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 |
Carbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Advantra Elite (PPO) - H5522-008-0 Benefit Details |
Carbon | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $19.00 Preferred Brand: $37.00 Non-Preferred Brand: $92.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Gold (HMO) - H3959-037-0 Benefit Details |
Carbon | $0.00 | $0 | Some Generics | Preferred Generic: $6.00 Non-Preferred Generic: $20.00 Preferred Brand: $35.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,300 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
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 (HMO) - H3959-011-0 Benefit Details |
Carbon | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $19.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Silver (PPO) - H5522-004-0 Benefit Details |
Carbon | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $20.00 Preferred Brand: $35.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Aetna Medicare Basic Plan (HMO) - H3931-054-0 Benefit Details |
Carbon | $0.00 | 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 | |||||||||
Freedom Blue PPO HD Rx (PPO) - H3916-025-0 Benefit Details |
Carbon | $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 | |||||
Geisinger Gold Classic 4 (HMO) - H3954-138-0 Benefit Details |
Carbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,250 | ||||||
Humana Gold Choice H8145-055 (PFFS) - H8145-055-0 Benefit Details |
Carbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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 |
Carbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Today's Options Premier 700 (PFFS) - H2816-008-0 Benefit Details |
Carbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Freedom Blue PPO Value (PPO) - H3916-012-0 Benefit Details |
Carbon | $30.00 | 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 | |||||||||
Freedom Blue PPO ValueRx (PPO) - H3916-018-0 Benefit Details |
Carbon | $31.00 | $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 | |||||
Geisinger Gold Preferred 2 (PPO) - H3924-051-0 Benefit Details |
Carbon | $31.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 | ||||||
Advantra Cares (HMO SNP) - H3959-036-0 Benefit Details |
Carbon | $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 | |||||
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 Secure 1 (HMO SNP) - H3954-097-0 Benefit Details |
Carbon | $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 | |||||
HumanaChoice H5525-007 (PPO) - H5525-007-0 Benefit Details |
Carbon | $41.00 | $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% | $6,700 Browse Formulary | |||||
Geisinger Gold Classic 4 $0 Deductible Rx (HMO) - H3954-139-0 Benefit Details |
Carbon | $45.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $2,250 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 Premier 100 (PFFS) - H2816-002-0 Benefit Details |
Carbon | $47.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Advantra Silver Plus (PPO) - H5522-013-0 Benefit Details |
Carbon | $49.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $20.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Geisinger Gold Classic 1 (HMO) - H3954-136-0 Benefit Details |
Carbon | $50.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,800 | ||||||
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 Plus (HMO-POS) - H3954-154-0 Benefit Details |
Carbon | $60.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,300 | ||||||
Humana Gold Choice H8145-052 (PFFS) - H8145-052-0 Benefit Details |
Carbon | $60.00 | $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 | |||||
Aetna Medicare Standard Plan (HMO) - H3931-070-0 Benefit Details |
Carbon | $61.00 | $0 | Few Generics | Generic: $7.00 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 | |||||||||
Geisinger Gold Preferred 2 $0 Deductible Rx (PPO) - H3924-052-0 Benefit Details |
Carbon | $66.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,900 Browse Formulary | |||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Carbon | $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 | |||||
Geisinger Gold Classic 1 $0 Deductible Rx (HMO) - H3954-137-0 Benefit Details |
Carbon | $88.00 | $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 | |||||
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 |
Carbon | $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 | |||||
Geisinger Gold Preferred 3 (PPO) - H3924-053-0 Benefit Details |
Carbon | $96.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Advantra Gold (PPO) - H5522-002-0 Benefit Details |
Carbon | $99.00 | $0 | Some Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,500 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
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 Plus $0 Deductible Rx (HMO-POS) - H3954-155-0 Benefit Details |
Carbon | $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% | $4,300 Browse Formulary | |||||
Aetna Medicare Premier Plan (PPO) - H5521-012-0 Benefit Details |
Carbon | $141.00 | $0 | Few Generics | Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $6,700 Browse Formulary | |||||
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Geisinger Gold Preferred 3 $0 Deductible Rx (PPO) - H3924-054-0 Benefit Details |
Carbon | $148.00 | $0 | Few Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $39.00 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 | |||||||||
Freedom Blue PPO Standard (PPO) - H3916-015-0 Benefit Details |
Carbon | $172.00 | $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% | $6,700 Browse Formulary | |||||
Freedom Blue PPO Deluxe (PPO) - H3916-005-0 Benefit Details |
Carbon | $219.00 | $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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