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 |
Wayne | $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 |
Wayne | $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 |
Wayne | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H8145-055 (PFFS) - H8145-055-0 Benefit Details |
Wayne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
-- | -- | ||||||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Wayne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
-- | |||||||||||
Geisinger Gold Preferred 2 (PPO) - H3924-047-0 Benefit Details |
Wayne | $10.00 | 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Geisinger Gold Classic 3 $0 Deductible Rx (HMO) - H3954-100-0 Benefit Details |
Wayne | $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 | |||||
FreedomBlue PPO Basic Rx (PPO) - H3916-018-0 Benefit Details |
Wayne | $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) - H3924-048-0 Benefit Details |
Wayne | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H8145-052 (PFFS) - H8145-052-0 Benefit Details |
Wayne | $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 | |||||
-- | -- | ||||||||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Wayne | $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 |
Wayne | $59.00 | 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 | |||||||||
FreedomBlue PPO Value (PPO) - H3916-012-0 Benefit Details |
Wayne | $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 |
Wayne | $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 | |||||
-- | |||||||||||
Geisinger Gold Preferred 1 (PPO) - H3924-001-0 Benefit Details |
Wayne | $88.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,550 | ||||||
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 |
Wayne | $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 |
Wayne | $110.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
-- | -- | -- | |||||||||
FreedomBlue PPO Standard (PPO) - H3916-015-0 Benefit Details |
Wayne | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Geisinger Gold Classic 1 (HMO) - H3954-003-0 Benefit Details |
Wayne | $133.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,800 | ||||||
Geisinger Gold Secure 3 (HMO SNP) - H3954-134-0 Benefit Details |
Wayne | $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 |
Wayne | $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 | |||||
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 |
Wayne | $152.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd | $3,400 Browse Formulary | |||||
-- | -- | -- | |||||||||
Geisinger Gold Classic 1 $0 Deductible Rx (HMO) - H3954-021-0 Benefit Details |
Wayne | $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 | |||||
FreedomBlue PPO Deluxe (PPO) - H3916-005-0 Benefit Details |
Wayne | $167.00 | $0 | Many Generics | Tier 1: $8.00 Tier 2: $42.00 Tier 3: $90.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
|