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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BlueSaver MSA (MSA) - H9788-001-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
BlueCross BlueShield Senior Blue HMO 601 (HMO) - H3384-022-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
BlueCross BlueShield Senior Blue HMO 651 PartD (HMO) - H3384-019-0 Benefit Details |
Erie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $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 | |||||||||
Care Improvement Plus Copper RX (PPO SNP) - H0084-040-0 Benefit Details |
Erie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx (PPO SNP) - H0084-023-0 Benefit Details |
Erie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Independent Health Encompass 65 (HMO) - H3362-016-0 Benefit Details |
Erie | $0.00 | 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 | |||||||||
Independent Health's Encompass 65 Essential (HMO-POS) - H3362-026-0 Benefit Details |
Erie | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
Today's Options Advantage 400 (PPO) - H2775-094-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,400 | ||||||
Today's Options Premier 400 (PFFS) - H2816-007-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,400 | ||||||
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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 | |||||||||
UnitedHealthcare MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Erie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,900 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) - R5342-002-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 | ||||||
Univera SeniorChoice Value (HMO) - H3351-010-0 Benefit Details |
Erie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $2.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 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 | |||||||||
WellCare Advance (HMO) - H3361-059-0 Benefit Details |
Erie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
WellCare Choice (HMO-POS) - H3361-129-0 Benefit Details |
Erie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $0.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
WellCare Value (HMO-POS) - H3361-099-0 Benefit Details |
Erie | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $3.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
WellCare Access (HMO SNP) - H3361-065-0 Benefit Details |
Erie | $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 | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Today's Options Premier 100 (PFFS) - H2816-001-0 Benefit Details |
Erie | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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WellCare Liberty (HMO SNP) - H3361-043-0 Benefit Details |
Erie | $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 | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 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 Advantage Plus 450B (PPO) - H2775-088-0 Benefit Details |
Erie | $26.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | $4,400 Browse Formulary | |||||
Today's Options Premier Plus 450B (PFFS) - H2816-019-0 Benefit Details |
Erie | $26.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | $4,400 Browse Formulary | |||||
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Preferred Gold (HMO-POS) - H3305-007-0 Benefit Details |
Erie | $27.80 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
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 | |||||||||
Univera SeniorChoice Value Plus (HMO) - H3351-012-0 Benefit Details |
Erie | $33.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $2.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
GoldAnywhere Rx Option 2 (PPO) - H9615-007-0 Benefit Details |
Erie | $33.80 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $4,000 Browse Formulary | |||||
Independent Health Medicare Passport Basic (PPO) - H3344-006-0 Benefit Details |
Erie | $36.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 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 | |||||||||
Univera Medicare Classic PPO (PPO) - H3335-002-0 Benefit Details |
Erie | $40.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $2.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $4,400 Browse Formulary | |||||
GoldValue Rx (HMO-POS) - H3305-015-0 Benefit Details |
Erie | $41.00 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $6,000 Browse Formulary | |||||
UnitedHealthcare Nursing Home Plan (HMO SNP) - H3379-022-0 Benefit Details |
Erie | $42.60 | $325 | 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 | |||||||||
Care Improvement Plus Chrome RX (PPO SNP) - H0084-039-0 Benefit Details |
Erie | $43.20 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Care Improvement Plus Silver Rx (PPO SNP) - H0084-022-0 Benefit Details |
Erie | $43.20 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
Independent Health Medicare Family Choice (HMO SNP) - H3362-020-0 Benefit Details |
Erie | $43.20 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 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 | |||||||||
Independent Health's Dual Difference (HMO SNP) - H3362-025-0 Benefit Details |
Erie | $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% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
Independent Health Encompass 65 Basic (HMO) - H3362-017-0 Benefit Details |
Erie | $62.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Today's Options Advantage Plus 150A (PPO) - H2775-082-0 Benefit Details |
Erie | $68.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 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 | |||||||||
BlueCross BlueShield Senior Blue HMO 653 PartD (HMO) - H3384-041-0 Benefit Details |
Erie | $75.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Today's Options Premier Plus 150A (PFFS) - H2816-013-0 Benefit Details |
Erie | $77.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Univera SeniorChoice Select (HMO-POS) - H3351-001-0 Benefit Details |
Erie | $80.00 | 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 | |||||||||
Independent Health Medicare Passport Advantage (PPO) - H3344-005-0 Benefit Details |
Erie | $101.90 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $42.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Univera SeniorChoice Secure (HMO-POS) - H3351-002-0 Benefit Details |
Erie | $114.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $2.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
BlueCross BlueShield Senior Blue HMO 654 (HMO) - H3384-056-0 Benefit Details |
Erie | $115.00 | $0 | Some Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 30% | $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 | |||||||||
BlueCross BlueShield Forever Blue Medicare PPO 751 (PPO) - H5526-004-0 Benefit Details |
Erie | $120.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $7.50 Preferred Brand: $45.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $5,100 Browse Formulary | |||||
Preferred Gold Rx (HMO-POS) - H3305-011-0 Benefit Details |
Erie | $122.50 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $4,500 Browse Formulary | |||||
GoldAnywhere Rx Option 1 (PPO) - H9615-002-0 Benefit Details |
Erie | $192.00 | $0 | Few Generics | Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Specialty Tier: $0.00 | $2,000 Browse Formulary | |||||
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