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 |
Franklin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
FreedomBlue PPO HD Rx (PPO) - H3916-025-0 Benefit Details |
Franklin | $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 | |||||
Humana Gold Choice H8145-055 (PFFS) - H8145-055-0 Benefit Details |
Franklin | $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 | |||||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Franklin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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SeniorBlue - Option 3 (HMO) - H3962-007-0 Benefit Details |
Franklin | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $36.00 Tier 3: 33% | $3,400 Browse Formulary | |||||
Today's Options Premier 400 (PFFS) - H2816-008-0 Benefit Details |
Franklin | $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 | |||||||||
Today's Options Premier Plus 450B (PFFS) - H2816-020-0 Benefit Details |
Franklin | $35.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
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FreedomBlue PPO Basic Rx (PPO) - H3916-018-0 Benefit Details |
Franklin | $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 | |||||
SeniorBlue - Option 2 (PPO) - H3923-013-0 Benefit Details |
Franklin | $42.10 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $40.00 Tier 3: $89.00 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 | |||||||||
Today's Options Premier 100 (PFFS) - H2816-002-0 Benefit Details |
Franklin | $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 |
Franklin | $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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HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Franklin | $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 | |||||||||
FreedomBlue PPO Value (PPO) - H3916-012-0 Benefit Details |
Franklin | $61.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Franklin | $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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Today's Options Premier Plus 150A (PFFS) - H2816-014-0 Benefit Details |
Franklin | $100.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 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 | |||||||||
SeniorBlue - Option 2 (HMO) - H3962-004-0 Benefit Details |
Franklin | $107.40 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $36.00 Tier 3: $89.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) - H3916-015-0 Benefit Details |
Franklin | $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 | |||||
SeniorBlue - Option 1 (HMO) - H3962-001-0 Benefit Details |
Franklin | $156.80 | $0 | Many Generics | Tier 1: $5.00 Tier 2: $36.00 Tier 3: $89.00 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 | |||||||||
SeniorBlue - Option 1 (PPO) - H3923-017-0 Benefit Details |
Franklin | $162.70 | $0 | Many Generics | Tier 1: $6.00 Tier 2: $38.00 Tier 3: $89.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
FreedomBlue PPO Deluxe (PPO) - H3916-005-0 Benefit Details |
Franklin | $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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