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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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Health Plan SecureCare (HMO) - H5151-004-0 Benefit Details |
Monongalia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 738 members | ||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Monongalia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Statewide | $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 | |||||||||
SecureChoice (PPO) - H8604-004-0 Benefit Details |
Monongalia | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 20 members | ||||||
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Humana Gold Choice H2944-095 (PFFS) - H2944-095-0 Benefit Details |
Monongalia | $40.00 | $0 | Few Generics, Few Brand | Preferred Generic: $9.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 656 members Browse Formulary | |||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Monongalia | $67.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 590 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Statewide | $67.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 590 members Browse Formulary | |||||
FreedomBlue PPO Value (PPO) - H5106-018-0 Benefit Details |
Monongalia | $70.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 133 members | ||||||
Humana Gold Choice H2944-081 (PFFS) - H2944-081-0 Benefit Details |
Monongalia | $70.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 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 | |||||||||
CIGNA Medicare Access Plan One (PFFS) - H2762-015-0 Benefit Details |
Monongalia | $80.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 150 members | ||||||
FreedomBlue PFFS Choice Plus (PFFS) - H1643-001-0 Benefit Details |
Monongalia | $82.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | 224 members Browse Formulary | |||||
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FreedomBlue PFFS Choice (PFFS) - H1643-002-0 Benefit Details |
Monongalia | $85.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 29 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 | |||||||||
Today's Options Value (PFFS) - H3333-146-0 Benefit Details |
Monongalia | $90.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 304 members | ||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-034-0 Benefit Details |
Monongalia | $95.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 627 members Browse Formulary | |||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Monongalia | $95.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty: 33% | 2,986 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Statewide | $95.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty: 33% | 2,986 members Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) - H5106-015-0 Benefit Details |
Monongalia | $99.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 2,049 members Browse Formulary | |||||
Health Plan SecureCare (HMO) - H5151-002-0 Benefit Details |
Monongalia | $99.00 | $0 | All Generics | Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: 50% Specialty: 20% | 7,109 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) - H3333-147-0 Benefit Details |
Monongalia | $104.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 372 members Browse Formulary | |||||
UPMC for Life West Virginia (HMO) - H2169-004-0 Benefit Details |
Monongalia | $108.60 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | < 10 members | ||||||
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SecureChoice (PPO) - H8604-003-0 Benefit Details |
Monongalia | $119.00 | $0 | All Generics | Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: 50% Specialty: 20% | 201 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 | |||||||||
UPMC for Life PPO High Deductible with Rx WV (PPO) - H9670-004-0 Benefit Details |
Monongalia | $124.00 | $0 | No Gap Coverage | Tier 1 - Generic: $5.00 Tier 2 - Preferred Brand: $32.00 Tier 3 - Non-Preferred Brand: $80.00 Tier 4 - Specialty: 33% | < 10 members Browse Formulary | |||||
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Today's Options Premier (PFFS) - H3333-144-0 Benefit Details |
Monongalia | $134.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 587 members | ||||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-019-0 Benefit Details |
Monongalia | $135.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 57 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
UPMC for Life HMO Rx West Virginia (HMO) - H2169-005-0 Benefit Details |
Monongalia | $142.50 | $0 | No Gap Coverage | Tier 1 - Generic: $5.00 Tier 2 - Preferred Brand: $32.00 Tier 3 - Non-Preferred Brand: $80.00 Tier 4 - Specialty: 33% | < 10 members Browse Formulary | |||||
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UPMC for Life HMO Rx Enhanced West Virginia (HMO) - H2169-006-0 Benefit Details |
Monongalia | $157.70 | $0 | No Gap Coverage | Tier 1 - Generic: $5.00 Tier 2 - Preferred Brand: $32.00 Tier 3 - Non-Preferred Brand: $80.00 Tier 4 - Specialty: 33% | 22 members Browse Formulary | |||||
new | new | new | |||||||||
Today's Options Premier powered by CCRx (PFFS) - H3333-145-0 Benefit Details |
Monongalia | $175.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 402 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Deluxe (PPO) - H5106-016-0 Benefit Details |
Monongalia | $186.00 | $0 | Many Generics | Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | n/a Browse Formulary | |||||
UPMC for Life PPO Rx Enhanced West Virginia (PPO) - H9670-002-0 Benefit Details |
Monongalia | $219.90 | $0 | Many Generics | Tier 1 - Generic: $5.00 Tier 2 - Preferred Brand: $30.00 Tier 3 - Non-Preferred Brand: $85.00 Tier 4 - Specialty: 33% | < 10 members Browse Formulary | |||||
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