How the Plan Works

Select Advantage

Prescription Drug Benefit Resources

View prescription drug benefit information

Select Advantage, a Private Fee-For-Service (PFFS) plan, combines savings and convenience, and coverage anywhere in the U.S. Add prescription drug coverage, and pay less for your Medicare Part D prescription drugs.

With Select Advantage, you have the freedom to choose any physician or go to any hospital as long as the health care provider accepts the plan's payment Terms and Conditions and is Medicare-approved.. You are not required to choose a primary care physician or get a referral to see a specialist.

Please note: A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital is not required to agree to accept the plan’s terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can find the plan’s terms and conditions on our website at: PFFS terms and conditions.

The chart below provides a comparison of the different plan options offered by Select Advantage:

	Select Advantage Silver
Medical-Only Plan	$176 monthly premium No Part D coverage
Medical plus prescription drug	$223.50 monthly premium

For more complete information, see the Benefit and Plan Choices Brochure.

Prescription Coverage

You may select a plan with or without Part D prescription drug coverage. If you choose to enroll in a plan with Part D, you’ll have the convenience of paying just one premium each month for both your medical and drug coverage. Check the Drug Formulary for a complete listing of covered drugs.

The Select Advantage Silver Rx plan includes Medicare Part D prescription drug coverage and uses a pharmacy network. You can go to thousands of pharmacies within the network and simply present your Select Advantage card. However, covered Part D drugs are available at out-of-network pharmacies in special circumstances while traveling within the United States. You will need to pay the entire cost of the drug, and we will reimburse you the full amount minus the applicable cost-sharing.

How the Rx Option works:

The chart below provides a comparison of how the Part D coverage works for both Select Advantage options:

	Select Advantage Silver Rx
Deductible	No deductible
Copay	You pay: $5 for generics $30 for preferred brand $69 for non-preferred brand 25% Specialty drugs
Gap coverage – Brand	100% Brand drug liability until $4,350 TROOP.
Gap coverage – Generics	You pay $5 after yearly drug costs reach $2,700.
Maximum out-of-pocket costs	After you reach $4,350, you pay the greater of: $2.40 for generic drugs, or $6.00 for all other drugs or 5% of your drug costs

Summary of Benefits

For details of covered services, copays, and deductibles for the Select Advantage plan, see the Summary of Benefits.

Need extra help with health plan and drug costs?

If you have limited income and resources, you may qualify for low-income subsidy. When you join Select Advantage, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay. If you qualify, your drug costs will also be lower.

You can see if you qualify for a low-income subsidy by calling:

1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048), 24 hours a day/7 days a week
Pennsylvania Office of Medical Assistance Programs (Medicaid) at 1-717-787-1870
The Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778), 7 a.m. to 7 p.m., Monday through Friday

Benefits, formulary, pharmacy and provider networks, premiums, and/or copays may change on January 1, 2010. Please contact Select Advantage for details.

To obtain more information, please call 1-877-393-6733 (TTY/TDD: 1-877-219-5457), 8 a.m. to 8 p.m., seven days a week.