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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 2 (MSA) - H8468-002-0 Benefit Details |
Susquehanna | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 19 members | ||||||
FreedomBlue PPO HD Rx (PPO) - H3916-025-0 Benefit Details |
Susquehanna | $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 | |||||
Geisinger Gold Classic 3 (HMO) - H3954-098-0 Benefit Details |
Susquehanna | $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 |
Statewide | $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 |
Susquehanna | $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 |
Susquehanna | $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) - H3333-039-0 Benefit Details |
Susquehanna | $10.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 956 members | ||||||
Geisinger Gold Classic 2 (HMO) - H3954-089-0 Benefit Details |
Susquehanna | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 13 members | ||||||
Humana Gold Choice H2944-102 (PFFS) - H2944-102-0 Benefit Details |
Susquehanna | $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 | |||||||||
SecureHorizons MedicareDirect Rx Plan 51 (PFFS) - H5435-014-0 Benefit Details |
Susquehanna | $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 |
Susquehanna | $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 | |||||
SecureHorizons MedicareDirect Plan 100 (PFFS) - H5435-020-0 Benefit Details |
Susquehanna | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 4,121 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 Standard Rx (HMO) - H3954-099-0 Benefit Details |
Susquehanna | $29.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 338 members Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H3333-057-0 Benefit Details |
Susquehanna | $29.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 843 members Browse Formulary | |||||
Geisinger Gold Secure 1 (HMO) - H3954-097-0 Benefit Details |
Susquehanna | $ 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: $95.00 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 | |||||||||
Geisinger Gold Classic 3 $0 Deductible Rx (HMO) - H3954-100-0 Benefit Details |
Susquehanna | $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 | |||||
FreedomBlue PPO Basic Rx (PPO) - H3916-018-0 Benefit Details |
Susquehanna | $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 | |||||
CIGNA Medicare Access Plan One (PFFS) - H2762-021-0 Benefit Details |
Susquehanna | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 550 members | ||||||
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 |
Susquehanna | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-044-0 Benefit Details |
Susquehanna | $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 | |||||
FreedomBlue PPO Value (PPO) - H3916-012-0 Benefit Details |
Susquehanna | $40.00 | 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 | |||||||||
Humana Gold Choice H2944-074 (PFFS) - H2944-074-0 Benefit Details |
Susquehanna | $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 | |||||
Any, Any, Any MA Only (PFFS) - H5820-028-0 Benefit Details |
Susquehanna | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 122 members | ||||||
Geisinger Gold Classic 2 Standard Rx (HMO) - H3954-090-0 Benefit Details |
Susquehanna | $49.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | < 10 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 Premier (PFFS) - H3333-033-0 Benefit Details |
Susquehanna | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,587 members | ||||||
Geisinger Gold Classic 2 $0 Deductible Rx (HMO) - H3954-091-0 Benefit Details |
Susquehanna | $53.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | 57 members Browse Formulary | |||||
SecurityChoice Classic (PFFS) - H0540-088-0 Benefit Details |
Susquehanna | $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 |
Susquehanna | $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 |
Susquehanna | $58.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 55 members | ||||||
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Any, Any, Any Gold (PFFS) - H5820-004-0 Benefit Details |
Susquehanna | $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 |
Susquehanna | $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 |
Susquehanna | $60.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 174 members | ||||||
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Geisinger Gold Preferred (PPO) - H3924-017-0 Benefit Details |
Susquehanna | $60.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 52 members | ||||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Geisinger Gold Classic 1 (HMO) - H3954-110-0 Benefit Details |
Susquehanna | $63.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 38 members | ||||||
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 | |||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Susquehanna | $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 |
Susquehanna | $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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CIGNA Medicare Access Plan Three (PFFS) - H2762-025-0 Benefit Details |
Susquehanna | $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 |
Susquehanna | $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 | |||||
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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) - H5820-010-0 Benefit Details |
Susquehanna | $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 | |||||
Geisinger Gold Preferred Standard Rx (PPO) - H3924-018-0 Benefit Details |
Susquehanna | $89.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 31 members Browse Formulary | |||||
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Geisinger Gold Classic 1 Standard Rx (HMO) - H3954-111-0 Benefit Details |
Susquehanna | $92.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 36 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 Premier powered by CCRx (PFFS) - H3333-051-0 Benefit Details |
Susquehanna | $92.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 598 members Browse Formulary | |||||
Geisinger Gold Preferred $0 Deductible Rx (PPO) - H3924-019-0 Benefit Details |
Susquehanna | $93.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | 418 members Browse Formulary | |||||
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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 | |||||
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 |
Susquehanna | $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 Classic 1 $0 Deductible Rx (HMO) - H3954-112-0 Benefit Details |
Susquehanna | $96.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | 181 members Browse Formulary | |||||
Geisinger Gold Secure 2 (HMO) - H3954-106-0 Benefit Details |
Susquehanna | $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 |
Susquehanna | $99.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) - H3916-015-0 Benefit Details |
Susquehanna | $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 | |||||
Geisinger Gold Secure 3 (HMO) - H3954-135-0 Benefit Details |
Susquehanna | $115.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | 16 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 |
Susquehanna | $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 |
Susquehanna | $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 | |||||
FreedomBlue PPO Deluxe (PPO) - H3916-005-0 Benefit Details |
Susquehanna | $138.00 | $0 | Many Generics | Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 17,715 members Browse Formulary | |||||
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