$dynamicTitle=$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 |
|||||||||
Fresenius Medical Care Health Plan (PFFS) - H5301-002-0 Benefit Details |
Coffee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 74 members | ||||||
HealthSpring HealthyAdvantage (HMO) - H4454-012-0 Benefit Details |
Coffee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,934 members | ||||||
HealthSpring HealthyAdvantage Preferred (HMO) - H4454-002-0 Benefit Details |
Coffee | $0.00 | $0 | Many Generics, Few Brand | Preferred Generic: $2.50 Generic: $7.50 Preferred Brand: $40.00 Non-Preferred Brand: $70.00 Specialty: 33% | 39,180 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-065 (Regional PPO) - R5826-065-0 Benefit Details |
Coffee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
HumanaChoice R5826-065 (Regional PPO) - R5826-065-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Windsor Medicare Extra Emerald Plan (HMO) - H5698-062-0 Benefit Details |
Coffee | $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 |
Coffee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Windsor Medicare Extra Gold Plan (HMO) - H5698-036-0 Benefit Details |
Coffee | $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 | |||||
HealthSpring HealthyLiving Preferred (HMO) - H4454-007-0 Benefit Details |
Coffee | $26.00 | $0 | Many Generics, Few Brand | Preferred Generic: $3.50 Generic: $8.50 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 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 | |||||||||
HealthSpring TotalCare (HMO) - H4454-020-0 Benefit Details |
Coffee | $ 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% | 6,306 members Browse Formulary | |||||
AmeriChoice Secure Plus Complete (HMO) - H0251-001-0 Benefit Details |
Coffee | $ 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% | 9,681 members Browse Formulary | |||||
-- | |||||||||||
Windsor Medicare Extra Comprehensive Plan (HMO) - H5698-003-0 Benefit Details |
Coffee | $ 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% Tier 5: 25% | 2,088 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
BlueAdvantage Sapphire (PPO) - H7917-005-0 Benefit Details |
Coffee | $35.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | 347 members Browse Formulary | |||||
-- | |||||||||||
BlueAdvantage Basic (PFFS) - H4979-001-1 Benefit Details |
Coffee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 430 members | ||||||
HealthSpring HealthyAdvantage Select (HMO) - H4454-021-0 Benefit Details |
Coffee | $55.00 | $0 | Many Generics, Few Brand | Preferred Generic: $2.50 Generic: $7.50 Preferred Brand: $40.00 Non-Preferred Brand: $70.00 Specialty: 33% | 2,016 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) - H5006-018-2 Benefit Details |
Coffee | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
Windsor Medicare Extra Fusion Plan (HMO) - H5698-141-0 Benefit Details |
Coffee | $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 | |||||
HumanaChoice R5826-001 (Regional PPO) - R5826-001-0 Benefit Details |
Coffee | $80.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 3,238 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-001 (Regional PPO) - R5826-001-0 Benefit Details |
Statewide | $80.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 3,238 members Browse Formulary | |||||
BlueAdvantage Classic (PFFS) - H4979-003-1 Benefit Details |
Coffee | $92.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,111 members | ||||||
BlueAdvantage Ruby (PPO) - H7917-013-0 Benefit Details |
Coffee | $93.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $30.00 Tier 4: $55.00 Tier 5: 33% | 160 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) - H5006-014-2 Benefit Details |
Coffee | $94.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
Today's Options Value (PFFS) - H5421-181-0 Benefit Details |
Coffee | $100.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 962 members | ||||||
BlueAdvantage Gold (PFFS) - H5884-003-1 Benefit Details |
Coffee | $101.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $30.00 Tier 4: $55.00 Tier 5: 33% | 4,354 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) - H5006-017-2 Benefit Details |
Coffee | $107.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
Today's Options Value powered by CCRx (PFFS) - H5421-182-0 Benefit Details |
Coffee | $114.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Sterling Option IV (PFFS) - H5006-016-2 Benefit Details |
Coffee | $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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO) - H5698-156-0 Benefit Details |
Coffee | $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 | |||||
BlueAdvantage Diamond (PPO) - H7917-009-0 Benefit Details |
Coffee | $133.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $30.00 Tier 4: $55.00 Tier 5: 33% | 964 members Browse Formulary | |||||
-- | |||||||||||
Today's Options Premier (PFFS) - H5421-179-0 Benefit Details |
Coffee | $134.00 | 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 | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) - H5698-068-0 Benefit Details |
Coffee | $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 | |||||
BlueAdvantage Platinum (PFFS) - H5884-004-1 Benefit Details |
Coffee | $161.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $30.00 Tier 4: $55.00 Tier 5: 33% | 12,199 members Browse Formulary | |||||
Today's Options Premier powered by CCRx (PFFS) - H5421-180-0 Benefit Details |
Coffee | $203.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 735 members Browse Formulary | |||||
|