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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Geisinger Gold Reserve (MSA) - H8468-001-0 Benefit Details |
Bucks | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
Any, Any, Any Gold (PFFS) - H8098-001-0 Benefit Details |
Bucks | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $4.00 Generic Drugs: $15.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
Any, Any, Any Gold MA Only (PFFS) - H8098-003-0 Benefit Details |
Bucks | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
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 | |||||||||
Bravo Achieve (HMO SNP) - H3949-024-0 Benefit Details |
Bucks | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $3.00 Generic Drugs: $8.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% Generic and Brand Drugs: $5.00 | n/a Browse Formulary | |||||
Bravo Classic (HMO) - H3949-002-0 Benefit Details |
Bucks | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: 0% Generic Drugs: 0% Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
Bravo Gold (HMO) - H3964-001-0 Benefit Details |
Bucks | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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 | |||||||||
e-Any, Any, Any Gold Direct (PFFS) - H8098-005-0 Benefit Details |
Bucks | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic Drugs: $15.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Bucks | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Statewide | $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 | |||||||||
Aetna Medicare Standard Plan (HMO) - H3931-064-0 Sanctioned Plan |
Bucks | $6.10 | $310 | n/a | Tier 1: Preferred Generic Drugs: $5.00 Tier 2: Non-Preferred Generic Drugs: $20.00 Tier 3: Preferred Brand Drugs: $34.00 Tier 4: Non-Preferred Brand Drugs: $74.00 Tier 5: Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
Today's Options Advantage 900 (PPO) - H2775-096-0 Sanctioned Plan |
Bucks | $10.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Bravo Gold Rx (HMO-POS) - H3964-003-0 Benefit Details |
Bucks | $27.70 | $185 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $7.00 Generic Drugs: $11.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 28% | $6,700 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 | |||||||||
Erickson Advantage Guardian (HMO-POS SNP) - H5652-003-0 Benefit Details |
Bucks | $29.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
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Today's Options Premier 800 (PFFS) - H2816-009-0 Sanctioned Plan |
Bucks | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
Today's Options Advantage 850B powered by CCRx (PPO) - H2775-084-0 Sanctioned Plan |
Bucks | $34.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic and Preferred Brand Drugs: $4.00 Non-Preferred Generic and Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $65.00 Specialty Tier Drugs: 29% | $6,700 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 | |||||||||
Bravo Select (HMO SNP) - H3949-009-0 Benefit Details |
Bucks | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Bravo Silver (HMO SNP) - H3964-002-0 Benefit Details |
Bucks | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Bravo Traditions (HMO SNP) - H3949-016-0 Benefit Details |
Bucks | $34.10 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a 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 | |||||||||
Evercare Plan IP (PPO SNP) - H3912-001-0 Benefit Details |
Bucks | $34.10 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | n/a Browse Formulary | |||||
Aetna Medicare Premier Plan (HMO) - H3931-004-0 Sanctioned Plan |
Bucks | $43.30 | $0 | n/a | Tier 1: Preferred Generic Drugs: $5.00 Tier 2: Non-Preferred Generic Drugs: $30.00 Tier 3: Preferred Brand Drugs: $45.00 Tier 4: Non-Preferred Brand Drugs: $85.00 Tier 5: Specialty Tier Drugs: 33% | n/a Browse Formulary | |||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Bucks | $60.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $7,500 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 R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Statewide | $60.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $7,500 Browse Formulary | |||||
Keystone 65 Advantage Medical Only (HMO) - H3952-042-0 Benefit Details |
Bucks | $62.40 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Today's Options Premier 850B powered by CCRx (PFFS) - H2816-021-0 Sanctioned Plan |
Bucks | $64.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic and Preferred Brand Drugs: $4.00 Non-Preferred Generic and Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $65.00 Specialty Tier Drugs: 29% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
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 | |||||||||
Bravo Premier (HMO) - H3949-013-0 Benefit Details |
Bucks | $67.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: 0% Generic Drugs: 0% Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $70.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
Any, Any, Any Platinum (PFFS) - H8098-009-0 Benefit Details |
Bucks | $69.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: 0% Generic Drugs: $3.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Bucks | $80.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $84.00 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 R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Statewide | $80.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $84.00 Specialty Tier Drugs: 33% | $5,000 Browse Formulary | |||||
Keystone 65 Advantage Rx (HMO) - H3952-043-0 Benefit Details |
Bucks | $100.80 | $280 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $3.00 Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 25% | $6,700 Browse Formulary | |||||
Keystone 65 Preferred Medical Only (HMO) - H3952-008-0 Benefit Details |
Bucks | $104.40 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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 | |||||||||
Erickson Advantage Signature without Drugs (HMO-POS) - H5652-002-0 Benefit Details |
Bucks | $121.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
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Keystone 65 Preferred Rx (HMO) - H3952-020-0 Benefit Details |
Bucks | $143.20 | $100 | Many Generics | Generic Drugs: $5.00 Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 25% | $6,700 Browse Formulary | |||||
Erickson Advantage Champion (HMO-POS SNP) - H5652-004-0 Benefit Details |
Bucks | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | n/a 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 | |||||||||
Erickson Advantage Signature with Drugs (HMO-POS) - H5652-001-0 Benefit Details |
Bucks | $159.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | $2,500 Browse Formulary | |||||
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Humana Gold Choice H8145-054 (PFFS) - H8145-054-0 Benefit Details |
Bucks | $191.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $8.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
Personal Choice 65 Medical Only (PPO) - H3909-007-0 Benefit Details |
Bucks | $245.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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 | |||||||||
Personal Choice 65 Rx (PPO) - H3909-001-0 Benefit Details |
Bucks | $285.20 | $215 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $3.00 Preferred Brand Drugs: $30.00 Non-Preferred Brand Drugs: $65.00 Specialty Tier Drugs: 25% | $6,700 Browse Formulary | |||||
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