Lasso Healthcare (MSA) - H1924-003-0
Benefit Details
|
Chester |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
AARP Medicare Advantage Choice Plan 2 (PPO) - H2228-085-0
Benefit Details
|
Chester |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Aetna Medicare Advantra Credit Value (PPO) - H5522-017-0
Benefit Details
|
Chester |
$0.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| $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 Advantra Value (HMO) - H3959-052-0
Benefit Details
|
Chester |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Elite (HMO) - H3931-112-0
Benefit Details
|
Chester |
$0.00 |
$150 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Main Line Health Prime (HMO) - H3931-105-0
Benefit Details
|
Chester |
$0.00 |
$300 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
| $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 Value (PPO) - H5521-263-0
Benefit Details
|
Chester |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Allwell Medicare (HMO) - H2915-006-0
Benefit Details
|
Chester |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
-- |
-- |
|
|
Cigna-HealthSpring Achieve (HMO C-SNP) - H3949-024-0
Benefit Details
|
Chester |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Diabetic Drugs: $5.00
| n/a 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 |
Cigna-HealthSpring Advantage (HMO) - H3949-026-0
Benefit Details
|
Chester |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Cigna-HealthSpring True Choice (PPO) - H7849-006-0
Benefit Details
|
Chester |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Drug: $80.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
new |
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Geisinger Gold Classic Essential Rx (HMO) - H3954-159-17
Benefit Details
|
Chester |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Geisinger Gold Preferred Complete Rx (PPO) - H3924-060-17
Benefit Details
|
Chester |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| $6,700 Browse Formulary |
|
|
|
|
Health Partners Medicare Simple (HMO-POS) - H9207-011-0
Benefit Details
|
Chester |
$0.00 |
$350 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 25% Specialty Tier: 26%
| $6,700 Browse Formulary |
|
|
|
|
Humana Gold Plus H6622-037 (HMO) - H6622-037-0
Benefit Details
|
Chester |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $5,900 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 |
Humana Honor (PPO) - H5216-221-0
Benefit Details
|
Chester |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-116 (PPO) - H5216-116-0
Benefit Details
|
Chester |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 |
|
|
|
|
HumanaChoice H5525-038 (PPO) - H5525-038-0
Benefit Details
|
Chester |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 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 |
HumanaChoice H5525-047 (PPO) - H5525-047-0
Benefit Details
|
Chester |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R0923-001 (Regional PPO) - R0923-001-0
Benefit Details
|
Chester |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 |
|
-- |
|
|
Keystone 65 Basic Rx (HMO) - H3952-056-0
Benefit Details
|
Chester |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 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 |
Personal Choice 65 Prime Rx PPO (PPO) - H3909-015-0
Benefit Details
|
Chester |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Sunrise Advantage Plan (HMO I-SNP) - H4236-001-0
Benefit Details
|
Chester |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| n/a Browse Formulary |
-- |
-- |
|
|
UPMC for Life HMO No Rx (HMO) - H3907-002-0
Benefit Details
|
Chester |
$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 |
Service |
Exper. |
Cost Info |
Aetna Medicare Advantra Cares (HMO D-SNP) - H3959-035-0
Benefit Details
|
Chester |
$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 | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| n/a Browse Formulary |
|
|
|
|
UPMC for Life HMO Deductible with Rx (HMO) - H3907-044-0
Benefit Details
|
Chester |
$16.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Keystone 65 Focus Rx (HMO-POS) - H3952-054-0
Benefit Details
|
Chester |
$19.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 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 |
Cigna-HealthSpring Preferred (HMO) - H3949-030-0
Benefit Details
|
Chester |
$20.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UnitedHealthcare Dual Complete (HMO D-SNP) - H3113-009-0
Benefit Details
|
Chester |
$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 | : $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
| n/a Browse Formulary |
|
|
|
|
Humana Gold Plus SNP-DE H6622-038 (HMO D-SNP) - H6622-038-0
Benefit Details
|
Chester |
$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 | Preferred Generic: $0.00 Generic: $19.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a 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 |
AARP Medicare Advantage (HMO) - H1944-009-0
Benefit Details
|
Chester |
$29.00 |
$200 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
|
Geisinger Gold Classic Advantage (HMO) - H3954-156-17
Benefit Details
|
Chester |
$30.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
Allwell Dual Medicare (HMO D-SNP) - H2915-002-0
Benefit Details
|
Chester |
$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 | : $0.00
| 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 |
Cigna-HealthSpring TotalCare (HMO D-SNP) - H3949-009-0
Benefit Details
|
Chester |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
UPMC for Life PPO High Deductible with Rx (PPO) - H5533-003-0
Benefit Details
|
Chester |
$35.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) - H0710-017-0
Benefit Details
|
Chester |
$35.40 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 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 |
Service |
Exper. |
Cost Info |
Cigna-HealthSpring Traditions (HMO I-SNP) - H3949-016-0
Benefit Details
|
Chester |
$35.60 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
| n/a Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Diamond (HMO D-SNP) - H5932-001-0
Benefit Details
|
Chester |
$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 | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 44% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Ruby (HMO D-SNP) - H5932-009-0
Benefit Details
|
Chester |
$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 | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 44% 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 |
Service |
Exper. |
Cost Info |
Geisinger Gold Secure Rx (HMO D-SNP) - H3954-097-0
Benefit Details
|
Chester |
$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 | : 15%
| n/a Browse Formulary |
|
|
|
|
Health Partners Medicare Prime (HMO-POS) - H9207-002-0
Benefit Details
|
Chester |
$35.60 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 25% Specialty Tier: 26% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
|
|
|
Health Partners Medicare Special (HMO D-SNP) - H9207-004-0
Benefit Details
|
Chester |
$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 | : 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 |
Keystone First VIP Choice (HMO D-SNP) - H4227-001-0
Benefit Details
|
Chester |
$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 Brand: 25%
| n/a Browse Formulary |
|
|
|
|
Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) - H4093-001-0
Benefit Details
|
Chester |
$35.60 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 25%
| n/a Browse Formulary |
-- |
-- |
|
|
UPMC for Life Dual (HMO D-SNP) - H7123-001-0
Benefit Details
|
Chester |
$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 | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $10.00 Non-Preferred Drug: 46% Specialty Tier: 25%
| n/a Browse Formulary |
new |
new |
|
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 Complete Rx (HMO) - H3954-158-17
Benefit Details
|
Chester |
$38.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| $4,900 Browse Formulary |
|
|
|
|
Humana Gold Choice H8145-055 (PFFS) - H8145-055-0
Benefit Details
|
Chester |
$38.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
-- |
|
|
Reflections (HMO C-SNP) - H4236-002-0
Benefit Details
|
Chester |
$39.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $100.00 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 |
Sunrise Advantage Community Plan (HMO) - H4236-003-0
Benefit Details
|
Chester |
$39.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $5,700 Browse Formulary |
-- |
-- |
|
|
Aetna Medicare Advantra Premier (HMO) - H3959-033-0
Benefit Details
|
Chester |
$43.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Geisinger Gold Preferred Enhanced Rx (PPO) - H3924-062-17
Benefit Details
|
Chester |
$45.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| $5,500 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Keystone 65 Select Medical Only (HMO) - H3952-050-0
Benefit Details
|
Chester |
$49.50 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
HumanaChoice H5525-005 (PPO) - H5525-005-0
Benefit Details
|
Chester |
$53.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AARP Medicare Advantage Choice Plan 1 (PPO) - H2228-037-0
Benefit Details
|
Chester |
$58.00 |
$295 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Silver (HMO) - H3931-070-0
Benefit Details
|
Chester |
$59.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna-HealthSpring True Choice Plus (PPO) - H7849-007-0
Benefit Details
|
Chester |
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Drug: $80.00 Specialty Tier: 33%
| $5,500 Browse Formulary |
new |
new |
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Higher cost-sharing at standard network pharmacies. Details:
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Aetna Medicare Advantra Premier Plus (PPO) - H5522-014-0
Benefit Details
|
Chester |
$66.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,600 Browse Formulary |
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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 |
HumanaChoice R0923-002 (Regional PPO) - R0923-002-0
Benefit Details
|
Chester |
$71.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Humana Gold Choice H8145-052 (PFFS) - H8145-052-0
Benefit Details
|
Chester |
$74.00 |
$360 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Keystone 65 Select Rx (HMO) - H3952-051-0
Benefit Details
|
Chester |
$80.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $5,500 Browse Formulary |
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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 |
UPMC for Life HMO Rx (HMO) - H3907-048-0
Benefit Details
|
Chester |
$82.40 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Premier (HMO) - H3931-064-0
Benefit Details
|
Chester |
$86.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Geisinger Gold Preferred Advantage Rx (PPO) - H3924-059-17
Benefit Details
|
Chester |
$87.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| $4,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Cigna-HealthSpring PreferredPlus (HMO) - H3949-013-0
Benefit Details
|
Chester |
$135.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $2.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $4,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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UPMC for Life PPO Rx Enhanced (PPO) - H5533-005-0
Benefit Details
|
Chester |
$135.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Gold Plan (PPO) - H5521-122-0
Benefit Details
|
Chester |
$146.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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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 Advantage Rx (HMO) - H3954-157-17
Benefit Details
|
Chester |
$149.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| $3,400 Browse Formulary |
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HumanaChoice H5216-122 (PPO) - H5216-122-0
Benefit Details
|
Chester |
$156.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Personal Choice 65 Rx (PPO) - H3909-009-0
Benefit Details
|
Chester |
$159.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $5,500 Browse Formulary |
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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 Premier Plus (HMO) - H3931-004-0
Benefit Details
|
Chester |
$178.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Keystone 65 Preferred Medical Only (HMO) - H3952-044-0
Benefit Details
|
Chester |
$194.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 |
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Keystone 65 Preferred Rx (HMO) - H3952-045-0
Benefit Details
|
Chester |
$256.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $4,000 Browse Formulary |
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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 |
UPMC for Life HMO Rx Enhanced (HMO) - H3907-006-0
Benefit Details
|
Chester |
$301.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|