2011 / 2012 Medicare Advantage Plan Information Click here to jump to the Chart Legend | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Plan Name | Monthly Premium |
Part A&B Maximum Out-Of |
Part D Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Formulary Drugs | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2011 AARP MedicareComplete Choice (PPO) | $0.00 | $3,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H3812 -001 -0 | $5.00 | $42.00 | $80.00 | $80.00 | n/a | ||
2012 AARP MedicareComplete Choice (PPO) | $0.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $44.00 | $44.00 | 3,614 2012 Formulary | |||
2011 Health Net Violet Option 2 (PPO) | $0.00 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H5520 -005 -0 | $7.00 | $41.00 | $79.00 | $79.00 | n/a | ||
2012 Health Net Violet Option 2 (PPO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | tbd | |||||||
-- This plan not offered in 2011 -- |
H3864 -015 -0 | |||||||||||
2012 PacificSource Medicare Essentials Rx 15 (HMO) | $0.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $40.00 | $80.00 | $80.00 | 4,794 2012 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2011 Trillium Advantage TLC ISNP (HMO SNP) | $35.30 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H2174 -003 -0 | n/a | ||||||
2012 Trillium Advantage TLC ISNP (HMO SNP) | $18.90 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 2,840 2012 Formulary | ||||||
2011 Trillium Advantage TLC Community ISNP (HMO SNP) | $35.30 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H2174 -005 -0 | n/a | ||||||
2012 Trillium Advantage TLC Community ISNP (HMO SNP) | $21.80 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 2,840 2012 Formulary | ||||||
-- This plan not offered in 2011 -- |
H4754 -005 -0 | |||||||||||
-- | ||||||||||||
2012 PacificSource Medicare Explorer 5 (PPO) | $30.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2011 Trillium Advantage Dual (HMO SNP) | $35.30 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H2174 -001 -0 | 0% | $45.00 | $95.00 | $95.00 | n/a | ||
2012 Trillium Advantage Dual (HMO SNP) | $33.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 2,840 2012 Formulary | |||||
2011 Regence MedAdvantage (PPO) | $45.00 | $2,500 | No Rx Coverage | H3817 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 Regence MedAdvantage Basic (PPO) | $35.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 Evercare Plan IP (PPO SNP) | $28.90 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H3812 -005 -0 | n/a | ||||||
2012 UnitedHealthcare Nursing Home Plan (PPO SNP) | $35.20 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,614 2012 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2011 Providence Medicare Choice (HMO-POS) | $40.00 | $3,400 | No Rx Coverage | H9047 -035 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 Providence Medicare Choice (HMO-POS) | $40.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 ODS Advantage PPO (PPO) | $64.10 | $3,400 | No Rx Coverage | H3813 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 ODS Advantage PPO (PPO) | $40.60 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 Health Net Aqua (PPO) | $39.00 | $2,500 | No Rx Coverage | H5520 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 Health Net Aqua (PPO) | $45.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2011 AARP MedicareComplete (HMO) | $49.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H3805 -007 -0 | $5.00 | $42.00 | $80.00 | $80.00 | n/a | ||
2012 AARP MedicareComplete (HMO) | $49.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $44.00 | $44.00 | 3,614 2012 Formulary | |||
2011 Trillium Advantage (HMO) | $67.00 | $2,500 | No Rx Coverage | H2174 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 Trillium Advantage (HMO) | $59.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 Regence MedAdvantage + Rx Classic (PPO) | $80.00 | $3,400 | $100 | No additional gap coverage, only the Donut Hole Discount | H3817 -002 -0 | $5.00 | $35.00 | $35.00 | $35.00 | n/a | ||
2012 Regence MedAdvantage + Rx Classic (PPO) | $67.00 | $3,400 | $160 | No additional gap coverage, only the Donut Hole Discount | $7.50 | $33.00 | $45.00 | $45.00 | 4,317 2012 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2011 Providence Medicare Choice + RX (HMO-POS) | $71.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H9047 -024 -0 | n/a | ||||||
2012 Providence Medicare Choice + RX (HMO-POS) | $76.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $50.00 | 33% | 2,718 2012 Formulary | ||||
-- This plan not offered in 2011 -- |
H4754 -004 -0 | |||||||||||
-- | ||||||||||||
2012 PacificSource Medicare Explorer Rx 4 (PPO) | $78.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $30.00 | $70.00 | $70.00 | 4,794 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H2174 -008 -0 | |||||||||||
2012 Trillium Advantage Rx Smart (HMO) | $78.00 | $6,700 | $0 | Many Generics | $9.00 | $45.00 | $80.00 | $80.00 | 2,838 2012 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2011 Providence Medicare Extra (HMO) | $87.00 | $2,500 | No Rx Coverage | H9047 -033 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 Providence Medicare Extra (HMO) | $87.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 Health Net Violet Option 1 (PPO) | $99.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H5520 -002 -0 | $6.00 | $38.00 | $76.00 | $76.00 | n/a | ||
2012 Health Net Violet Option 1 (PPO) | $99.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | tbd | |||||||
2011 ODS Advantage PPORX Select (PPO) | $127.30 | $3,400 | $120 | No additional gap coverage, only the Donut Hole Discount | H3813 -003 -0 | 10% | 32% | 50% | 50% | n/a | ||
2012 ODS Advantage PPORX Select (PPO) | $128.30 | $3,400 | $120 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $33.00 | $40.00 | $40.00 | 3,377 2012 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2011 Providence Medicare Extra + RX (HMO) | $128.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H9047 -001 -0 | n/a | ||||||
2012 Providence Medicare Extra + RX (HMO) | $130.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $50.00 | 33% | 2,718 2012 Formulary | ||||
2011 Regence MedAdvantage + Rx Enhanced (PPO) | $127.00 | $2,500 | $0 | Many Generics | H3817 -003 -0 | $5.00 | $35.00 | $35.00 | $35.00 | n/a | ||
2012 Regence MedAdvantage + Rx Enhanced (PPO) | $135.00 | $2,500 | $0 | Many Generics | $5.00 | $33.00 | $45.00 | $45.00 | 4,317 2012 Formulary | |||
2011 Health Net Healthy Heart (PPO) | $139.00 | $1,750 | $0 | No additional gap coverage, only the Donut Hole Discount | H5520 -009 -0 | $5.00 | $35.00 | $70.00 | $70.00 | n/a | ||
2012 Health Net Healthy Heart (PPO) | $149.00 | $1,750 | $0 | No additional gap coverage, only the Donut Hole Discount | tbd | |||||||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2011 Trillium Advantage Rx (HMO) | $135.00 | $2,500 | $0 | Many Generics | H2174 -002 -0 | $9.00 | $35.00 | $56.00 | n/a | |||
2012 Trillium Advantage Rx (HMO) | $164.00 | $2,500 | $0 | Many Generics | $9.00 | $40.00 | $60.00 | 4,764 2012 Formulary | ||||
|