2011 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
Geisinger Gold Reserve (MSA) - H8468-001-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | N/A | ||||||
AARP MedicareComplete Choice (PPO) - H3921-008-0 Benefit Details |
Erie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $79.00 Specialty Tier Drugs: 33% | $4,900 Browse Formulary | |||||
-- | |||||||||||
Advantra Elite (PPO) - H5522-009-0 Benefit Details |
Erie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $4.00 Generic Drugs: $25.00 Preferred Brand Drugs: $36.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Advantra Silver (HMO) - H3959-011-0 Benefit Details |
Erie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic Drugs: $25.00 Preferred Brand Drugs: $35.00 Non-Preferred Generic and Non-Preferred Brand Drug: $70.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
Advantra Silver (PPO) - H5522-005-0 Benefit Details |
Erie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $4.00 Generic Drugs: $27.00 Preferred Brand Drugs: $37.00 Non-Preferred Generic and Non-Preferred Brand Drug: $74.00 Specialty Tier Drugs: 33% | $6,100 Browse Formulary | |||||
Any, Any, Any Gold (PFFS) - H8098-001-0 Benefit Details |
Erie | $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 | |||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any Gold MA Only (PFFS) - H8098-003-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
e-Any, Any, Any Gold Direct (PFFS) - H8098-005-0 Benefit Details |
Erie | $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 | |||||||||
FreedomBlue PPO HD Rx (PPO) - H3916-020-0 Benefit Details |
Erie | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Erie | $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 | ||||||
SecurityBlue HD (HMO) - H3957-037-0 Benefit Details |
Erie | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UnitedHealthcare MedicareComplete (HMO) - H3920-001-0 Benefit Details |
Erie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $5.00 Generic and Preferred Brand Drugs: $42.00 Non-Preferred Generic and Non-Preferred Brand Drug: $79.00 Specialty Tier Drugs: 33% | $4,900 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Essential (HMO) - H3920-007-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,600 | ||||||
UPMC for Life (HMO) - H3907-002-0 Benefit Details |
Erie | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
UPMC for Life PPO High Deductible with Rx (PPO) - H5533-003-0 Benefit Details |
Erie | $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 | |||||
Today's Options Advantage 900 (PPO) - H2775-096-0 Sanctioned Plan |
Erie | $10.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
-- | |||||||||||
Humana Gold Choice H8145-055 (PFFS) - H8145-055-0 Benefit Details |
Erie | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 | ||||||
new | new | new | |||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UnitedHealthcare Dual Complete (HMO SNP) - H3920-009-0 Benefit Details |
Erie | $ 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 |
Erie | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice H6900-002 (PPO) - H6900-002-0 Benefit Details |
Erie | $27.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $6.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier 800 (PFFS) - H2816-009-0 Sanctioned Plan |
Erie | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
SecurityBlue Care (HMO SNP) - H3957-030-0 Benefit Details |
Erie | $ 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 | |||||
Today's Options Advantage 850B powered by CCRx (PPO) - H2775-084-0 Sanctioned Plan |
Erie | $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 | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UPMC for Life Specialty Plan (HMO SNP) - H3907-020-0 Benefit Details |
Erie | $ 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 | |||||
Gateway Health Plan Medicare Assured (HMO SNP) - H5932-001-0 Benefit Details |
Erie | $ 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 | |||||
Humana Gold Choice H8145-052 (PFFS) - H8145-052-0 Benefit Details |
Erie | $49.00 | $0 | Few Generics, Few Brands | Preferred Generic Drugs: $6.00 Non-Preferred Generic and Preferred Brand Drugs: $40.00 Non-Preferred Brand Drugs: $80.00 Specialty Tier Drugs: 33% | $5,500 Browse Formulary | |||||
new | new | new | |||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UPMC for Life HMO Rx (HMO) - H3907-029-0 Benefit Details |
Erie | $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 |
Erie | $60.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $7,500 Browse Formulary | |||||
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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
SecurityBlue ValueRx (HMO) - H3957-032-0 Benefit Details |
Erie | $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 | |||||
Today's Options Premier 850B powered by CCRx (PFFS) - H2816-021-0 Sanctioned Plan |
Erie | $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 | |||||||||
FreedomBlue PPO Select (PPO) - H3916-024-0 Benefit Details |
Erie | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any Platinum (PFFS) - H8098-009-0 Benefit Details |
Erie | $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 |
Erie | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Advantra Gold (HMO) - H3959-002-0 Benefit Details |
Erie | $81.00 | $0 | Some Generics | Preferred Generic Drugs: $5.00 Generic Drugs: $26.00 Preferred Brand Drugs: $36.00 Non-Preferred Generic and Non-Preferred Brand Drug: $75.00 Specialty Tier Drugs: 33% | $6,700 Browse Formulary | |||||
UPMC for Life PPO Rx (PPO) - H5533-004-0 Benefit Details |
Erie | $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 | |||||
SecurityBlue Standard (HMO) - H3957-006-0 Benefit Details |
Erie | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Classic (PPO) - H3916-002-0 Benefit Details |
Erie | $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 |
Erie | $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 | |||||
UPMC for Life HMO Rx Enhanced (HMO) - H3907-006-0 Benefit Details |
Erie | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Platinum (PPO) - H3916-027-0 Benefit Details |
Erie | $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 | |||||
|