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 |
Carbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Advantra Elite (PPO) - H5522-008-0 Benefit Details |
Carbon | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $5.00 Tier 2: $24.00 Tier 3: $37.00 Tier 4: $88.00 Tier 5: 33% | $6,400 Browse Formulary | |||||
Advantra Silver (HMO) - H3959-011-0 Benefit Details |
Carbon | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $24.00 Tier 3: $35.00 Tier 4: $85.00 Tier 5: 33% | $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 | |||||||||
Advantra Silver (PPO) - H5522-004-0 Benefit Details |
Carbon | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $25.00 Tier 3: $35.00 Tier 4: $75.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
Aetna Medicare Basic Plan (HMO) - H3931-054-0 Benefit Details |
Carbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Any, Any, Any Gold (PFFS) - H8098-001-0 Benefit Details |
Carbon | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $85.00 Tier 5: 33% | $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 | |||||||||
Any, Any, Any Gold MA Only (PFFS) - H8098-003-0 Benefit Details |
Carbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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FreedomBlue PPO HD Rx (PPO) - H3916-025-0 Benefit Details |
Carbon | $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% | $2,700 Browse Formulary | |||||
Geisinger Gold Classic 4 (HMO) - H3954-138-0 Benefit Details |
Carbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $1,800 | ||||||
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 | |||||||||
Humana Gold Choice H8145-055 (PFFS) - H8145-055-0 Benefit Details |
Carbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Carbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Today's Options Premier 400 (PFFS) - H2816-008-0 Benefit Details |
Carbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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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 | |||||||||
Universal Hassle-Free (PPO) - H5096-001-0 Benefit Details |
Carbon | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $15.00 Tier 3: $45.00 Tier 4: $85.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
Universal Hassle-Free MA Only (PPO) - H5096-002-0 Benefit Details |
Carbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
Geisinger Gold Preferred 2 (PPO) - H3924-051-0 Benefit Details |
Carbon | $16.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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 1 (HMO SNP) - H3954-097-0 Benefit Details |
Carbon | $ 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 | |||||
Today's Options Premier Plus 450B (PFFS) - H2816-020-0 Benefit Details |
Carbon | $35.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
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Aetna Medicare Standard Plan (HMO) - H3931-070-0 Benefit Details |
Carbon | $36.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $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 | |||||||||
Advantra Silver Plus (PPO) - H5522-013-0 Benefit Details |
Carbon | $39.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $25.00 Tier 3: $35.00 Tier 4: $80.00 Tier 5: 33% | $4,700 Browse Formulary | |||||
FreedomBlue PPO Basic Rx (PPO) - H3916-018-0 Benefit Details |
Carbon | $39.00 | $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 Classic 4 $0 Deductible Rx (HMO) - H3954-139-0 Benefit Details |
Carbon | $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% | $1,800 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 Preferred 2 $0 Deductible Rx (PPO) - H3924-052-0 Benefit Details |
Carbon | $46.00 | $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 | |||||
Today's Options Premier 100 (PFFS) - H2816-002-0 Benefit Details |
Carbon | $47.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Humana Gold Choice H8145-052 (PFFS) - H8145-052-0 Benefit Details |
Carbon | $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 | |||||
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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 | |||||||||
Geisinger Gold Classic 1 (HMO) - H3954-136-0 Benefit Details |
Carbon | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,800 | ||||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Carbon | $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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FreedomBlue PPO Value (PPO) - H3916-012-0 Benefit Details |
Carbon | $61.00 | 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 R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Carbon | $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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Geisinger Gold Classic 1 $0 Deductible Rx (HMO) - H3954-137-0 Benefit Details |
Carbon | $83.00 | $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 | |||||
Advantra Gold (PPO) - H5522-002-0 Benefit Details |
Carbon | $89.00 | $0 | Some Generics | Tier 1: $2.00 Tier 2: $23.00 Tier 3: $40.00 Tier 4: $85.00 Tier 5: 33% | $4,300 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 Preferred 3 (PPO) - H3924-053-0 Benefit Details |
Carbon | $96.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,550 | ||||||
Today's Options Premier Plus 150A (PFFS) - H2816-014-0 Benefit Details |
Carbon | $100.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
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Aetna Medicare Premier Plan (PPO) - H5521-012-0 Benefit Details |
Carbon | $120.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $6.00 Tier 2: $33.00 Tier 3: $45.00 Tier 4: $95.00 Tier 5: 33% | $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 | |||||||||
FreedomBlue PPO Standard (PPO) - H3916-015-0 Benefit Details |
Carbon | $132.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $8.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Geisinger Gold Secure 3 (HMO SNP) - H3954-134-0 Benefit Details |
Carbon | $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 3 $0 Deductible Rx (PPO) - H3924-054-0 Benefit Details |
Carbon | $143.00 | $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 | |||||
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 | |||||||||
FreedomBlue PPO Deluxe (PPO) - H3916-005-0 Benefit Details |
Carbon | $167.00 | $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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