$dynamicTitle=$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 |
|||||||||
Care Improvement Plus Gold Rx (Regional PPO) - R9896-009-0 Benefit Details |
Fairfield | $0.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx (Regional PPO) - R9896-009-0 Benefit Details |
Statewide | $0.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plan One (PFFS) - H2762-012-0 Benefit Details |
Fairfield | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,544 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Guardian Tribute (PFFS) - H4917-001-0 Benefit Details |
Fairfield | $0.00 | $0 | Many Generics | Generic: $0.00 Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty: 33% | 9,349 members Browse Formulary | |||||
new | new | new | |||||||||
Guardian Tribute Pride Plan (PFFS) - H4917-003-0 Benefit Details |
Fairfield | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 8,495 members | ||||||
new | new | new | |||||||||
HumanaChoice R5826-064 (Regional PPO) - R5826-064-0 Benefit Details |
Fairfield | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,697 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-064 (Regional PPO) - R5826-064-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,697 members | ||||||
Medicare Blue (PPO) - H4209-001-0 Benefit Details |
Fairfield | $0.00 | $0 | No Gap Coverage | Generics: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $75.00 Specialty: 33% | 2,867 members Browse Formulary | |||||
-- | |||||||||||
Medicare Blue Private (PFFS) - H4205-002-0 Benefit Details |
Fairfield | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,510 members | ||||||
new | new | new | |||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Presidential Plan (PFFS) - H9720-025-0 Benefit Details |
Fairfield | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 141 members | ||||||
-- | |||||||||||
SecurityChoice Classic (PFFS) - H0540-001-0 Benefit Details |
Fairfield | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 22,271 members | ||||||
Windsor Medicare Extra Emerald Plan (HMO) - H5698-062-0 Benefit Details |
Fairfield | $0.00 | $0 | Few Generics | Tier 1- Preferred Generic: $5.00 Tier 2 - Generic or Brand: $10.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - NonPreferred Brand/NonPreferred Generic: $60.00 Tier 5 - 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 | |||||||||
Windsor Medicare Extra Silver Plan (HMO) - H5698-035-0 Benefit Details |
Fairfield | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) - R9896-010-0 Benefit Details |
Fairfield | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) - R9896-010-0 Benefit Details |
Statewide | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary 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 Plus RX Plan Two (PFFS) - H2762-028-0 Benefit Details |
Fairfield | $20.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 7,225 members Browse Formulary | |||||
SecurityChoice Plus (PFFS) - H0540-020-0 Benefit Details |
Fairfield | $23.00 | $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% | 15,526 members Browse Formulary | |||||
Humana Gold Choice H2944-150 (PFFS) - H2944-150-0 Benefit Details |
Fairfield | $24.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 155 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Gold Plan (HMO) - H5698-036-0 Benefit Details |
Fairfield | $25.00 | $0 | Few Generics | Tier 1- Preferred Generic: $5.00 Tier 2 - Generic or Brand: $10.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - NonPreferred Brand/NonPreferred Generic: $60.00 Tier 5 - Specialty: 33% | 3,309 members Browse Formulary | |||||
Today's Options Value (PFFS) - H5421-055-0 Benefit Details |
Fairfield | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 5,383 members | ||||||
Care Improvement Plus Silver Rx (Regional PPO) - R9896-008-0 Benefit Details |
Fairfield | $32.50 | $0 | No Gap Coverage | Formulary Generic: $0.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary 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 | |||||||||
Care Improvement Plus Silver Rx (Regional PPO) - R9896-008-0 Benefit Details |
Statewide | $32.50 | $0 | No Gap Coverage | Formulary Generic: $0.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Sterling Basic Plus (PFFS) - H5006-018-1 Benefit Details |
Fairfield | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
Medicare Blue Private Complete (PFFS) - H4205-005-0 Benefit Details |
Fairfield | $43.00 | $0 | Many Generics | Value Generics: $3.00 Generics: $11.00 Preferred Brand: $40.00 Non-Preferred Brand: $75.00 Specialty: 33% | n/a 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 | |||||||||
Presidential Plus Plan (PFFS) - H9720-026-0 Benefit Details |
Fairfield | $45.00 | $0 | No Gap Coverage | Tier 1: $0.00 Tier2: $45.00 Tier 3: $75.00 Tier 4: 33% | 117 members Browse Formulary | |||||
-- | |||||||||||
Any, Any, Any MA Only (PFFS) - H5820-029-0 Benefit Details |
Fairfield | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 872 members | ||||||
Guardian Tribute Enhanced (PFFS) - H4917-002-0 Benefit Details |
Fairfield | $49.00 | $0 | Many Generics | Generic: $0.00 Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty: 33% | 749 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 | |||||||||
Care Improvement Plus Medicare Advantage (Regional PPO) - R9896-012-0 Benefit Details |
Fairfield | $50.00 | $0 | No Gap Coverage | Formulary Generic: $9.00 Formulary Preferred Brand: $37.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (Regional PPO) - R9896-012-0 Benefit Details |
Statewide | $50.00 | $0 | No Gap Coverage | Formulary Generic: $9.00 Formulary Preferred Brand: $37.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H5421-073-0 Benefit Details |
Fairfield | $51.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 10,805 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 H2944-149 (PFFS) - H2944-149-0 Benefit Details |
Fairfield | $56.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 4,555 members Browse Formulary | |||||
HumanaChoice R5826-077 (Regional PPO) - R5826-077-0 Benefit Details |
Fairfield | $57.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 148 members Browse Formulary | |||||
HumanaChoice R5826-077 (Regional PPO) - R5826-077-0 Benefit Details |
Statewide | $57.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 148 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 Gold (PFFS) - H5820-011-0 Benefit Details |
Fairfield | $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 | |||||
HumanaChoice R5826-004 (Regional PPO) - R5826-004-0 Benefit Details |
Fairfield | $59.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $84.00 Specialty: 33% | 14,668 members Browse Formulary | |||||
HumanaChoice R5826-004 (Regional PPO) - R5826-004-0 Benefit Details |
Statewide | $59.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $84.00 Specialty: 33% | 14,668 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 |
Fairfield | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-016-0 Benefit Details |
Fairfield | $60.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 608 members | ||||||
Today's Options Premier (PFFS) - H5421-049-0 Benefit Details |
Fairfield | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 8,597 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Fusion Plan (HMO) - H5698-141-0 Benefit Details |
Fairfield | $74.00 | $0 | No Gap Coverage | Tier 1- Preferred Generic or Brand: $5.00 Tier 2 - Generic or Brand: $10.00 Tier 3 - Preferred Brand: $25.00 Tier 4 - Non-Preferred Brand/Non-Preferred Generic: $45.00 Tier 5 - Specialty: 33% | 219 members Browse Formulary | |||||
Medicare Blue Private Complete Plus (PFFS) - H4205-007-0 Benefit Details |
Fairfield | $85.00 | $0 | Many Generics | Value Generics: $3.00 Generics: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $75.00 Specialty: 33% | 747 members Browse Formulary | |||||
new | new | new | |||||||||
Any, Any, Any Platinum (PFFS) - H5820-013-0 Benefit Details |
Fairfield | $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 | |||||
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 Four (PFFS) - H2762-036-0 Benefit Details |
Fairfield | $90.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 2,420 members Browse Formulary | |||||
Medicare Blue Plus (PPO) - H4209-004-0 Benefit Details |
Fairfield | $99.00 | $0 | Many Generics | Value Generics: $2.00 Generics: $9.00 Value Preferred Brand: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $75.00 Specialty: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Sterling Option II (PFFS) - H5006-017-1 Benefit Details |
Fairfield | $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 | |||||||||
Today's Options Premier powered by CCRx (PFFS) - H5421-067-0 Benefit Details |
Fairfield | $112.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 4,339 members Browse Formulary | |||||
Sterling Option IV (PFFS) - H5006-016-1 Benefit Details |
Fairfield | $119.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO) - H5698-156-0 Benefit Details |
Fairfield | $132.00 | $0 | No Gap Coverage | Tier 1- Preferred Generic or Brand: $5.00 Tier 2 - Generic or Brand: $10.00 Tier 3 - Preferred Brand: $25.00 Tier 4 - Non-Preferred Brand/Non-Preferred Generic: $45.00 Tier 5 - Specialty: 33% | 96 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) - H5698-068-0 Benefit Details |
Fairfield | $138.00 | $0 | Few Generics | Tier 1- Preferred Generic: $5.00 Tier 2 - Generic or Brand: $10.00 Tier 3 - Preferred Brand: $35.00 Tier 4 - NonPreferred Brand/NonPreferred Generic: $60.00 Tier 5 - Specialty: 33% | n/a Browse Formulary | |||||
|