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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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HealthSpring HealthyAdvantage (HMO) - H4454-012-0 Benefit Details |
Sequatchie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,934 members | ||||||
HealthSpring HealthyAdvantage Preferred East& West (HMO) - H4454-019-0 Benefit Details |
Sequatchie | $0.00 | $0 | Many Generics, Few Brand | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $60.00 Specialty: 33% | 8,627 members Browse Formulary | |||||
HumanaChoice R5826-065 (Regional PPO) - R5826-065-0 Benefit Details |
Sequatchie | $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 | |||||||||
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 | ||||||
SecureHorizons MedicareDirect Plan 2 (PFFS) - H5435-002-0 Benefit Details |
Sequatchie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 16,559 members | ||||||
SecureHorizons MedicareDirect Rx Plan 55 (PFFS) - H5435-024-0 Benefit Details |
Sequatchie | $0.00 | $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% | 54,374 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecurityChoice Classic (PFFS) - H0540-001-0 Benefit Details |
Sequatchie | $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 |
Sequatchie | $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 | |||||
Windsor Medicare Extra Silver Plan (HMO) - H5698-035-0 Benefit Details |
Sequatchie | $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 | |||||||||
BlueAdvantage Basic (PFFS) - H4979-001-3 Benefit Details |
Sequatchie | $13.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 430 members | ||||||
SecurityChoice Plus (PFFS) - H0540-020-0 Benefit Details |
Sequatchie | $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 | |||||
Windsor Medicare Extra Gold Plan (HMO) - H5698-036-0 Benefit Details |
Sequatchie | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HealthSpring HealthyLiving Preferred (HMO) - H4454-007-0 Benefit Details |
Sequatchie | $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 | |||||
HealthSpring HealthyAdvantage Primary Plan (HMO) - H4454-028-0 Benefit Details |
Sequatchie | $27.30 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 783 members Browse Formulary | |||||
BlueAdvantage Sapphire (PPO) - H7917-006-0 Benefit Details |
Sequatchie | $30.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | 307 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 | |||||||||
Humana Gold Choice H2944-093 (PFFS) - H2944-093-0 Benefit Details |
Sequatchie | $36.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 422 members Browse Formulary | |||||
Sterling Basic Plus (PFFS) - H5006-018-1 Benefit Details |
Sequatchie | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
CIGNA Medicare Access Plan One (PFFS) - H2762-014-0 Benefit Details |
Sequatchie | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 215 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HealthSpring HealthyAdvantage Select (HMO) - H4454-021-0 Benefit Details |
Sequatchie | $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 | |||||
Sterling Option I (PFFS) - H5006-014-1 Benefit Details |
Sequatchie | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
Today's Options Value (PFFS) - H5421-165-0 Benefit Details |
Sequatchie | $65.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,006 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) - H2762-032-0 Benefit Details |
Sequatchie | $70.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 942 members Browse Formulary | |||||
Windsor Medicare Extra Fusion Plan (HMO) - H5698-141-0 Benefit Details |
Sequatchie | $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 | |||||
Today's Options Value powered by CCRx (PFFS) - H5421-166-0 Benefit Details |
Sequatchie | $76.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 3,797 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
BlueAdvantage Classic (PFFS) - H4979-003-4 Benefit Details |
Sequatchie | $77.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,111 members | ||||||
BlueAdvantage Ruby (PPO) - H7917-014-0 Benefit Details |
Sequatchie | $77.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $30.00 Tier 4: $55.00 Tier 5: 33% | 852 members Browse Formulary | |||||
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HumanaChoice R5826-001 (Regional PPO) - R5826-001-0 Benefit Details |
Sequatchie | $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 Gold (PFFS) - H5884-003-2 Benefit Details |
Sequatchie | $81.00 | $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 | |||||
Humana Gold Choice H2944-092 (PFFS) - H2944-092-0 Benefit Details |
Sequatchie | $84.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 6,467 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 |
Sequatchie | $99.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
Today's Options Premier (PFFS) - H5421-163-0 Benefit Details |
Sequatchie | $104.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 6,062 members | ||||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-018-0 Benefit Details |
Sequatchie | $110.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 151 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
BlueAdvantage Diamond (PPO) - H7917-010-0 Benefit Details |
Sequatchie | $117.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $30.00 Tier 4: $55.00 Tier 5: 33% | 5,327 members Browse Formulary | |||||
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Sterling Option IV (PFFS) - H5006-016-1 Benefit Details |
Sequatchie | $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 |
Sequatchie | $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 | |||||||||
BlueAdvantage Platinum (PFFS) - H5884-004-2 Benefit Details |
Sequatchie | $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% | 12,199 members Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) - H5698-068-0 Benefit Details |
Sequatchie | $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 | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) - H2762-040-0 Benefit Details |
Sequatchie | $145.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 254 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) - H5421-164-0 Benefit Details |
Sequatchie | $151.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 2,969 members Browse Formulary | |||||
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