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 |
Philadelphia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Advantra Silver (HMO) - H3959-031-0 Benefit Details |
Philadelphia | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Aetna Medicare Basic Plan (HMO) - H3931-054-0 Benefit Details |
Philadelphia | $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 | |||||||||
Cigna-HealthSpring Advantage (HMO) - H3949-026-0 Benefit Details |
Philadelphia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Health Partners Medicare Basic (HMO) - H9207-001-0 Benefit Details |
Philadelphia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
Health Partners Medicare Prime (HMO) - H9207-002-0 Benefit Details |
Philadelphia | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $0.00 Brand: $45.00 Specialty Tier: 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 | |||||||||
Humana Gold Plus H6859-006 (HMO) - H6859-006-0 Benefit Details |
Philadelphia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
new | new | new | |||||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Philadelphia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Keystone 65 Select Medical Only (HMO) - H3952-048-0 Benefit Details |
Philadelphia | $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 | |||||||||
Keystone 65 Select Rx (HMO) - H3952-049-0 Benefit Details |
Philadelphia | $0.00 | $280 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Cigna-HealthSpring Achieve (HMO SNP) - H3949-024-0 Benefit Details |
Philadelphia | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% Tier 6: $5.00 | n/a Browse Formulary | |||||
Cigna-HealthSpring Preferred (HMO) - H3949-002-0 Benefit Details |
Philadelphia | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 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 | |||||||||
Humana Gold Plus H6859-004 (HMO) - H6859-004-0 Benefit Details |
Philadelphia | $22.00 | $175 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $18.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28% | $6,700 Browse Formulary | |||||
new | new | new | |||||||||
UnitedHealthcare Nursing Home Plan (PPO SNP) - H3912-001-0 Benefit Details |
Philadelphia | $29.50 | $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 | |||||
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Cigna-HealthSpring TotalCare (HMO SNP) - H3949-009-0 Benefit Details |
Philadelphia | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Gateway Health Medicare Assured Ruby (HMO SNP) - H5932-009-0 Benefit Details |
Philadelphia | $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 | |||||
Cigna-HealthSpring Traditions (HMO SNP) - H3949-016-0 Benefit Details |
Philadelphia | $33.60 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% | n/a Browse Formulary | |||||
Cigna-HealthSpring Premier (HMO-POS) - H3949-027-0 Benefit Details |
Philadelphia | $34.00 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 28% | $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 | |||||||||
Gateway Health Medicare Assured Gold (HMO SNP) - H5932-007-0 Benefit Details |
Philadelphia | $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 | |||||
Advantra Cares (HMO SNP) - H3959-035-0 Benefit Details |
Philadelphia | $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 |
Philadelphia | $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 | |||||||||
Health Partners Medicare Special (HMO SNP) - H9207-004-0 Benefit Details |
Philadelphia | $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% | n/a Browse Formulary | |||||
new | new | new | |||||||||
Keystone VIP Choice (HMO SNP) - H4227-001-0 Benefit Details |
Philadelphia | $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: tbd | n/a Browse Formulary | |||||
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Health Partners Medicare PrimePlus (HMO) - H9207-003-0 Benefit Details |
Philadelphia | $52.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $0.00 Brand: $45.00 Specialty Tier: 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Gateway Health Medicare Assured Platinum (HMO SNP) - H5932-008-0 Benefit Details |
Philadelphia | $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 H5525-005 (PPO) - H5525-005-0 Benefit Details |
Philadelphia | $67.00 | $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 | |||||
Advantra Gold (PPO) - H5522-014-0 Benefit Details |
Philadelphia | $72.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $20.00 Preferred Brand: $38.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $6,700 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 | |||||||||
Aetna Medicare Standard Plan (HMO) - H3931-065-0 Benefit Details |
Philadelphia | $75.50 | $260 | No additional gap coverage, only the Donut Hole Discount | Generic: $7.00 Preferred Brand: $41.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00 | $6,700 Browse Formulary | |||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Philadelphia | $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 | |||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Philadelphia | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Cigna-HealthSpring Preferred Plus (HMO) - H3949-013-0 Benefit Details |
Philadelphia | $106.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Keystone 65 Preferred Medical Only (HMO) - H3952-008-0 Benefit Details |
Philadelphia | $125.40 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Personal Choice 65 Medical Only (PPO) - H3909-007-0 Benefit Details |
Philadelphia | $145.00 | 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Aetna Medicare Premier Plan (HMO) - H3931-058-0 Benefit Details |
Philadelphia | $172.00 | $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 | |||||
Keystone 65 Preferred Rx (HMO) - H3952-020-0 Benefit Details |
Philadelphia | $182.60 | $100 | Many Generics | Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Humana Gold Choice H8145-053 (PFFS) - H8145-053-0 Benefit Details |
Philadelphia | $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 | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Personal Choice 65 Rx (PPO) - H3909-001-0 Benefit Details |
Philadelphia | $222.50 | $285 | No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
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