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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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Gundersen Lutheran Sr. Pref. Value (no RX) (HMO) - H5262-004-0 Benefit Details |
Buffalo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 345 members | ||||||
HumanaChoice R5826-023 (Regional PPO) - R5826-023-0 Benefit Details |
Buffalo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 9,018 members | ||||||
HumanaChoice R5826-023 (Regional PPO) - R5826-023-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 9,018 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 |
Buffalo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 27,113 members | ||||||
Today's Options Value (PFFS) - H5421-149-0 Benefit Details |
Buffalo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 2,299 members | ||||||
SecureHorizons MedicareDirect Rx Plan 51 (PFFS) - H5435-014-0 Benefit Details |
Buffalo | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SmartValue Classic (PFFS) - H0540-090-0 Benefit Details |
Buffalo | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 11,362 members | ||||||
Today's Options Value powered by CCRx (PFFS) - H5421-150-0 Benefit Details |
Buffalo | $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 | |||||
SecureHorizons MedicareDirect Plan 100 (PFFS) - H5435-020-0 Benefit Details |
Buffalo | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 4,121 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Gundersen Lutheran Senior Pref. Value w/RX (HMO) - H5262-003-0 Benefit Details |
Buffalo | $34.60 | $0 | No Gap Coverage | Tier 1 - Generic Drugs: $9.00 Tier 2 - Formulary Preferred Brand Drugs: $32.00 Tier 3 - Formulary Non-Preferred Brand Drugs: $87.00 Tier 4 - Specialty High Cost Drugs: 33% | 661 members Browse Formulary | |||||
SecureHorizons MedicareDirect Rx Plan 150 (PFFS) - H5435-027-0 Benefit Details |
Buffalo | $35.00 | $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% | 4,555 members Browse Formulary | |||||
SmartValue Plus (PFFS) - H0540-091-0 Benefit Details |
Buffalo | $40.00 | $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% | 12,629 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Value (HMO-POS) - H4270-001-0 Benefit Details |
Buffalo | $51.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 813 members | ||||||
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Sterling Basic Plus (PFFS) - H5006-018-2 Benefit Details |
Buffalo | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
UCare for Seniors Value Plus (HMO-POS) - H4270-003-0 Benefit Details |
Buffalo | $61.50 | $0 | No Gap Coverage | Tier 1: $8.00 Tier 2: $30.00 Tier 3: $60.00 Tier 4: 25% | 2,157 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 H2944-067 (PFFS) - H2944-067-0 Benefit Details |
Buffalo | $63.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 6,354 members Browse Formulary | |||||
Today's Options Premier (PFFS) - H5421-147-0 Benefit Details |
Buffalo | $74.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Gundersen Lutheran Sr. Pref. Elite (no RX) (HMO) - H5262-005-0 Benefit Details |
Buffalo | $79.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,691 members | ||||||
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 |
Buffalo | $94.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
Sterling Option II (PFFS) - H5006-017-2 Benefit Details |
Buffalo | $107.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Elite w/RX (HMO) - H5262-001-0 Benefit Details |
Buffalo | $113.60 | $0 | No Gap Coverage | Tier 1 - Generic Drugs: $9.00 Tier 2 - Formulary Preferred Brand Drugs: $24.00 Tier 3 - Formulary Non-Preferred Brand Drugs: $80.00 Tier 4 - Specialty High Cost Drugs: 33% | 7,149 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) - H5006-016-2 Benefit Details |
Buffalo | $120.00 | $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 |
Buffalo | $120.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 643 members Browse Formulary | |||||
UCare for Seniors Classic (HMO-POS) - H4270-002-0 Benefit Details |
Buffalo | $128.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $30.00 Tier 3: $60.00 Tier 4: 25% | n/a 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 | |||||||||
HumanaChoice R5826-009 (Regional PPO) - R5826-009-0 Benefit Details |
Buffalo | $179.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
HumanaChoice R5826-009 (Regional PPO) - R5826-009-0 Benefit Details |
Statewide | $179.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
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