- | |||||||||||
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) - H2762-025-0 Benefit Details |
Potter | $85.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 236 members | ||||||
Geisinger Gold Open 3 $0 Deductible Rx (PFFS) - H5812-054-0 Benefit Details |
Potter | $85.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | 132 members Browse Formulary | |||||
-- | |||||||||||
Any, Any, Any Platinum (PFFS) - H5820-010-0 Benefit Details |
Potter | $89.00 | $0 | No Gap Coverage | Value Generic: $2.00 Generic: $7.00 Preferred Brand: $30.00 Non Preferred Brand: $60.00 Speciality: 33% | 97 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 |
Potter | $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 | |||||
Geisinger Gold Secure 2 (HMO) - H3954-106-0 Benefit Details |
Potter | $96.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | < 10 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 II (PFFS) - H5006-017-1 Benefit Details |
Potter | $99.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
Geisinger Gold Classic 1 (HMO) - H3954-003-0 Benefit Details |
Potter | $107.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,258 members | ||||||
Geisinger Gold Preferred Standard Rx (PPO) - H3924-002-0 Benefit Details |
Potter | $108.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 31 members Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Geisinger Gold Preferred $0 Deductible Rx (PPO) - H3924-003-0 Benefit Details |
Potter | $112.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | 395 members Browse Formulary | |||||
-- | |||||||||||
Sterling Option IV (PFFS) - H5006-016-1 Benefit Details |
Potter | $119.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) - H2762-052-0 Benefit Details |
Potter | $130.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 480 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Geisinger Gold Secure 3 (HMO) - H3954-134-0 Benefit Details |
Potter | $130.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | 18 members Browse Formulary | |||||
FreedomBlue PPO Classic (PPO) - H3916-002-0 Benefit Details |
Potter | $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 | |||||
Geisinger Gold Classic 1 Standard Rx (HMO) - H3954-020-0 Benefit Details |
Potter | $136.00 | $310 | 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 | |||||||||
Geisinger Gold Classic 1 $0 Deductible Rx (HMO) - H3954-021-0 Benefit Details |
Potter | $140.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | 5,688 members Browse Formulary | |||||
FreedomBlue PPO Platinum (PPO) - H3916-027-0 Benefit Details |
Potter | $179.00 | $0 | Many Generics | Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | n/a Browse Formulary | |||||
|