2012 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 |
Cambria | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
FreedomBlue PPO HD Rx (PPO) - H3916-019-0 Benefit Details |
Cambria | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | $3,000 Browse Formulary | |||||
Geisinger Gold Classic 3 (HMO) - H3954-098-0 Benefit Details |
Cambria | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,500 | ||||||
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 |
Cambria | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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SecurityBlue HD (HMO) - H3957-036-0 Benefit Details |
Cambria | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | $3,000 Browse Formulary | |||||
UPMC for Life (HMO) - H3907-002-0 Benefit Details |
Cambria | $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 |
Cambria | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $42.00 Tier 3: $95.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Geisinger Gold Preferred 2 (PPO) - H3924-047-0 Benefit Details |
Cambria | $10.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
UnitedHealthcare Dual Complete (HMO SNP) - H3920-009-0 Benefit Details |
Cambria | $ 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: 0% Tier 2: 0% | 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 | |||||||||
SecurityBlue Value (HMO) - H3957-024-0 Benefit Details |
Cambria | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
SecurityBlue Care (HMO SNP) - H3957-030-0 Benefit Details |
Cambria | $ 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: 15% Tier 2: 15% | n/a Browse Formulary | |||||
Gateway Health Plan Medicare Assured (HMO SNP) - H5932-001-0 Benefit Details |
Cambria | $ 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: 0% Tier 2: 0% | 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 | |||||||||
UPMC for Life Specialty Plan (HMO SNP) - H3907-034-0 Benefit Details |
Cambria | $ 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: $0.00 Tier 2: $37.00 Tier 3: $80.00 Tier 4: 25% | n/a Browse Formulary | |||||
UPMC for You Advantage (HMO SNP) - H4279-001-0 Benefit Details |
Cambria | $ 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: $0.00 Tier 2: $37.00 Tier 3: $80.00 Tier 4: 25% | n/a Browse Formulary | |||||
new | new | new | |||||||||
Geisinger Gold Classic 3 $0 Deductible Rx (HMO) - H3954-100-0 Benefit Details |
Cambria | $36.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $7.00 Tier 3: $39.00 Tier 4: $69.00 Tier 5: 33% | $1,500 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 | |||||||||
SecurityBlue ValueRx (HMO) - H3957-031-0 Benefit Details |
Cambria | $38.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Geisinger Gold Preferred 2 $0 Deductible Rx (PPO) - H3924-048-0 Benefit Details |
Cambria | $40.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $7.00 Tier 3: $39.00 Tier 4: $69.00 Tier 5: 33% | $3,000 Browse Formulary | |||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Cambria | $58.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $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 | |||||||||
UPMC for Life HMO Rx (HMO) - H3907-029-0 Benefit Details |
Cambria | $69.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $42.00 Tier 3: $95.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
FreedomBlue PPO Select (PPO) - H3916-022-0 Benefit Details |
Cambria | $76.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Cambria | $79.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $44.00 Tier 3: $85.00 Tier 4: 33% | $5,000 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 | |||||||||
UPMC for Life PPO Rx (PPO) - H5533-004-0 Benefit Details |
Cambria | $81.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $42.00 Tier 3: $95.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Geisinger Gold Preferred 1 (PPO) - H3924-001-0 Benefit Details |
Cambria | $88.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,550 | ||||||
Geisinger Gold Classic 1 (HMO) - H3954-003-0 Benefit Details |
Cambria | $133.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,800 | ||||||
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 | |||||||||
Geisinger Gold Secure 3 (HMO SNP) - H3954-134-0 Benefit Details |
Cambria | $133.00 | $0 | Few Generics | Tier 1: $3.00 Tier 2: $7.00 Tier 3: $39.00 Tier 4: $69.00 Tier 5: 33% | n/a Browse Formulary | |||||
Geisinger Gold Preferred 1 $0 Deductible Rx (PPO) - H3924-003-0 Benefit Details |
Cambria | $135.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $7.00 Tier 3: $39.00 Tier 4: $69.00 Tier 5: 33% | $2,550 Browse Formulary | |||||
SecurityBlue Standard (HMO) - H3957-003-0 Benefit Details |
Cambria | $156.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 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 | |||||||||
Geisinger Gold Classic 1 $0 Deductible Rx (HMO) - H3954-021-0 Benefit Details |
Cambria | $166.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $7.00 Tier 3: $39.00 Tier 4: $69.00 Tier 5: 33% | $2,800 Browse Formulary | |||||
UPMC for Life HMO Rx Enhanced (HMO) - H3907-006-0 Benefit Details |
Cambria | $196.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $42.00 Tier 3: $95.00 Tier 4: 33% | $3,200 Browse Formulary | |||||
FreedomBlue PPO Classic (PPO) - H3916-001-0 Benefit Details |
Cambria | $205.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $42.00 Tier 3: $90.00 Tier 4: 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 Deluxe (HMO) - H3957-020-0 Benefit Details |
Cambria | $228.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $42.00 Tier 3: $90.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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