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 |
Lancaster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Advantra Elite (PPO) - H5522-008-0 Benefit Details |
Lancaster | $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 |
Lancaster | $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 |
Lancaster | $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 |
Lancaster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Bravo Achieve (HMO SNP) - H3949-024-0 Benefit Details |
Lancaster | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $10.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 33% Tier 6: $5.00 | 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 | |||||||||
Bravo Classic (HMO) - H3949-002-0 Benefit Details |
Lancaster | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $10.00 Tier 3: $40.00 Tier 4: $80.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
FreedomBlue PPO HD Rx (PPO) - H3916-025-0 Benefit Details |
Lancaster | $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 3 (HMO) - H3954-098-0 Benefit Details |
Lancaster | $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 | |||||||||
Humana Gold Choice H8145-055 (PFFS) - H8145-055-0 Benefit Details |
Lancaster | $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 |
Lancaster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Today's Options Advantage 400 (PPO) - H2775-095-0 Benefit Details |
Lancaster | $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 Advantage Plus 650B (PPO) - H2775-089-0 Benefit Details |
Lancaster | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $6,700 Browse Formulary | |||||
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Today's Options Premier 400 (PFFS) - H2816-008-0 Benefit Details |
Lancaster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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UnitedHealthcare MedicareComplete (HMO) - H3920-001-0 Benefit Details |
Lancaster | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $7.00 Tier 3: $45.00 Tier 4: $95.00 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 | |||||||||
UnitedHealthcare MedicareComplete Choice (PPO) - H3921-001-0 Benefit Details |
Lancaster | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $3.00 Tier 2: $6.00 Tier 3: $45.00 Tier 4: $90.00 Tier 5: 33% | $4,900 Browse Formulary | |||||
Geisinger Gold Preferred 2 (PPO) - H3924-045-0 Benefit Details |
Lancaster | $10.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
HumanaChoice H6900-004 (PPO) - H6900-004-0 Benefit Details |
Lancaster | $19.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $43.00 Tier 3: $86.00 Tier 4: 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 | |||||||||
UnitedHealthcare Dual Complete (HMO SNP) - H3920-009-0 Benefit Details |
Lancaster | $ 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 | |||||
Geisinger Gold Preferred 1 (PPO) - H3924-021-0 Benefit Details |
Lancaster | $28.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,550 | ||||||
UnitedHealthcare Nursing Home Plan (PPO SNP) - H3912-001-0 Benefit Details |
Lancaster | $32.70 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | 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 | |||||||||
Gateway Health Plan Medicare Assured (HMO SNP) - H5932-001-0 Benefit Details |
Lancaster | $ 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 | |||||
Bravo Select (HMO SNP) - H3949-009-0 Benefit Details |
Lancaster | $ 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 | |||||
Bravo Traditions (HMO SNP) - H3949-016-0 Benefit Details |
Lancaster | $34.30 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | 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 | |||||||||
Today's Options Premier Plus 450B (PFFS) - H2816-020-0 Benefit Details |
Lancaster | $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 |
Lancaster | $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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Geisinger Gold Classic 3 $0 Deductible Rx (HMO) - H3954-100-0 Benefit Details |
Lancaster | $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 | |||||||||
Advantra Silver Plus (PPO) - H5522-013-0 Benefit Details |
Lancaster | $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 |
Lancaster | $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 Preferred 2 $0 Deductible Rx (PPO) - H3924-046-0 Benefit Details |
Lancaster | $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 | |||||
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 (PPO) - H3923-013-0 Benefit Details |
Lancaster | $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 | |||||
Today's Options Premier 100 (PFFS) - H2816-002-0 Benefit Details |
Lancaster | $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 |
Lancaster | $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 | |||||||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Lancaster | $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 |
Lancaster | $61.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Geisinger Gold Preferred 1 $0 Deductible Rx (PPO) - H3924-023-0 Benefit Details |
Lancaster | $64.00 | $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 | |||||||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Lancaster | $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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Advantra Gold (PPO) - H5522-002-0 Benefit Details |
Lancaster | $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 | |||||
Today's Options Advantage Plus 150A (PPO) - H2775-083-0 Benefit Details |
Lancaster | $90.00 | $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 | |||||||||
Today's Options Premier Plus 150A (PFFS) - H2816-014-0 Benefit Details |
Lancaster | $100.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
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Geisinger Gold Classic 1 (HMO) - H3954-007-0 Benefit Details |
Lancaster | $112.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,800 | ||||||
Geisinger Gold Secure 3 (HMO SNP) - H3954-135-0 Benefit Details |
Lancaster | $118.00 | $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 | |||||
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 H6900-005 (PPO) - H6900-005-0 Benefit Details |
Lancaster | $119.00 | $0 | Few Generics, Few Brands | Tier 1: $6.00 Tier 2: $41.00 Tier 3: $86.00 Tier 4: 33% | $5,000 Browse Formulary | |||||
Aetna Medicare Premier Plan (PPO) - H5521-012-0 Benefit Details |
Lancaster | $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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FreedomBlue PPO Standard (PPO) - H3916-015-0 Benefit Details |
Lancaster | $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 | |||||
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) - H3954-033-0 Benefit Details |
Lancaster | $137.00 | $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 | |||||
SeniorBlue - Option 1 (PPO) - H3923-017-0 Benefit Details |
Lancaster | $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 |
Lancaster | $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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