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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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AARP MedicareComplete Plus (HMO-POS) - H4604-003-0 Benefit Details |
Salt Lake | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $38.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $72.00 Tier 4 Specialty: 33% | 20,050 members Browse Formulary | |||||
AARP MedicareComplete Plus Essential (HMO-POS) - H4604-005-0 Benefit Details |
Salt Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 963 members | ||||||
Altius Advantra Option 1 (HMO-POS) - H8649-003-0 Benefit Details |
Salt Lake | $0.00 | $0 | No Gap Coverage | Preferred Generic: $7.00 Preferred Brand: $30.00 Non-Preferred Generic/Non-Preferred Brand: $74.00 Specialty - Generic and Brand: 33% | 4,037 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 | |||||||||
Evercare Plan MH-POS (HMO-POS) - H4604-008-0 Benefit Details |
Salt Lake | $0.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $45.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $85.00 Tier 4 Specialty: 33% | n/a Browse Formulary | |||||
Humana Gold Plus H2486-002 (HMO) - H2486-002-0 Benefit Details |
Salt Lake | $0.00 | $0 | Few Generics, Few Brand | Preferred Generic: $7.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | n/a Browse Formulary | |||||
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HumanaChoice H4606-006 (PPO) - H4606-006-0 Benefit Details |
Salt Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 486 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Molina Medicare Options (HMO) - H5628-002-0 Benefit Details |
Salt Lake | $0.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $55.00 Specialty Drug: 33% | 2,923 members Browse Formulary | |||||
SecureHorizons MedicareDirect Plan 1 (PFFS) - H5435-001-0 Benefit Details |
Salt Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 27,113 members | ||||||
SecurityChoice Classic (PFFS) - H0540-001-0 Benefit Details |
Salt Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 22,271 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Sierra Optima Select (PFFS) - H4449-011-0 Benefit Details |
Salt Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 777 members | ||||||
new | new | new | |||||||||
Sierra Optima Select Rx (PFFS) - H4449-013-0 Benefit Details |
Salt Lake | $0.00 | $0 | No Gap Coverage | Preferred Generic/Some Brand Maintenance: $6.00 Preferred Brand: $45.00 Non-Preferred: $80.00 Specialty: 33% | n/a Browse Formulary | |||||
new | new | new | |||||||||
Today's Options Value (PFFS) - H5421-149-0 Benefit Details |
Salt Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,299 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 |
Salt Lake | $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 | |||||
SecurityChoice Plus (PFFS) - H0540-020-0 Benefit Details |
Salt Lake | $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 Value powered by CCRx (PFFS) - H5421-150-0 Benefit Details |
Salt Lake | $23.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 2,210 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H4606-001 (PPO) - H4606-001-0 Benefit Details |
Salt Lake | $25.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 13,880 members Browse Formulary | |||||
Evercare Plan DH (HMO) - H4604-006-0 Benefit Details |
Salt Lake | $ 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% | 749 members Browse Formulary | |||||
Humana Gold Choice H2944-057 (PFFS) - H2944-057-0 Benefit Details |
Salt Lake | $30.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $42.00 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 | |||||||||
Sterling Basic Plus (PFFS) - H5006-018-1 Benefit Details |
Salt Lake | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
Healthy Advantage (HMO) - H5628-006-0 Benefit Details |
Salt Lake | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty: 25% | n/a Browse Formulary | |||||
Molina Medicare Options Plus (HMO) - H5628-001-0 Benefit Details |
Salt Lake | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty: 25% | 2,603 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 MA Only (PFFS) - H5820-028-0 Benefit Details |
Salt Lake | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 122 members | ||||||
Sterling Partners (PPO) - H8558-003-0 Benefit Details |
Salt Lake | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | < 10 members | ||||||
Any, Any, Any Gold (PFFS) - H5820-004-0 Benefit Details |
Salt Lake | $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 |
Salt Lake | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
Altius Advantra Option 2 (HMO-POS) - H8649-002-0 Benefit Details |
Salt Lake | $69.00 | $0 | No Gap Coverage | Preferred Generic: $7.00 Preferred Brand: $30.00 Non-Preferred Generic/Non-Preferred Brand: $70.00 Specialty - Generic and Brand: 33% | 812 members Browse Formulary | |||||
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Humana Gold Choice H2944-058 (PFFS) - H2944-058-0 Benefit Details |
Salt Lake | $71.00 | $0 | Few Generics, Few Brand | Preferred Generic: $5.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 217 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) - H5421-147-0 Benefit Details |
Salt Lake | $74.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Sterling Partners (PPO) - H8558-004-0 Benefit Details |
Salt Lake | $85.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | < 10 members Browse Formulary | |||||
Any, Any, Any Platinum (PFFS) - H5820-010-0 Benefit Details |
Salt Lake | $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 | |||||
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 |
Salt Lake | $99.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
Regence MedAdvantage (PPO) - H4605-001-0 Benefit Details |
Salt Lake | $102.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Regence MedAdvantage + Rx Classic (PPO) - H4605-002-0 Benefit Details |
Salt Lake | $117.00 | $200 | No Gap Coverage | Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $56.00 Miscellaneous Injectables: 27% Specialty: 27% | 8,484 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 |
Salt Lake | $119.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
Today's Options Premier powered by CCRx (PFFS) - H5421-148-0 Benefit Details |
Salt Lake | $120.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 643 members Browse Formulary | |||||
Regence MedAdvantage + Rx Enhanced (PPO) - H4605-004-0 Benefit Details |
Salt Lake | $165.00 | $0 | Many Generics | Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $56.00 Miscellaneous Injectables: 30% Specialty: 30% | 8,905 members Browse Formulary | |||||
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