2014 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 |
Allegheny | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Advantra Silver (HMO) - H3959-010-0 Benefit Details |
Allegheny | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $19.00 Preferred Brand: $35.00 Non-Preferred Brand: $86.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Allegheny | $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 | |||||||||
Security Blue HD (HMO) - H3957-036-0 Benefit Details |
Allegheny | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $20.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
UPMC for Life (HMO) - H3907-002-0 Benefit Details |
Allegheny | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Security Blue ValueRx (HMO) - H3957-031-0 Benefit Details |
Allegheny | $20.00 | $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% | $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 | |||||||||
Freedom Blue PPO HD Rx (PPO) - H3916-019-0 Benefit Details |
Allegheny | $21.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $20.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Gateway Health Medicare Assured Ruby (HMO SNP) - H5932-009-0 Benefit Details |
Allegheny | $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: 15% | n/a Browse Formulary | |||||
Gateway Health Medicare Assured Gold (HMO SNP) - H5932-007-0 Benefit Details |
Allegheny | $34.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Tier 6: $10.00 | 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 | |||||||||
UnitedHealthcare Nursing Home Plan (HMO-POS SNP) - H5322-011-0 Benefit Details |
Allegheny | $34.30 | $310 | 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 | |||||
new | new | new | |||||||||
Advantra Cares (HMO SNP) - H3959-036-0 Benefit Details |
Allegheny | $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: 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15% | n/a Browse Formulary | |||||
Gateway Health Medicare Assured Diamond (HMO SNP) - H5932-001-0 Benefit Details |
Allegheny | $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: 0% | 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 | |||||||||
UPMC Community Care (HMO SNP) - H4279-002-0 Benefit Details |
Allegheny | $35.50 | $310 | 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 | |||||
UPMC for Life Options (HMO SNP) - H3907-032-0 Benefit Details |
Allegheny | $35.50 | $310 | 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 | |||||
UPMC for You Advantage (HMO SNP) - H4279-001-0 Benefit Details |
Allegheny | $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: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 25% Select Care Drugs: $0.00 | 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 | |||||||||
Security Blue Value (HMO) - H3957-024-0 Benefit Details |
Allegheny | $37.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
UPMC for Life HMO Deductible with Rx (HMO) - H3907-037-0 Benefit Details |
Allegheny | $37.50 | $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% Select Care Drugs: $0.00 | $4,000 Browse Formulary | |||||
Freedom Blue PPO ValueRx (PPO) - H3916-032-0 Benefit Details |
Allegheny | $40.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 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 | |||||||||
UPMC for Life PPO High Deductible with Rx (PPO) - H5533-003-0 Benefit Details |
Allegheny | $40.00 | $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% Select Care Drugs: $0.00 | $6,700 Browse Formulary | |||||
Gateway Health Medicare Assured Platinum (HMO SNP) - H5932-008-0 Benefit Details |
Allegheny | $56.40 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Tier 6: $10.00 | n/a Browse Formulary | |||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Allegheny | $78.00 | $310 | 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 | |||||
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 (HMO) - H3907-029-0 Benefit Details |
Allegheny | $84.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $3,400 Browse Formulary | |||||
Advantra Gold (PPO) - H5522-001-0 Benefit Details |
Allegheny | $86.00 | $0 | Some Generics | Preferred Generic: $5.00 Non-Preferred Generic: $19.00 Preferred Brand: $34.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $5,500 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Allegheny | $88.00 | $0 | Few Generics, Few Brands | Preferred Generic: $7.00 Non-Preferred Generic: $18.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,900 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) - H3959-001-0 Benefit Details |
Allegheny | $95.00 | $0 | Some Generics | Preferred Generic: $5.00 Non-Preferred Generic: $20.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Freedom Blue PPO Select (PPO) - H3916-022-0 Benefit Details |
Allegheny | $109.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
UPMC for Life PPO Rx Enhanced (PPO) - H5533-005-0 Benefit Details |
Allegheny | $118.50 | $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% Select Care Drugs: $0.00 | $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 | |||||||||
Security Blue Standard (HMO) - H3957-003-0 Benefit Details |
Allegheny | $179.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Humana Gold Choice H8145-053 (PFFS) - H8145-053-0 Benefit Details |
Allegheny | $197.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $18.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
UPMC for Life HMO Rx Enhanced (HMO) - H3907-006-0 Benefit Details |
Allegheny | $224.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $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 Classic (PPO) - H3916-001-0 Benefit Details |
Allegheny | $232.00 | $0 | Many Generics | Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Security Blue Deluxe (HMO) - H3957-020-0 Benefit Details |
Allegheny | $253.00 | $0 | Many Generics | Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
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