2013 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 |
Pike | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Freedom Blue PPO HD Rx (PPO) - H3916-025-0 Benefit Details |
Pike | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
Geisinger Gold Classic 3 (HMO) - H3954-098-0 Benefit Details |
Pike | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,000 | ||||||
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 | |||||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Pike | $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 |
Pike | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Geisinger Gold Secure 1 (HMO SNP) - H3954-097-0 Benefit Details |
Pike | $0.00 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: 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 | |||||||||
Geisinger Gold Classic 3 $0 Deductible Rx (HMO) - H3954-100-0 Benefit Details |
Pike | $41.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $39.00 Non-Preferred Brand: $69.00 Specialty Tier: 33% | $2,000 Browse Formulary | |||||
Freedom Blue PPO ValueRx (PPO) - H3916-018-0 Benefit Details |
Pike | $60.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Geisinger Gold Classic Plus (HMO-POS) - H3954-140-0 Benefit Details |
Pike | $60.00 | 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 |
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Service | Exper. | Cost Info | |||||||||
Geisinger Gold Preferred 2 $0 Deductible Rx (PPO) - H3924-048-0 Benefit Details |
Pike | $60.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $39.00 Non-Preferred Brand: $69.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Pike | $75.00 | $325 | 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 | |||||
Freedom Blue PPO Value (PPO) - H3916-012-0 Benefit Details |
Pike | $81.00 | 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 |
Pike | $85.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,300 Browse Formulary | |||||
Geisinger Gold Preferred 1 (PPO) - H3924-001-0 Benefit Details |
Pike | $98.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Geisinger Gold Classic Plus $0 Deductible Rx (HMO-POS) - H3954-141-0 Benefit Details |
Pike | $100.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $39.00 Non-Preferred Brand: $69.00 Specialty Tier: 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 | |||||||||
Geisinger Gold Classic 1 (HMO) - H3954-003-0 Benefit Details |
Pike | $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 |
Pike | $138.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $39.00 Non-Preferred Brand: $69.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Geisinger Gold Preferred 1 $0 Deductible Rx (PPO) - H3924-003-0 Benefit Details |
Pike | $150.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $39.00 Non-Preferred Brand: $69.00 Specialty Tier: 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 | |||||||||
Freedom Blue PPO Standard (PPO) - H3916-015-0 Benefit Details |
Pike | $165.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Geisinger Gold Classic 1 $0 Deductible Rx (HMO) - H3954-021-0 Benefit Details |
Pike | $171.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $39.00 Non-Preferred Brand: $69.00 Specialty Tier: 33% | $2,800 Browse Formulary | |||||
Freedom Blue PPO Deluxe (PPO) - H3916-005-0 Benefit Details |
Pike | $208.00 | $0 | Many Generics | Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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