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 |
Clarion | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
FreedomBlue PPO HD Rx (PPO) - H3916-020-0 Benefit Details |
Clarion | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $90.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Clarion | $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 | |||||||||
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 | ||||||
SecurityBlue HD (HMO) - H3957-037-0 Benefit Details |
Clarion | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $90.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
UPMC for Life (HMO) - H3907-002-0 Benefit Details |
Clarion | $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 | |||||||||
UPMC for Life PPO High Deductible with Rx (PPO) - H5533-003-0 Benefit Details |
Clarion | $0.00 | $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 | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H3920-009-0 Benefit Details |
Clarion | $ 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 | |||||
SecurityBlue Value (HMO) - H3957-025-0 Benefit Details |
Clarion | $25.00 | 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 | |||||||||
UPMC for Life Specialty Plan (HMO SNP) - H3907-020-0 Benefit Details |
Clarion | $ 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 | Generic Drugs: 0% Preferred Brand Drugs: $37.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 25% | n/a Browse Formulary | |||||
UPMC for Life HMO Rx (HMO) - H3907-029-0 Benefit Details |
Clarion | $59.00 | $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 | |||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Clarion | $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 | |||||
SecurityBlue ValueRx (HMO) - H3957-032-0 Benefit Details |
Clarion | $60.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $90.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
FreedomBlue PPO Select (PPO) - H3916-024-0 Benefit Details |
Clarion | $68.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Preferred Brand Drugs: $45.00 Non-Preferred Brand Drugs: $90.00 Specialty Tier Drugs: 33% | $3,400 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 |
Clarion | $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 | |||||
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 | |||||
UPMC for Life PPO Rx (PPO) - H5533-004-0 Benefit Details |
Clarion | $83.00 | $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 | |||||
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 | |||||||||
SecurityBlue Standard (HMO) - H3957-006-0 Benefit Details |
Clarion | $143.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $7.00 Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
FreedomBlue PPO Classic (PPO) - H3916-002-0 Benefit Details |
Clarion | $157.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $42.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
SecurityBlue Deluxe (HMO) - H3957-021-0 Benefit Details |
Clarion | $175.00 | $0 | Many Generics | Generic Drugs: $7.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 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 | |||||||||
Humana Gold Choice H8145-054 (PFFS) - H8145-054-0 Benefit Details |
Clarion | $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 | |||||||||
UPMC for Life HMO Rx Enhanced (HMO) - H3907-006-0 Benefit Details |
Clarion | $194.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $5.00 Preferred Brand Drugs: $38.00 Non-Preferred Brand Drugs: $88.00 Specialty Tier Drugs: 33% | $3,200 Browse Formulary | |||||
FreedomBlue PPO Platinum (PPO) - H3916-027-0 Benefit Details |
Clarion | $226.00 | $0 | Many Generics | Generic Drugs: $6.00 Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $3,400 Browse Formulary | |||||
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