Landscape of Plan

Options in

Kentucky

Medicare Advantage
Cost Plans and Demonstrations

1-800-MEDICARE
TTY 1-877-486-2048
www.medicare.gov
Medicare Advantage, Cost Plans, and Demonstrations Landscape
What is the Landscape of Local Plans?
The Landscape of Local Plans lists all plans available in your area, providing important information on:

• Cost (premiums, deductibles and payments)

• Coverage (important issues around what and how drugs are covered)
• Convenience (pharmacy and mail-order options)

How to read the Medicare Advantage, Cost Plans, and Demonstrations Landscape
Medicare Advantage Plans (like an HMO or PPO), Cost Plans, and Demonstrations allow you to get your health care, including prescription drug
coverage at a significantly lower cost through a network of doctors, hospitals, and pharmacies. To help you better understand this information,
read on for a description of each column in the Landscape. Please note, a dash in the "Drug Premium" column means that plan does not offer
prescription drug coverage.

DESCRIPTION
County: The county where the plan is available. To find a plan for you, start by finding your county.

Organization Name: The name of the company offering the Medicare drug plan. Some organizations offer more than one Medicare drug plan.

Plan Name: The name of the Medicare Advantage or other Medicare Health Plan.

i
Type of Medicare Health Plan

HMO: A type of health plan in which you generally must see doctors and hospitals on the plan's list (network) except in an emergency. You also
need a referral to see a specialist.

Local PPO or Regional PPO: A type of health plan in which you pay less if you use doctors and hospitals on the plan's list (network). You can
go to any doctor or hospital not on the plan's list, but it will usually cost more. You do not need a referral to see a specialist. A regional PPO has a
larger service area than a local PPO.

Private Fee-for-Service: A type of health plan in which you can go to any doctor or hospital that accepts the terms of the plan's payment. You do
not need a referral to see a specialist.

Cost Plan: A type of health plan in which you can use doctors and hospitals on the plan's list (network). However, unlike Medicare Advantage
Plans, if you get services from a non-network provider, they are covered under the Original Medicare Plan. Coverage in Medicare Cost Plans can
include prescription drug coverage. These plans don't provide free additional benefits or savings on your Medicare Part B or prescription drug
coverage premiums. There are a limited number of Medicare Cost Plans. Some Medicare Cost Plans cannot accept new enrollment, please check
with the plan for enrollment availability.

Demo Plan: These plans are special projects that test possible future improvements in Medicare coverage, costs, and quality of care.

COST
Total Premium: The total amount you would pay the plan each month for your health care and prescription drug coverage.

Drug Premium: The amount of the total premium that goes toward the drug coverage portion of the Medicare Advantage or other Medicare
Health Plan. This is not an additional amount you pay. A dash in the "Drug Premium" column means that plan does not offer prescription drug
coverage.

Drug Deductible: The amount you pay before the drug plan begins to pay.

ii
COVERAGE
Offers Variable Copayments (tiers): In plans that offer variable copayments, you will pay a fixed amount for each drug and this fixed amount
may be different depending on the type of drug. For example, you may pay a lower copayment for generic medications compared to brand
medications because generic medications may be on a lower formulary level (tier) than brand medications.

Type of Extra Coverage Offered in the Gap: All plans offer coverage until you hit a limit of $2,250 in total drug costs. And all plans offer
coverage when your out-of-pocket costs exceed $3,600. Some plans offer coverage during the gap between $2,250 in total costs and $3,600 in
out-of-pocket costs.

Generics Only: Plan covers generic drugs in coverage gap.

Generics and Brands: Plan covers generic and brand drugs in coverage gap.

Number of Top 100 Drugs on Formulary: How many of the most commonly used 100 drugs by people with Medicare the plan covers.

CONVENIENCE
Mail Order Offered: Whether you can get your drugs in the mail.

For more information about Medicare prescription drug coverage, visit www.medicare.gov on the web.

Technical Note: Medicare Advantage, Cost Plans, and Demonstrations Landscapes are large documents (most are in excess of 50 pages). We
recommend you print just the county you are specifically interested in viewing. To print a single county:

• Open the state landscape file you wish to view/print

• Select the county you want to print by scrolling to the specific county page
• Choose File>Print
• In the Print Range area, choose Current Page
• Click the OK button

iii
 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Anthem Blue Cross and Blue
Adair Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Adair Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Adair Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Adair Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Adair Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Adair Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Adair Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Allen Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Allen Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Allen Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Allen Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Allen Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Allen Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Allen Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Anderson Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Anderson Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Anderson Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Anderson Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Anderson Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Anderson Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Anderson Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Ballard Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Ballard Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Ballard Humana Insurance Company 022 Regional PPO $39.00 -

Plans approved as of: 11/13/05 1 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Ballard Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Ballard Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Ballard Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Ballard Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Barren Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Barren Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Barren Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Barren Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Barren Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Barren Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Barren Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Bath Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Bath Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Bath Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Bath Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Bath Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Bath Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Bath SecureHorizons Direct SecureHorizons Direct Plan 1 PFFS $0.00 -

SecureHorizons Direct Premier
Bath SecureHorizons Direct Plan 200 PFFS $85.00 -

Bath Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Bath Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Bath Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Bell Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Bell Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •

Plans approved as of: 11/13/05 2 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Bell Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Bell Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Bell Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Bell Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Bell Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Boone Shield Anthem Senior Advantage - Basic Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Senior Advantage -
Boone Shield Enhanced Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Boone Shield Standard Local PPO $22.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Boone Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Boone Shield Premier Local PPO $42.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Boone Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Boone Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO H3619-
Boone Humana Insurance Company 001 Local PPO $22.00 $8.20 $0 • G 99 •
HumanaChoicePPO PPO R5826-
Boone Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Boone Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Boone Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Boone SecureHorizons Direct SecureHorizons Direct Plan 4 PFFS $25.00 -

SecureHorizons Direct Premier
Boone SecureHorizons Direct Plan 200 PFFS $85.00 -

Boone Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Bourbon Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Bourbon Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Bourbon Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Bourbon Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Bourbon Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •

Plans approved as of: 11/13/05 3 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Bourbon Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Bourbon Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Boyd Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Boyd Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Boyd Humana Insurance Company 022 Regional PPO $39.00 -
Humana Gold Choice PFFS
Boyd Humana Insurance Company H1804-068 PFFS $64.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Boyd Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Boyd Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Boyd Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Boyle Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Boyle Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Boyle Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Boyle Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Boyle Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Boyle Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Boyle Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Bracken Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Bracken Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Bracken Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO H3619-
Bracken Humana Insurance Company 001 Local PPO $22.00 $8.20 $0 • G 99 •
HumanaChoicePPO PPO R5826-
Bracken Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Bracken Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Bracken Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Bracken Sterling Option I Sterling Option I PFFS $9.00 -

Plans approved as of: 11/13/05 4 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Anthem Blue Cross and Blue
Breathitt Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Breathitt Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Breathitt Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Breathitt Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Breathitt Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Breathitt Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Breathitt Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Breckinridge Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Breckinridge Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Breckinridge Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Breckinridge Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Breckinridge Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Breckinridge Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Breckinridge Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Bullitt Shield Anthem Senior Advantage - Basic Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Senior Advantage -
Bullitt Shield Enhanced Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Bullitt Shield Standard Local PPO $22.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Bullitt Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Bullitt Shield Premier Local PPO $42.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Bullitt Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO H1806-
Bullitt Humana Insurance Company 001 Local PPO $32.00 $9.38 $0 • G 99 •
HumanaChoicePPO PPO R5826-
Bullitt Humana Insurance Company 022 Regional PPO $39.00 -
Humana Gold Choice PFFS
Bullitt Humana Insurance Company H1804-068 PFFS $64.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Bullitt Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •

Plans approved as of: 11/13/05 5 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Bullitt Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Bullitt Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Butler Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Butler Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Butler Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Butler Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Butler Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Butler Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Butler Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Caldwell Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Caldwell Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Caldwell Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Caldwell Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Caldwell Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Caldwell Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Caldwell Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Calloway Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Calloway Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Calloway Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Calloway Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Calloway Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Calloway Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Calloway Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue Anthem Senior Advantage -
Campbell Shield Enhanced Local HMO $0.00 $0.00 $0 • 92 •

Plans approved as of: 11/13/05 6 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Anthem Blue Cross and Blue
Campbell Shield Anthem Senior Advantage - Basic Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Campbell Shield Standard Local PPO $22.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Campbell Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Campbell Shield Premier Local PPO $42.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Campbell Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Campbell Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO H3619-
Campbell Humana Insurance Company 001 Local PPO $22.00 $8.20 $0 • G 99 •
HumanaChoicePPO PPO R5826-
Campbell Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Campbell Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Campbell Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Campbell SecureHorizons Direct SecureHorizons Direct Plan 3 PFFS $0.00 -

SecureHorizons Direct Premier
Campbell SecureHorizons Direct Plan 200 PFFS $85.00 -

Campbell Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Carlisle Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Carlisle Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Carlisle Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Carlisle Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Carlisle Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Carlisle Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Carlisle Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Carroll Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Carroll Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Carroll Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Carroll Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •

Plans approved as of: 11/13/05 7 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Humana Gold Choice PFFS
Carroll Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Carroll Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Carroll Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Carter Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Carter Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Carter Humana Insurance Company 022 Regional PPO $39.00 -
Humana Gold Choice PFFS
Carter Humana Insurance Company H1804-068 PFFS $64.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Carter Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Carter Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Carter Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Casey Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Casey Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Casey Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Casey Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Casey Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Casey Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Casey Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Christian Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Christian Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Christian Humana Insurance Company 022 Regional PPO $39.00 -
Humana Gold Choice PFFS
Christian Humana Insurance Company H1804-068 PFFS $64.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Christian Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Christian Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Christian Sterling Option I Sterling Option I PFFS $9.00 -

Plans approved as of: 11/13/05 8 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Anthem Blue Cross and Blue
Clark Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Clark Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Clark Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Clark Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Clark Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Clark Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Clark SecureHorizons Direct SecureHorizons Direct Plan 1 PFFS $0.00 -

SecureHorizons Direct Premier
Clark SecureHorizons Direct Plan 200 PFFS $85.00 -

Clark Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Clark Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Clark Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Clay Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Clay Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Clay Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Clay Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Clay Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Clay Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Clay Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Clinton Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Clinton Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Clinton Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Clinton Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Clinton Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Clinton Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Plans approved as of: 11/13/05 9 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered

Clinton Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Crittenden Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Crittenden Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Crittenden Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Crittenden Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Crittenden Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Crittenden Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Crittenden Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Cumberland Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Cumberland Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Cumberland Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Cumberland Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Cumberland Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Cumberland Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Cumberland Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Daviess Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Daviess Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Daviess Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Daviess Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Daviess Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Daviess Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Daviess Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Edmonson Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Edmonson Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •

Plans approved as of: 11/13/05 10 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Humana Gold Choice PFFS
Edmonson Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Edmonson Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Edmonson Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Edmonson Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Edmonson Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Elliott Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Elliott Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Elliott Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Elliott Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Elliott Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Elliott Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Elliott SecureHorizons Direct SecureHorizons Direct Plan 2 PFFS $0.00 -

SecureHorizons Direct Premier
Elliott SecureHorizons Direct Plan 200 PFFS $85.00 -

Elliott Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Elliott Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Elliott Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Estill Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Estill Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Estill Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Estill Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Estill Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Estill Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Estill Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Fayette Shield Anthem Senior Advantage - Basic Local HMO $0.00 $0.00 $0 • 92 •

Plans approved as of: 11/13/05 11 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Anthem Blue Cross and Blue Anthem Senior Advantage -
Fayette Shield Enhanced Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Fayette Shield Standard Local PPO $22.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Fayette Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Fayette Shield Premier Local PPO $42.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Fayette Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO H1806-
Fayette Humana Insurance Company 002 Local PPO $0.00 $0.00 $0 • G 99 •
Humana Gold Choice PFFS
Fayette Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Fayette Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Fayette Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Fayette Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Fayette SecureHorizons Direct SecureHorizons Direct Plan 1 PFFS $0.00 -

SecureHorizons Direct Premier
Fayette SecureHorizons Direct Plan 200 PFFS $85.00 -

Fayette Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Fayette Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Fayette Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Fleming Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Fleming Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Fleming Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Fleming Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Fleming Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Fleming Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Fleming Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Floyd Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Floyd Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •

Plans approved as of: 11/13/05 12 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Floyd Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Floyd Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Floyd Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Floyd Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Floyd Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Franklin Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Franklin Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Franklin Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Franklin Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Franklin Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Franklin Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Franklin Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Fulton Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Fulton Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Fulton Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Fulton Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Fulton Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Fulton Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Fulton Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Gallatin Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Gallatin Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Gallatin Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO H3619-
Gallatin Humana Insurance Company 001 Local PPO $22.00 $8.20 $0 • G 99 •
HumanaChoicePPO PPO R5826-
Gallatin Humana Insurance Company 022 Regional PPO $39.00 -

Plans approved as of: 11/13/05 13 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Gallatin Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Gallatin Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Gallatin Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Garrard Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Garrard Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Garrard Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Garrard Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Garrard Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Garrard Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Garrard Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Grant Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Grant Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Grant Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO H3619-
Grant Humana Insurance Company 001 Local PPO $22.00 $8.20 $0 • G 99 •
HumanaChoicePPO PPO R5826-
Grant Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Grant Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Grant Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Grant Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Graves Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Graves Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Graves Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Graves Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Graves Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Graves Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Plans approved as of: 11/13/05 14 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered

Graves Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Grayson Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Grayson Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Grayson Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Grayson Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Grayson Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Grayson Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Grayson Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Green Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Green Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Green Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Green Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Green Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Green Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Green Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Greenup Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Greenup Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Greenup Humana Insurance Company 022 Regional PPO $39.00 -
Humana Gold Choice PFFS
Greenup Humana Insurance Company H1804-068 PFFS $64.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Greenup Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Greenup Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Greenup Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Hancock Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Hancock Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •

Plans approved as of: 11/13/05 15 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Hancock Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Hancock Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Hancock Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Hancock Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Hancock Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Hardin Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Hardin Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Hardin Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Hardin Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Hardin Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Hardin Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Hardin Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Harlan Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Harlan Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Harlan Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Harlan Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Harlan Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Harlan Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Harlan Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Harrison Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Harrison Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Harrison Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Harrison Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Harrison Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •

Plans approved as of: 11/13/05 16 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Harrison Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Harrison SecureHorizons Direct SecureHorizons Direct Plan 4 PFFS $25.00 -

SecureHorizons Direct Premier
Harrison SecureHorizons Direct Plan 200 PFFS $85.00 -

Harrison Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Harrison Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Harrison Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Hart Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Hart Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Hart Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Hart Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Hart Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Hart Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Hart Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Henderson Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Henderson Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Henderson Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Henderson Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Henderson Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Henderson Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Henderson Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Henry Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Henry Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Henry Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Henry Humana Insurance Company 022 Regional PPO $39.00 -

Plans approved as of: 11/13/05 17 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Henry Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Henry Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Henry Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Hickman Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Hickman Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Hickman Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Hickman Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Hickman Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Hickman Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Hickman Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Hopkins Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Hopkins Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Hopkins Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Hopkins Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Hopkins Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Hopkins Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Hopkins Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Jackson Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Jackson Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Jackson Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Jackson Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Jackson Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Jackson Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Jackson Sterling Option I Sterling Option I PFFS $9.00 -

Plans approved as of: 11/13/05 18 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Anthem Blue Cross and Blue
Jefferson Shield Anthem Senior Advantage - Basic Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Senior Advantage -
Jefferson Shield Enhanced Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Jefferson Shield Standard Local PPO $22.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Jefferson Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Jefferson Shield Premier Local PPO $42.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Jefferson Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO H1806-
Jefferson Humana Insurance Company 001 Local PPO $32.00 $9.38 $0 • G 99 •
HumanaChoicePPO PPO R5826-
Jefferson Humana Insurance Company 022 Regional PPO $39.00 -
Humana Gold Choice PFFS
Jefferson Humana Insurance Company H1804-068 PFFS $64.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Jefferson Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Jefferson Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Jefferson Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Jessamine Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Jessamine Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO H1806-
Jessamine Humana Insurance Company 002 Local PPO $0.00 $0.00 $0 • G 99 •
Humana Gold Choice PFFS
Jessamine Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Jessamine Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Jessamine Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Jessamine Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Jessamine SecureHorizons Direct SecureHorizons Direct Plan 1 PFFS $0.00 -

SecureHorizons Direct Premier
Jessamine SecureHorizons Direct Plan 200 PFFS $85.00 -

Jessamine Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Jessamine Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Jessamine Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •

Plans approved as of: 11/13/05 19 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Anthem Blue Cross and Blue
Johnson Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Johnson Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Johnson Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Johnson Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Johnson Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Johnson Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Johnson Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Kenton Shield Anthem Senior Advantage - Basic Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Senior Advantage -
Kenton Shield Enhanced Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Kenton Shield Standard Local PPO $22.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Kenton Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Kenton Shield Premier Local PPO $42.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Kenton Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Kenton Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO H3619-
Kenton Humana Insurance Company 001 Local PPO $22.00 $8.20 $0 • G 99 •
HumanaChoicePPO PPO R5826-
Kenton Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Kenton Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Kenton Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Kenton SecureHorizons Direct SecureHorizons Direct Plan 3 PFFS $0.00 -

SecureHorizons Direct Premier
Kenton SecureHorizons Direct Plan 200 PFFS $85.00 -

Kenton Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Knott Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Knott Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Knott Humana Insurance Company 022 Regional PPO $39.00 -

Plans approved as of: 11/13/05 20 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Knott Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Knott Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Knott Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Knott Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Knox Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Knox Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Knox Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Knox Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Knox Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Knox Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Knox Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Larue Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Larue Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Larue Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Larue Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Larue Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Larue Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Larue Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Laurel Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Laurel Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Laurel Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Laurel Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Laurel Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Laurel Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Plans approved as of: 11/13/05 21 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered

Laurel Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Lawrence Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Lawrence Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Lawrence Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Lawrence Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Lawrence Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Lawrence Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Lawrence Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Lee Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Lee Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Lee Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Lee Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Lee Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Lee Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Lee Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Leslie Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Leslie Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Leslie Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Leslie Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Leslie Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Leslie Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Leslie Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Letcher Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Letcher Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •

Plans approved as of: 11/13/05 22 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Letcher Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Letcher Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Letcher Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Letcher Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Letcher Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Lewis Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Lewis Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Lewis Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Lewis Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Lewis Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Lewis Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Lewis Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Lincoln Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Lincoln Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Lincoln Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Lincoln Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Lincoln Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Lincoln Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Lincoln SecureHorizons Direct SecureHorizons Direct Plan 4 PFFS $25.00 -

SecureHorizons Direct Premier
Lincoln SecureHorizons Direct Plan 200 PFFS $85.00 -

Lincoln Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Lincoln Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Lincoln Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Livingston Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •

Plans approved as of: 11/13/05 23 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Anthem Blue Cross and Blue
Livingston Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Livingston Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Livingston Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Livingston Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Livingston Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Livingston Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Logan Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Logan Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Logan Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Logan Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Logan Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Logan Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Logan Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Lyon Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Lyon Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Lyon Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Lyon Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Lyon Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Lyon Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Lyon Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue Anthem Senior Advantage -
Madison Shield Enhanced Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue
Madison Shield Anthem Senior Advantage - Basic Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Madison Shield Standard Local PPO $22.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Madison Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •

Plans approved as of: 11/13/05 24 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Madison Shield Premier Local PPO $42.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Madison Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Madison Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Madison Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Madison Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Madison Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Madison SecureHorizons Direct SecureHorizons Direct Plan 1 PFFS $0.00 -

SecureHorizons Direct Premier
Madison SecureHorizons Direct Plan 200 PFFS $85.00 -

Madison Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Madison Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Madison Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Magoffin Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Magoffin Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Magoffin Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Magoffin Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Magoffin Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Magoffin Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Magoffin Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Marion Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Marion Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Marion Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Marion Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Marion Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Marion Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Plans approved as of: 11/13/05 25 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered

Marion SecureHorizons Direct SecureHorizons Direct Plan 2 PFFS $0.00 -

SecureHorizons Direct Premier
Marion SecureHorizons Direct Plan 200 PFFS $85.00 -

Marion Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Marion Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Marion Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Marshall Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Marshall Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Marshall Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Marshall Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Marshall Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Marshall Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Marshall Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Martin Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Martin Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Martin Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Martin Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Martin Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Martin Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Martin Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Mason Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Mason Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Mason Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO H3619-
Mason Humana Insurance Company 001 Local PPO $22.00 $8.20 $0 • G 99 •
HumanaChoicePPO PPO R5826-
Mason Humana Insurance Company 022 Regional PPO $39.00 -

Plans approved as of: 11/13/05 26 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Mason Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Mason Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Mason Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue Anthem Senior Advantage -
McCracken Shield Enhanced Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue
McCracken Shield Anthem Senior Advantage - Basic Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
McCracken Shield Standard Local PPO $22.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
McCracken Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
McCracken Shield Premier Local PPO $42.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
McCracken Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
McCracken Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
McCracken Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
McCracken Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
McCracken Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

McCracken Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
McCreary Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
McCreary Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
McCreary Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
McCreary Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
McCreary Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
McCreary Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

McCreary Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
McLean Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
McLean Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
McLean Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •

Plans approved as of: 11/13/05 27 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
McLean Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
McLean Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
McLean Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

McLean Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Meade Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Meade Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Meade Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Meade Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Meade Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Meade Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Meade Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Menifee Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Menifee Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Menifee Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Menifee Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Menifee Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Menifee Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Menifee SecureHorizons Direct SecureHorizons Direct Plan 1 PFFS $0.00 -

SecureHorizons Direct Premier
Menifee SecureHorizons Direct Plan 200 PFFS $85.00 -

Menifee Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Menifee Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Menifee Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Mercer Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Mercer Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •

Plans approved as of: 11/13/05 28 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Humana Gold Choice PFFS
Mercer Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Mercer Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Mercer Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Mercer Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Mercer SecureHorizons Direct SecureHorizons Direct Plan 4 PFFS $25.00 -

SecureHorizons Direct Premier
Mercer SecureHorizons Direct Plan 200 PFFS $85.00 -

Mercer Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Mercer Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Mercer Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Metcalfe Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Metcalfe Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Metcalfe Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Metcalfe Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Metcalfe Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Metcalfe Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Metcalfe Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Metcalfe Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Metcalfe Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Monroe Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Monroe Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Monroe Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Monroe Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Monroe Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Monroe Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Plans approved as of: 11/13/05 29 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered

Monroe Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Montgomery Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Montgomery Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Montgomery Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Montgomery Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Montgomery Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Montgomery Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Montgomery SecureHorizons Direct SecureHorizons Direct Plan 1 PFFS $0.00 -

SecureHorizons Direct Premier
Montgomery SecureHorizons Direct Plan 200 PFFS $85.00 -

Montgomery Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Montgomery Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Montgomery Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Morgan Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Morgan Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Morgan Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Morgan Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Morgan Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Morgan Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Morgan SecureHorizons Direct SecureHorizons Direct Plan 4 PFFS $25.00 -

SecureHorizons Direct Premier
Morgan SecureHorizons Direct Plan 200 PFFS $85.00 -

Morgan Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Morgan Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Morgan Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Muhlenberg Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •

Plans approved as of: 11/13/05 30 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Anthem Blue Cross and Blue
Muhlenberg Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Muhlenberg Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Muhlenberg Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Muhlenberg Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Muhlenberg Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Muhlenberg Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Nelson Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Nelson Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Nelson Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Nelson Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Nelson Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Nelson Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Nelson Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Nicholas Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Nicholas Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Nicholas Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Nicholas Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Nicholas Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Nicholas Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Nicholas Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Ohio Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Ohio Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Ohio Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Ohio Humana Insurance Company 022 Regional PPO $39.00 -

Plans approved as of: 11/13/05 31 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Ohio Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Ohio Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Ohio Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Oldham Shield Anthem Senior Advantage - Basic Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Senior Advantage -
Oldham Shield Enhanced Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Oldham Shield Standard Local PPO $22.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Oldham Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Oldham Shield Premier Local PPO $42.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Oldham Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO H1806-
Oldham Humana Insurance Company 001 Local PPO $32.00 $9.38 $0 • G 99 •
HumanaChoicePPO PPO R5826-
Oldham Humana Insurance Company 022 Regional PPO $39.00 -
Humana Gold Choice PFFS
Oldham Humana Insurance Company H1804-068 PFFS $64.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Oldham Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Oldham Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Oldham SecureHorizons Direct SecureHorizons Direct Plan 3 PFFS $0.00 -

SecureHorizons Direct Premier
Oldham SecureHorizons Direct Plan 200 PFFS $85.00 -

Oldham Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Owen Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Owen Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Owen Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Owen Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Owen Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Owen Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Owen Sterling Option I Sterling Option I PFFS $9.00 -

Plans approved as of: 11/13/05 32 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Anthem Blue Cross and Blue
Owsley Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Owsley Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Owsley Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Owsley Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Owsley Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Owsley Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Owsley Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Pendleton Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Pendleton Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Pendleton Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO H3619-
Pendleton Humana Insurance Company 001 Local PPO $22.00 $8.20 $0 • G 99 •
HumanaChoicePPO PPO R5826-
Pendleton Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Pendleton Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Pendleton Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Pendleton Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Perry Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Perry Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Perry Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Perry Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Perry Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Perry Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Perry Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Pike Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Pike Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •

Plans approved as of: 11/13/05 33 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Pike Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Pike Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Pike Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Pike Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Pike Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Powell Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Powell Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Powell Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Powell Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Powell Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Powell Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Powell SecureHorizons Direct SecureHorizons Direct Plan 1 PFFS $0.00 -

SecureHorizons Direct Premier
Powell SecureHorizons Direct Plan 200 PFFS $85.00 -

Powell Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Powell Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Powell Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Pulaski Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Pulaski Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Pulaski Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Pulaski Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Pulaski Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Pulaski Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Pulaski Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Pulaski Company SecurityChoice Classic PFFS $0.00 -

Plans approved as of: 11/13/05 34 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Unicare Life & Health Ins.
Pulaski Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Robertson Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Robertson Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Robertson Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Robertson Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Robertson Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Robertson Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Robertson Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Rockcastle Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Rockcastle Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Rockcastle Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Rockcastle Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Rockcastle Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Rockcastle Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Rockcastle Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Rowan Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Rowan Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Rowan Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Rowan Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Rowan Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Rowan Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Rowan SecureHorizons Direct SecureHorizons Direct Plan 4 PFFS $25.00 -

SecureHorizons Direct Premier
Rowan SecureHorizons Direct Plan 200 PFFS $85.00 -

Rowan Sterling Option I Sterling Option I PFFS $9.00 -

Plans approved as of: 11/13/05 35 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Unicare Life & Health Ins.
Rowan Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Rowan Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Russell Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Russell Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Russell Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Russell Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Russell Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Russell Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Russell Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Russell Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Russell Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Scott Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Scott Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Scott Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Scott Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Scott Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Scott Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Scott SecureHorizons Direct SecureHorizons Direct Plan 1 PFFS $0.00 -

SecureHorizons Direct Premier
Scott SecureHorizons Direct Plan 200 PFFS $85.00 -

Scott Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Scott Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Scott Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Shelby Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Shelby Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •

Plans approved as of: 11/13/05 36 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Humana Gold Choice PFFS
Shelby Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Shelby Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Shelby Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Shelby Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Shelby SecureHorizons Direct SecureHorizons Direct Plan 3 PFFS $0.00 -

SecureHorizons Direct Premier
Shelby SecureHorizons Direct Plan 200 PFFS $85.00 -

Shelby Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Shelby Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Shelby Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Simpson Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Simpson Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Simpson Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Simpson Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Simpson Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Simpson Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Simpson Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Spencer Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Spencer Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Spencer Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Spencer Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Spencer Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Spencer Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Spencer Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Taylor Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •

Plans approved as of: 11/13/05 37 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Anthem Blue Cross and Blue
Taylor Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Taylor Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Taylor Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Taylor Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Taylor Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Taylor Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Todd Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Todd Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Todd Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Todd Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Todd Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Todd Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Todd Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Trigg Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Trigg Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Trigg Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Trigg Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Trigg Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Trigg Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Trigg Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Trimble Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Trimble Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Trimble Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Trimble Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •

Plans approved as of: 11/13/05 38 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Humana Gold Choice PFFS
Trimble Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Trimble Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Trimble Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Union Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Union Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Union Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Union Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Union Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Union Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Union Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Warren Shield Anthem Senior Advantage - Basic Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Senior Advantage -
Warren Shield Enhanced Local HMO $0.00 $0.00 $0 • 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Warren Shield Standard Local PPO $22.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Warren Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue Anthem Medicare Preferred -
Warren Shield Premier Local PPO $42.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Warren Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Warren Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Warren Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Warren Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Warren Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Warren Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Washington Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Washington Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Washington Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •

Plans approved as of: 11/13/05 39 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
HumanaChoicePPO PPO R5826-
Washington Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Washington Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Washington Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Washington SecureHorizons Direct SecureHorizons Direct Plan 4 PFFS $25.00 -

SecureHorizons Direct Premier
Washington SecureHorizons Direct Plan 200 PFFS $85.00 -

Washington Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Wayne Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Wayne Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Wayne Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Wayne Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Wayne Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Wayne Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Wayne SecureHorizons Direct SecureHorizons Direct Plan 4 PFFS $25.00 -

SecureHorizons Direct Premier
Wayne SecureHorizons Direct Plan 200 PFFS $85.00 -

Wayne Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Webster Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Webster Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Webster Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Webster Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Webster Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Webster Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Webster SecureHorizons Direct SecureHorizons Direct Plan 2 PFFS $0.00 -

SecureHorizons Direct Premier
Webster SecureHorizons Direct Plan 200 PFFS $85.00 -

Webster Sterling Option I Sterling Option I PFFS $9.00 -

Plans approved as of: 11/13/05 40 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered
Unicare Life & Health Ins.
Webster Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Webster Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •
Anthem Blue Cross and Blue
Whitley Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Whitley Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Whitley Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Whitley Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Whitley Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Whitley Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Whitley Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Wolfe Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Wolfe Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
HumanaChoicePPO PPO R5826-
Wolfe Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Wolfe Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
Humana Gold Choice PFFS
Wolfe Humana Insurance Company H1804-070 PFFS $84.00 $25.66 $0 • 99 •
HumanaChoicePPO PPO R5826-
Wolfe Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Wolfe Sterling Option I Sterling Option I PFFS $9.00 -

Anthem Blue Cross and Blue
Woodford Shield Blue Medicare Access Standard Regional PPO $32.00 $0.00 $0 • G 92 •
Anthem Blue Cross and Blue
Woodford Shield Blue Medicare Access Premier Regional PPO $51.00 $0.00 $0 • G 92 •
Humana Gold Choice PFFS
Woodford Humana Insurance Company H1804-067 PFFS $0.00 $0.00 $0 • 99 •
HumanaChoicePPO PPO R5826-
Woodford Humana Insurance Company 022 Regional PPO $39.00 -
HumanaChoicePPO PPO R5826-
Woodford Humana Insurance Company 036 Regional PPO $78.99 $17.56 $250 99 •
HumanaChoicePPO PPO R5826-
Woodford Humana Insurance Company 008 Regional PPO $89.00 $27.28 $0 • 99 •

Woodford SecureHorizons Direct SecureHorizons Direct Plan 1 PFFS $0.00 -

SecureHorizons Direct Premier
Woodford SecureHorizons Direct Plan 200 PFFS $85.00 -

Plans approved as of: 11/13/05 41 of 42 Formulary data as of : 11/16/05

 Kentucky Medicare Advantage, Cost Plans, and Demonstrations
Description Cost Coverage Convenience
Type of Extra
Coverage
Total Offered in the
Premium Offers Gap Number of
Type of (Including Variable (G=generics; Top 100
Medicare Drug Drug Drug Copayments G/B=generics & Drugs on Mail Order
County Organization Name Plan Name Health Plan Premium) Premium Deductible (Tiers) brands) Formulary Offered

Woodford Sterling Option I Sterling Option I PFFS $9.00 -

Unicare Life & Health Ins.
Woodford Company SecurityChoice Classic PFFS $0.00 -
Unicare Life & Health Ins.
Woodford Company SecurityChoice Plus PFFS $13.00 $9.00 $250 • 92 •

Plans approved as of: 11/13/05 42 of 42 Formulary data as of : 11/16/05