2011 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) Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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Anthem Senior Advantage Basic (HMO) - H3655-013-0 Benefit Details |
Belmont | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $3,400 Browse Formulary | |||||
Anthem Senior Advantage Value (HMO) - H3655-031-0 Benefit Details |
Belmont | $0.00 | $0 | Many Generics | Generic Drugs: 0% Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: 0% | $3,400 Browse Formulary | |||||
Blue Medicare Access Classic (Regional PPO) - R5941-007-0 Benefit Details |
Belmont | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare Access Classic (Regional PPO) - R5941-007-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
Blue Medicare Access Value (Regional PPO) - R5941-008-0 Benefit Details |
Belmont | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $4,800 Browse Formulary | |||||
Blue Medicare Access Value (Regional PPO) - R5941-008-0 Benefit Details |
Statewide | $0.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $4,800 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-021 (Regional PPO) - R5826-021-0 Benefit Details |
Belmont | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
HumanaChoice R5826-021 (Regional PPO) - R5826-021-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
SecureCare - Option I (HMO) - H5151-004-0 Benefit Details |
Belmont | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureChoice - Option I (PPO) - H8604-004-0 Benefit Details |
Belmont | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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UPMC for Life PPO High Deductible with Rx OH (PPO) - H9670-003-0 Benefit Details |
Belmont | $27.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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Anthem Senior Advantage Plus (HMO) - H3655-030-0 Benefit Details |
Belmont | $29.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $3,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Medicare Preferred Standard (PPO) - H5529-001-0 Benefit Details |
Belmont | $34.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $4,500 Browse Formulary | |||||
HumanaChoice H3619-017 (PPO) - H3619-017-0 Benefit Details |
Belmont | $34.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $6.00 Non-Preferred Generic and Preferred Brand Drugs: $37.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,000 Browse Formulary | |||||
Anthem Medicare Preferred Select (PPO) - H5529-004-0 Benefit Details |
Belmont | $55.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $43.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $7.00 | $3,800 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-080 (Regional PPO) - R5826-080-0 Benefit Details |
Belmont | $61.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $8,500 Browse Formulary | |||||
HumanaChoice R5826-080 (Regional PPO) - R5826-080-0 Benefit Details |
Statewide | $61.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $8,500 Browse Formulary | |||||
HumanaChoice R5826-007 (Regional PPO) - R5826-007-0 Benefit Details |
Belmont | $71.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $7.00 Non-Preferred Generic and Preferred Brand Drugs: $39.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-007 (Regional PPO) - R5826-007-0 Benefit Details |
Statewide | $71.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $7.00 Non-Preferred Generic and Preferred Brand Drugs: $39.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,000 Browse Formulary | |||||
SecureCare - Option II (HMO) - H5151-002-0 Benefit Details |
Belmont | $91.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: 50% Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life HMO Rx OH (HMO) - H2169-002-0 Benefit Details |
Belmont | $109.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $86.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureChoice - Option II (PPO) - H8604-003-0 Benefit Details |
Belmont | $111.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: 50% Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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SecureCare - Option III (HMO) - H5151-006-0 Benefit Details |
Belmont | $117.00 | $0 | Many Generics | Generic Drugs: $3.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: 50% Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
SecureChoice - Option III (PPO) - H8604-006-0 Benefit Details |
Belmont | $137.00 | $0 | Many Generics | Generic Drugs: $3.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: 50% Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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