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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. |
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AARP MedicareComplete (HMO) - H4514-007-0 Benefit Details |
Liberty | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $38.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $72.00 Tier 4 Specialty: 33% | 3,822 members Browse Formulary | |||||
Bravo Achieve (HMO) - H4528-014-0 Benefit Details |
Liberty | $0.00 | $0 | No Gap Coverage | Generic: $3.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Specialty: 33% Preferred Diabetic Drugs: $0.00 | n/a Browse Formulary | |||||
Bravo Classic Plus (HMO-POS) - H4528-001-0 Benefit Details |
Liberty | $0.00 | $0 | No Gap Coverage | Generic: $3.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Specialty: 33% | 9,788 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Bravo Liberty I (PFFS) - H7406-006-0 Benefit Details |
Liberty | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 108 members | ||||||
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Bravo Liberty II Rx (PFFS) - H7406-004-0 Benefit Details |
Liberty | $0.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 186 members Browse Formulary | |||||
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Bravo Liberty Silver (PFFS) - H7406-011-0 Benefit Details |
Liberty | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 174 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 | |||||||||
Care Improvement Plus Gold Rx (Regional PPO) - R6801-009-0 Benefit Details |
Liberty | $0.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 8,547 members Browse Formulary | |||||
Care Improvement Plus Gold Rx (Regional PPO) - R6801-009-0 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% | 8,547 members Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (PPO) - H0084-001-0 Benefit Details |
Liberty | $0.00 | $0 | No Gap Coverage | Formulary Generic: $9.00 Formulary Preferred Brand: $39.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 775 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 | |||||||||
CIGNA Medicare Access Plan One (PFFS) - H2762-012-0 Benefit Details |
Liberty | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,544 members | ||||||
FRESENIUS MEDICAL CARE HEALTH PLAN (PFFS) - H5962-001-0 Benefit Details |
Liberty | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 198 members | ||||||
HealthSpring HealthyAdvantage Preferred (HMO) - H4513-001-0 Benefit Details |
Liberty | $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% | 28,258 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HealthSpring HealthyAdvantage True Choice (HMO) - H4513-009-0 Benefit Details |
Liberty | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
HumanaChoice R5826-026 (Regional PPO) - R5826-026-0 Benefit Details |
Liberty | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 5,537 members | ||||||
HumanaChoice R5826-026 (Regional PPO) - R5826-026-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 5,537 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Plan 1 (PFFS) - H5435-001-0 Benefit Details |
Liberty | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 27,113 members | ||||||
SecurityChoice Classic (PFFS) - H0540-001-0 Benefit Details |
Liberty | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 22,271 members | ||||||
TexanPlus Classic powered by CCRx (HMO) - H4506-003-0 Benefit Details |
Liberty | $0.00 | $0 | All Generics | Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 32,009 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
TexanPlus Premier powered by CCRx (HMO) - H4506-025-0 Benefit Details |
Liberty | $0.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 13,529 members Browse Formulary | |||||
TexanPlus Value (HMO) - H4506-010-0 Benefit Details |
Liberty | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,417 members | ||||||
Any, Any, Any MA Only (PFFS) - H5820-026-0 Benefit Details |
Liberty | $9.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 92 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) - R6801-010-0 Benefit Details |
Liberty | $12.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 2,341 members Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) - R6801-010-0 Benefit Details |
Statewide | $12.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 2,341 members Browse Formulary | |||||
Today's Options Value (PFFS) - H5421-101-0 Benefit Details |
Liberty | $15.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 47 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) - H2762-028-0 Benefit Details |
Liberty | $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 | |||||
SecureHorizons MedicareDirect Rx Plan 51 (PFFS) - H5435-014-0 Benefit Details |
Liberty | $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 | |||||
HealthSpring TotalCare (HMO) - H4513-010-0 Benefit Details |
Liberty | $ 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% | 10,072 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecurityChoice Plus (PFFS) - H0540-020-0 Benefit Details |
Liberty | $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 | |||||
Today's Options Advantage 2 powered by CCRx (PPO) - H5378-016-0 Benefit Details |
Liberty | $26.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 276 members Browse Formulary | |||||
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Bravo Traditions (HMO) - H4528-013-0 Benefit Details |
Liberty | $27.50 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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 | |||||||||
Care Improvement Plus Silver Rx (Regional PPO) - R6801-008-0 Benefit Details |
Liberty | $27.50 | $0 | No Gap Coverage | Formulary Generic: $9.00 Formulary Preferred Brand: $43.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 4,489 members Browse Formulary | |||||
Care Improvement Plus Silver Rx (Regional PPO) - R6801-008-0 Benefit Details |
Statewide | $27.50 | $0 | No Gap Coverage | Formulary Generic: $9.00 Formulary Preferred Brand: $43.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 4,489 members Browse Formulary | |||||
Any, Any, Any Gold (PFFS) - H5820-002-0 Benefit Details |
Liberty | $29.00 | $0 | No Gap Coverage | Value Generic: $4.00 Generic: $10.00 Preferred Brand: $35.00 Non Preferred Brand: $70.00 Speciality: 33% | 985 members 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 Medicare Advantage (Regional PPO) - R6801-012-0 Benefit Details |
Liberty | $33.00 | $0 | No Gap Coverage | Formulary Generic: $9.00 Formulary Preferred Brand: $39.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 2,438 members Browse Formulary | |||||
Care Improvement Plus Medicare Advantage (Regional PPO) - R6801-012-0 Benefit Details |
Statewide | $33.00 | $0 | No Gap Coverage | Formulary Generic: $9.00 Formulary Preferred Brand: $39.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | 2,438 members Browse Formulary | |||||
Today's Options Advantage 1 powered by CCRx (PPO) - H5378-004-0 Benefit Details |
Liberty | $35.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 190 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 | |||||||||
Today's Options Premier (PFFS) - H5421-100-0 Benefit Details |
Liberty | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 241 members | ||||||
Today's Options Value powered by CCRx (PFFS) - H5421-104-0 Benefit Details |
Liberty | $36.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 125 members Browse Formulary | |||||
HumanaChoice H4520-018 (PPO) - H4520-018-0 Benefit Details |
Liberty | $48.00 | $0 | Few Generics, Few Brand | Preferred Generic: $7.00 Non-Preferred Generic/Preferred Brand: $44.00 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 | |||||||||
HealthSpring HealthyAdvantage Select (HMO) - H4513-022-0 Benefit Details |
Liberty | $50.00 | $0 | Many Generics, Few Brand | Preferred Generic: $4.00 Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $60.00 Specialty: 33% | 794 members Browse Formulary | |||||
HumanaChoice R5826-012 (Regional PPO) - R5826-012-0 Benefit Details |
Liberty | $51.00 | $0 | Few Generics, Few Brand | Preferred Generic: $7.00 Non-Preferred Generic/Preferred Brand: $44.00 Non-Preferred Brand: $80.00 Specialty: 33% | 35,590 members Browse Formulary | |||||
HumanaChoice R5826-012 (Regional PPO) - R5826-012-0 Benefit Details |
Statewide | $51.00 | $0 | Few Generics, Few Brand | Preferred Generic: $7.00 Non-Preferred Generic/Preferred Brand: $44.00 Non-Preferred Brand: $80.00 Specialty: 33% | 35,590 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 Platinum (PFFS) - H5820-008-0 Benefit Details |
Liberty | $59.00 | $0 | No Gap Coverage | Value Generic: $2.00 Generic: $7.00 Preferred Brand: $30.00 Non Preferred Brand: $60.00 Speciality: 33% | 75 members Browse Formulary | |||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-016-0 Benefit Details |
Liberty | $60.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 608 members | ||||||
HealthSpring HealthyAdvantage Sadler (HMO) - H4513-020-0 Benefit Details |
Liberty | $60.00 | $0 | Many Generics, Few Brand | Preferred Generic: $4.00 Generic: $4.00 Preferred Brand: $30.00 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 | |||||||||
Bravo Freedom (PPO) - H1355-001-0 Benefit Details |
Liberty | $61.00 | $0 | No Gap Coverage | Generic: $4.00 Preferred Brand: $35.00 Non-Preferred Brand: $80.00 Specialty: 33% | 81 members Browse Formulary | |||||
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Today's Options Advantage 3 powered by CCRx (PPO) - H5378-010-0 Benefit Details |
Liberty | $63.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 301 members Browse Formulary | |||||
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Today's Options Premier powered by CCRx (PFFS) - H5421-103-0 Benefit Details |
Liberty | $73.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 340 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 H2944-026 (PFFS) - H2944-026-0 Benefit Details |
Liberty | $74.00 | $0 | Few Generics, Few Brand | Preferred Generic: $7.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 6,092 members Browse Formulary | |||||
HumanaChoice R5826-075 (Regional PPO) - R5826-075-0 Benefit Details |
Liberty | $76.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 104 members Browse Formulary | |||||
HumanaChoice R5826-075 (Regional PPO) - R5826-075-0 Benefit Details |
Statewide | $76.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 104 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 |
Liberty | $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 | |||||
HealthSpring OptimaCare (HMO) - H4513-019-0 Benefit Details |
Liberty | $91.50 | $0 | No Gap Coverage | Preferred Generic: $4.00 Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: 33% Specialty: 33% | n/a Browse Formulary | |||||
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