2012 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 |
Cameron | $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 |
Cameron | $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% | $2,750 Browse Formulary | |||||
Humana Gold Choice H8145-055 (PFFS) - H8145-055-0 Benefit Details |
Cameron | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Cameron | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
-- | |||||||||||
SecurityBlue HD (HMO) - H3957-037-0 Benefit Details |
Cameron | $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% | $2,750 Browse Formulary | |||||
UPMC for Life (HMO) - H3907-002-0 Benefit Details |
Cameron | $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 |
Cameron | $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 | |||||
SecurityBlue Value (HMO) - H3957-025-0 Benefit Details |
Cameron | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
UPMC for Life Specialty Plan (HMO SNP) - H3907-034-0 Benefit Details |
Cameron | $ 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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UPMC for You Advantage (HMO SNP) - H4279-001-0 Benefit Details |
Cameron | $ 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 | |||||||||
SecurityBlue ValueRx (HMO) - H3957-032-0 Benefit Details |
Cameron | $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 | |||||
Humana Gold Choice H8145-052 (PFFS) - H8145-052-0 Benefit Details |
Cameron | $49.00 | $0 | Few Generics, Few Brands | Tier 1: $7.00 Tier 2: $42.00 Tier 3: $84.00 Tier 4: 33% | $5,900 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 R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Cameron | $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 | |||||
-- | |||||||||||
Today's Options Premier 400 (PFFS) - H2816-010-0 Benefit Details |
Cameron | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
-- | -- | -- | |||||||||
UPMC for Life HMO Rx (HMO) - H3907-029-0 Benefit Details |
Cameron | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Select (PPO) - H3916-024-0 Benefit Details |
Cameron | $73.00 | $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 |
Cameron | $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 | |||||
-- | |||||||||||
UPMC for Life PPO Rx (PPO) - H5533-004-0 Benefit Details |
Cameron | $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 | |||||
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 Plus 450G (PFFS) - H2816-022-0 Benefit Details |
Cameron | $95.00 | $90 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
-- | -- | -- | |||||||||
Today's Options Premier 100 (PFFS) - H2816-026-0 Benefit Details |
Cameron | $110.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
-- | -- | -- | |||||||||
SecurityBlue Standard (HMO) - H3957-006-0 Benefit Details |
Cameron | $152.00 | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier Plus 150A (PFFS) - H2816-028-0 Benefit Details |
Cameron | $152.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
-- | -- | -- | |||||||||
FreedomBlue PPO Classic (PPO) - H3916-002-0 Benefit Details |
Cameron | $166.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $42.00 Tier 3: $90.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
SecurityBlue Deluxe (HMO) - H3957-021-0 Benefit Details |
Cameron | $189.00 | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
UPMC for Life HMO Rx Enhanced (HMO) - H3907-006-0 Benefit Details |
Cameron | $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 | |||||
|