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 |
Westmoreland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Advantra Elite (PPO) - H5522-009-0 Benefit Details |
Westmoreland | $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% | $6,550 Browse Formulary | |||||
Advantra Silver (HMO) - H3959-011-0 Benefit Details |
Westmoreland | $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 | |||||||||
Any, Any, Any Gold (PFFS) - H8098-001-0 Benefit Details |
Westmoreland | $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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Any, Any, Any Gold MA Only (PFFS) - H8098-003-0 Benefit Details |
Westmoreland | $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 |
Westmoreland | $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 |
Westmoreland | $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) - H3916-019-0 Benefit Details |
Westmoreland | $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% | $3,000 Browse Formulary | |||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Westmoreland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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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 | |||||||||
SecurityBlue HD (HMO) - H3957-036-0 Benefit Details |
Westmoreland | $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% | $3,000 Browse Formulary | |||||
UnitedHealthcare MedicareComplete (HMO) - H3920-001-0 Benefit Details |
Westmoreland | $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 | |||||
Universal Hassle-Free (PPO) - H5096-001-0 Benefit Details |
Westmoreland | $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 | |||||||||
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 MA Only (PPO) - H5096-002-0 Benefit Details |
Westmoreland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
UPMC for Life (HMO) - H3907-002-0 Benefit Details |
Westmoreland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
UPMC for Life PPO High Deductible with Rx (PPO) - H5533-003-0 Benefit Details |
Westmoreland | $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 | |||||
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) - H5522-005-0 Benefit Details |
Westmoreland | $23.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $4.00 Tier 2: $27.00 Tier 3: $37.00 Tier 4: $85.00 Tier 5: 33% | $5,900 Browse Formulary | |||||
UnitedHealthcare Dual Complete (HMO SNP) - H3920-009-0 Benefit Details |
Westmoreland | $ 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 | |||||
SecurityBlue Value (HMO) - H3957-024-0 Benefit Details |
Westmoreland | $30.00 | 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 | |||||||||
SecurityBlue Care (HMO SNP) - H3957-030-0 Benefit Details |
Westmoreland | $ 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 | |||||
Gateway Health Plan Medicare Assured (HMO SNP) - H5932-001-0 Benefit Details |
Westmoreland | $ 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 |
Westmoreland | $ 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 | |||||
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 Traditions (HMO SNP) - H3949-016-0 Benefit Details |
Westmoreland | $34.30 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | n/a Browse Formulary | |||||
UPMC for Life Specialty Plan (HMO SNP) - H3907-034-0 Benefit Details |
Westmoreland | $ 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 | |||||
UPMC for You Advantage (HMO SNP) - H4279-001-0 Benefit Details |
Westmoreland | $ 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 | |||||||||
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 | |||||||||
SecurityBlue ValueRx (HMO) - H3957-031-0 Benefit Details |
Westmoreland | $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 | |||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Westmoreland | $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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UPMC for Life HMO Rx (HMO) - H3907-029-0 Benefit Details |
Westmoreland | $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 |
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Service | Exper. | Cost Info | |||||||||
Advantra Gold (HMO) - H3959-002-0 Benefit Details |
Westmoreland | $72.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $25.00 Tier 3: $35.00 Tier 4: $80.00 Tier 5: 33% | $4,300 Browse Formulary | |||||
FreedomBlue PPO Select (PPO) - H3916-022-0 Benefit Details |
Westmoreland | $76.00 | $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 |
Westmoreland | $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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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 | |||||||||
UPMC for Life PPO Rx (PPO) - H5533-004-0 Benefit Details |
Westmoreland | $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 | |||||
Bravo Premier (HMO) - H3949-013-0 Benefit Details |
Westmoreland | $89.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $35.00 Tier 4: $70.00 Tier 5: 33% | $6,700 Browse Formulary | |||||
SecurityBlue Standard (HMO) - H3957-003-0 Benefit Details |
Westmoreland | $156.00 | $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 |
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Service | Exper. | Cost Info | |||||||||
UPMC for Life HMO Rx Enhanced (HMO) - H3907-006-0 Benefit Details |
Westmoreland | $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 | |||||
Humana Gold Choice H8145-053 (PFFS) - H8145-053-0 Benefit Details |
Westmoreland | $199.00 | $0 | Few Generics, Few Brands | Tier 1: $8.00 Tier 2: $43.00 Tier 3: $84.00 Tier 4: 33% | $6,700 Browse Formulary | |||||
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FreedomBlue PPO Classic (PPO) - H3916-001-0 Benefit Details |
Westmoreland | $205.00 | $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 |
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Service | Exper. | Cost Info | |||||||||
SecurityBlue Deluxe (HMO) - H3957-020-0 Benefit Details |
Westmoreland | $228.00 | $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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