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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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HumanaChoice R5826-063 (Regional PPO) - R5826-063-0 Benefit Details |
Fairfax | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
HumanaChoice R5826-063 (Regional PPO) - R5826-063-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Kaiser Permanente Medicare Plus Basic no D AB (Cost) - H2150-017-0 Benefit Details |
Fairfax | $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 | |||||||||
Kaiser Permanente Medicare Plus Std w/D AB (Cost) - H2150-009-0 Benefit Details |
Fairfax | $0.00 | $0 | No Gap Coverage | Generic: $10.00 Brand: $47.00 Specialty: 25% | 3,418 members Browse Formulary | |||||
Kaiser Permanente Medicare Plus Std w/o D AB (Cost) - H2150-022-0 Benefit Details |
Fairfax | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 479 members | ||||||
SecurityChoice Classic (PFFS) - H0540-001-0 Benefit Details |
Fairfax | $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 | |||||||||
Humana Gold Choice H2944-104 (PFFS) - H2944-104-0 Benefit Details |
Fairfax | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 451 members | ||||||
Humana Gold Choice H2944-097 (PFFS) - H2944-097-0 Benefit Details |
Fairfax | $22.00 | $0 | Few Generics, Few Brand | Preferred Generic: $9.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | n/a Browse Formulary | |||||
SecurityChoice Plus (PFFS) - H0540-020-0 Benefit Details |
Fairfax | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Erickson Advantage Guardian (HMO-POS) - H5678-003-0 Benefit Details |
Fairfax | $31.90 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $37.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $75.00 Tier 4 Specialty: 33% | < 10 members Browse Formulary | |||||
Evercare Plan IP (PPO) - H2111-001-0 Benefit Details |
Fairfax | $33.70 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 2,468 members Browse Formulary | |||||
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Aetna Medicare Standard Plan (HMO) - H4910-004-0 Benefit Details |
Fairfax | $35.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $6.00 Tier 2 - Non-Preferred Generic: $31.00 Tier 3 - Preferred Brand: $33.00 Tier 4 - Non-Preferred Brand: $76.00 Tier 5 - Specialty: 25% | 223 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) - H2762-021-0 Benefit Details |
Fairfax | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 550 members | ||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-044-0 Benefit Details |
Fairfax | $40.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 3,276 members Browse Formulary | |||||
Humana Gold Choice H2944-078 (PFFS) - H2944-078-0 Benefit Details |
Fairfax | $40.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 38,420 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Kaiser Permanente Medicare Plus High w/o D AB (Cost) - H2150-021-0 Benefit Details |
Fairfax | $53.60 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 703 members | ||||||
HumanaChoice R5826-079 (Regional PPO) - R5826-079-0 Benefit Details |
Fairfax | $56.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 727 members Browse Formulary | |||||
HumanaChoice R5826-079 (Regional PPO) - R5826-079-0 Benefit Details |
Statewide | $56.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 727 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 Value (PFFS) - H5421-165-0 Benefit Details |
Fairfax | $65.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,006 members | ||||||
HumanaChoice R5826-003 (Regional PPO) - R5826-003-0 Benefit Details |
Fairfax | $72.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty: 33% | 3,887 members Browse Formulary | |||||
HumanaChoice R5826-003 (Regional PPO) - R5826-003-0 Benefit Details |
Statewide | $72.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty: 33% | 3,887 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 Value powered by CCRx (PFFS) - H5421-166-0 Benefit Details |
Fairfax | $76.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 3,797 members Browse Formulary | |||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-025-0 Benefit Details |
Fairfax | $85.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 236 members | ||||||
Kaiser Permanente Medicare Plus High w/D AB (Cost) - H2150-002-0 Benefit Details |
Fairfax | $96.00 | $0 | All Generics | Generic: $10.00 Brand: $30.00 Specialty: 10% | 15,527 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Aetna Medicare Premier Plan (HMO) - H4910-005-0 Benefit Details |
Fairfax | $99.00 | $0 | Many Generics | Tier 1 - Preferred Generic: $5.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $40.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 33% | 164 members Browse Formulary | |||||
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Today's Options Premier (PFFS) - H5421-163-0 Benefit Details |
Fairfax | $104.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 6,062 members | ||||||
Erickson Advantage Signature without Drugs (HMO-POS) - H5678-002-0 Benefit Details |
Fairfax | $121.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | < 10 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 Four (PFFS) - H2762-052-0 Benefit Details |
Fairfax | $130.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 480 members Browse Formulary | |||||
Aetna Medicare Standard Plan (PPO) - H5521-027-0 Benefit Details |
Fairfax | $133.00 | $95 | No Gap Coverage | Tier 1 - Preferred Generic: $6.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $34.00 Tier 4 - Non-Preferred Brand: $74.00 Tier 5 - Specialty: 25% | 117 members Browse Formulary | |||||
Today's Options Premier powered by CCRx (PFFS) - H5421-164-0 Benefit Details |
Fairfax | $151.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 2,969 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Erickson Advantage Champion (HMO-POS) - H5678-004-0 Benefit Details |
Fairfax | $159.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $37.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $75.00 Tier 4 Specialty: 33% | 61 members Browse Formulary | |||||
Erickson Advantage Signature with Drugs (HMO-POS) - H5678-001-0 Benefit Details |
Fairfax | $159.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $5.00 Tier 2 Generic Preferred Brand: $37.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $75.00 Tier 4 Specialty: 33% | 49 members Browse Formulary | |||||
Aetna Medicare Premier Plan (PPO) - H5521-026-0 Benefit Details |
Fairfax | $197.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $6.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $36.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 166 members Browse Formulary | |||||
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