2011 / 2012 Medicare Advantage Plan Information Click here to jump to the Chart Legend | ||||||||||||
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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 |
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2011 AHM_Basic (HMO) | $0.00 | $2,500 | No Rx Coverage | H5774 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 AHM_Basic (HMO) | $0.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 AHM_Classic (HMO) | $0.00 | $2,500 | $0 | Many Generics | H5774 -008 -0 | $5.00 | $10.00 | $35.00 | $35.00 | n/a | ||
2012 AHM_Classic (HMO) | $0.00 | $2,500 | $0 | Many Generics | $5.00 | $10.00 | $35.00 | $35.00 | 3,055 2012 Formulary | |||
2011 AHM_Classic Plus (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H5774 -009 -0 | $5.00 | $10.00 | $35.00 | $35.00 | n/a | ||
2012 AHM_Classic Plus (HMO SNP) | $0.00 | n/a | $0 | Many Generics | $3.00 | $6.00 | $30.00 | $30.00 | 3,055 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 |
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2011 AHM_Opal (HMO-POS) | $0.00 | $2,500 | $0 | Many Generics | H5774 -014 -0 | $5.00 | $10.00 | $35.00 | $35.00 | n/a | ||
2012 AHM_Opal (HMO-POS) | $0.00 | $2,500 | $0 | Many Generics | $5.00 | $10.00 | $35.00 | $35.00 | 3,055 2012 Formulary | |||
2011 AHM_Platino Plus (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H5774 -019 -0 | n/a | ||||||
2012 AHM_Platino Plus (HMO SNP) | $0.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 2,851 2012 Formulary | |||||
2011 AHM_Standard (HMO) | $0.00 | $2,500 | $0 | Many Generics | H5774 -005 -0 | $2.00 | $4.00 | $25.00 | $25.00 | n/a | ||
2012 AHM_Standard (HMO) | $0.00 | $2,500 | $0 | Many Generics | $3.00 | $6.00 | $30.00 | $30.00 | 3,055 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 Dorado (HMO) | $0.00 | $3,400 | No Rx Coverage | H4004 -025 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 Dorado (HMO) | $0.00 | $3,250 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 Elite Dorado (HMO-POS) | $0.00 | $3,400 | $0 | Some Generics | H4004 -015 -0 | $5.00 | $29.00 | $50.00 | $50.00 | n/a | ||
2012 Elite Dorado (HMO-POS) | $0.00 | $3,250 | $0 | Many Generics | $5.00 | $29.00 | $50.00 | $50.00 | 2,603 2012 Formulary | |||
2011 First Care+Plus (HMO) | $0.00 | $6,700 | $0 | All Generics | H5887 -001 -0 | $4.00 | $20.00 | $30.00 | $30.00 | n/a | ||
2012 First Care+Plus (HMO) | $0.00 | $6,700 | $0 | All Generics | $5.00 | $25.00 | $45.00 | $45.00 | 3,465 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 First+Plus Advantage (PPO) | $0.00 | $6,700 | No Rx Coverage | H4011 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 First+Plus Advantage (PPO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 First+Plus Advantage Plus (PPO) | $0.00 | $6,700 | $0 | All Generics | H4011 -003 -0 | $5.00 | $20.00 | $30.00 | $30.00 | n/a | ||
2012 First+Plus Advantage Plus (PPO) | $0.00 | $6,700 | $0 | All Generics | $5.00 | $25.00 | $45.00 | $45.00 | 3,465 2012 Formulary | |||
2011 First+Plus Complete (HMO SNP) | $0.00 | n/a | $0 | All Generics | H5887 -007 -0 | $3.00 | $15.00 | $30.00 | $30.00 | n/a | ||
2012 First+Plus Complete (HMO SNP) | $0.00 | n/a | $0 | All Generics | $4.00 | $20.00 | $40.00 | $40.00 | 3,465 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 |
||||||
-- This plan not offered in 2011 -- |
H5887 -010 -0 | |||||||||||
2012 First+Plus Platino (HMO SNP) | $0.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 3,465 2012 Formulary | |||||
2011 Humana Gold Plus H4007-012 (HMO) | $0.00 | $3,500 | $0 | Few Generics, Few Brands |
H4007 -012 -0 | 0% | $20.00 | $40.00 | n/a | |||
2012 Humana Gold Plus H4007-012 (HMO) | $0.00 | $3,500 | $0 | Few Generics | $0.00 | $20.00 | $40.00 | 3,272 2012 Formulary | ||||
2011 Humana Gold Plus SNP-DE H4007-005 (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H4007 -005 -0 | n/a | ||||||
2012 Humana Gold Plus SNP-DE H4007-005 (HMO SNP) | $0.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 3,272 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 MAPFRE Medicare Excel (HMO-POS) | $0.00 | $6,700 | $0 | Many Generics | H5821 -001 -0 | $3.00 | 25% | 25% | 25% | n/a | ||
2012 MAPFRE Medicare Excel (HMO-POS) | $0.00 | $6,700 | $0 | Many Generics | $5.00 | 25% | 25% | 25% | 3,055 2012 Formulary | |||
2011 MAPFRE Medicare Excel Extended (HMO-POS) | $0.00 | $6,700 | $0 | Many Generics | H5821 -013 -0 | $3.00 | $25.00 | $35.00 | $35.00 | n/a | ||
2012 MAPFRE Medicare Excel Extended (HMO-POS) | $0.00 | $6,700 | $0 | Many Generics | $3.00 | $25.00 | $35.00 | $35.00 | 3,055 2012 Formulary | |||
2011 MAPFRE Medicare Excel VIP (HMO) | $0.00 | $6,700 | $0 | Many Generics | H5821 -020 -0 | $2.00 | $15.00 | $45.00 | $45.00 | n/a | ||
2012 MAPFRE Medicare Excel VIP (HMO) | $0.00 | $6,700 | $0 | Many Generics | $3.00 | $18.00 | $45.00 | $45.00 | 3,055 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 |
||||||
-- This plan not offered in 2011 -- |
H4006 -025 -0 | |||||||||||
2012 MCS Classicare B-Max (HMO) | $0.00 | $6,700 | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,202 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H5577 -005 -0 | |||||||||||
2012 MCS Classicare InteliCare (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $4.00 | $24.00 | $24.00 | 3,202 2012 Formulary | |||
2011 MCS Classicare MA (HMO) | $0.00 | $3,400 | No Rx Coverage | H4006 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 MCS Classicare MA (HMO) | $0.00 | $3,400 | 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 MCS Classicare Premium A (HMO) | $0.00 | $3,400 | $0 | Many Generics | H4006 -007 -0 | $6.00 | $27.00 | $52.00 | $52.00 | n/a | ||
2012 MCS Classicare Premium Health (HMO) | $0.00 | $3,400 | $0 | Many Generics | $4.00 | $25.00 | $50.00 | $50.00 | 3,202 2012 Formulary | |||
2011 Medicare en el Hogar Plus (HMO SNP) | $0.00 | n/a | $0 | Some Generics | H4004 -035 -0 | $5.00 | $29.00 | 25% | n/a | |||
2012 Medicare en el Hogar Plus (HMO SNP) | $0.00 | n/a | $0 | Many Generics | $5.00 | $29.00 | 25% | 2,544 2012 Formulary | ||||
2011 Medicare y Mucho Mas - BASICO SELECT (HMO) | $0.00 | $3,400 | $0 | Some Generics | H4003 -015 -0 | $2.00 | $29.00 | 25% | n/a | |||
2012 Medicare y Mucho Mas - BASICO SELECT (HMO) | $0.00 | $3,250 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $35.00 | 30% | 2,544 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 Medicare y Mucho Mas - DIAMANTE CHOICE (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands |
H4003 -017 -0 | 0% | 0% | 50% | n/a | |||
2012 Medicare y Mucho Mas - DIAMANTE CHOICE (HMO SNP) | $0.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 2,544 2012 Formulary | |||||
-- This plan not offered in 2011 -- |
H4003 -021 -0 | |||||||||||
2012 Medicare y Mucho Mas - DIAMANTE EXTRA (HMO SNP) | $0.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 2,544 2012 Formulary | |||||
2011 Medicare y Mucho Mas - ELITE (HMO-POS) | $0.00 | $3,400 | $0 | Some Generics | H4003 -001 -0 | $5.00 | $29.00 | $50.00 | $50.00 | n/a | ||
2012 Medicare y Mucho Mas - ELITE (HMO-POS) | $0.00 | $3,250 | $0 | Many Generics | $5.00 | $29.00 | $50.00 | $50.00 | 2,603 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 Medicare y Mucho Mas - Original (HMO) | $0.00 | $3,400 | No Rx Coverage | H4003 -018 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 Medicare y Mucho Mas - Original (HMO) | $0.00 | $3,250 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 Medicare y Mucho Mas - SUPREMO (HMO SNP) | $0.00 | n/a | $0 | Some Generics | H4003 -009 -0 | $3.00 | $5.00 | $20.00 | $20.00 | n/a | ||
2012 Medicare y Mucho Mas - SUPREMO (HMO SNP) | $0.00 | n/a | $0 | Many Generics | $3.00 | $5.00 | $20.00 | $20.00 | 2,544 2012 Formulary | |||
2011 Medicare y Mucho Mas - Unico (HMO) | $0.00 | $3,400 | $0 | Some Generics | H4003 -019 -0 | $5.00 | $25.00 | $50.00 | $50.00 | n/a | ||
2012 Medicare y Mucho Mas - Unico (HMO) | $0.00 | $3,250 | $0 | Many Generics | $5.00 | $25.00 | $50.00 | $50.00 | 2,603 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 PMC Max (HMO) | $0.00 | $3,400 | $0 | Some Generics | H4004 -050 -0 | $5.00 | $25.00 | 25% | n/a | |||
2012 PMC Max (HMO) | $0.00 | $3,250 | $0 | Many Generics | $5.00 | $25.00 | 25% | 2,544 2012 Formulary | ||||
2011 Premier Preferred (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H4004 -048 -0 | n/a | ||||||
2012 Premier Preferred (HMO SNP) | $0.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 2,544 2012 Formulary | |||||
2011 Triple-S Medicare Optimo (PPO) | $0.00 | $6,700 | No Rx Coverage | H4005 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 Triple-S Medicare Optimo (PPO) | $0.00 | $6,700 | 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 |
||||||
-- This plan not offered in 2011 -- |
H5732 -005 -0 | |||||||||||
2012 Triple-S Medicare Optimo Novel (HMO-POS) | $0.00 | $6,700 | $0 | Many Generics | $5.00 | $25.00 | 25% | 25% | 3,220 2012 Formulary | |||
2011 Triple-S Medicare Optimo Premier (HMO) | $0.00 | $6,700 | $0 | Many Generics | H5732 -001 -0 | $5.00 | $30.00 | $45.00 | $45.00 | n/a | ||
2012 Triple-S Medicare Optimo Premier (HMO) | $0.00 | $6,700 | $0 | Many Generics | $5.00 | $30.00 | $50.00 | $50.00 | 3,220 2012 Formulary | |||
2011 Triple-S Medicare Optimo Select (HMO) (HMO) | $0.00 | $6,700 | $0 | Many Generics | H4012 -008 -0 | 0% | $5.00 | $15.00 | $15.00 | n/a | ||
2012 Triple-S Medicare Optimo Select (HMO) (HMO) | $0.00 | $6,700 | $0 | Many Generics, Few Brands | $0.00 | $5.00 | $20.00 | $20.00 | 2,308 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 Triple-S Medicare Selecto with Medicare Platino (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H4012 -003 -0 | n/a | ||||||
2012 Triple-S Medicare Selecto with Medicare Platino (HMO SNP) | $0.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 2,308 2012 Formulary | |||||
-- This plan not offered in 2011 -- |
H4012 -009 -0 | |||||||||||
2012 Triple-S Medicare Selecto with Medicare Platino 2 (HMO SNP) | $0.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 2,308 2012 Formulary | |||||
2011 MCS Classicare Ideal D (HMO SNP) | $107.30 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H4006 -013 -0 | n/a | ||||||
2012 MCS Classicare Especial (HMO SNP) | $10.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 3,034 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 MCS Classicare Especial (HMO SNP) | $9.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H5577 -002 -0 | n/a | ||||||
2012 MCS Classicare Ideal (HMO SNP) | $10.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 3,034 2012 Formulary | |||||
2011 HumanaChoice H2029-001 (PPO) | $31.30 | $3,400 | $0 | Some Generics, Few Brands |
H2029 -001 -0 | $4.00 | $30.00 | $50.00 | $50.00 | n/a | ||
2012 HumanaChoice H2029-001 (PPO) | $30.70 | $3,400 | $0 | Some Generics, Few Brands | $4.00 | $39.00 | $77.00 | $77.00 | 3,798 2012 Formulary | |||
2011 Triple-S Medicare Optimo Plus (PPO) | $24.00 | $6,700 | $0 | Many Generics | H4005 -004 -0 | $5.00 | $25.00 | $45.00 | $45.00 | n/a | ||
2012 Triple-S Medicare Optimo Plus (PPO) | $55.00 | $6,700 | $0 | Many Generics | $5.00 | $15.00 | 25% | 25% | 3,349 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 MCS Classicare Premium B (HMO-POS) | $81.30 | $3,400 | $0 | Many Generics | H4006 -008 -0 | $4.00 | $24.00 | $44.00 | $44.00 | n/a | ||
2012 MCS Classicare Advanced Health (HMO-POS) | $67.00 | $3,400 | $0 | Many Generics | $0.00 | $3.00 | $18.00 | $18.00 | 3,202 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H2029 -002 -0 | |||||||||||
2012 HumanaChoice H2029-002 (PPO) | $79.00 | $3,400 | $0 | Some Generics, Few Brands | $3.00 | $30.00 | $68.00 | $68.00 | 3,798 2012 Formulary | |||
2011 Humana Gold Plus H4007-010 (HMO) | $0.00 | $5,000 | $0 | Few Generics, Few Brands |
H4007 -010 -0 | $5.00 | $25.00 | $50.00 | $50.00 | n/a | ||
-- This plan not offered in 2012 -- |
||||||||||||
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 First+Plus Titanio (HMO SNP) | $0.00 | n/a | $0 | All Generics | H5887 -006 -0 | 0% | $10.00 | $20.00 | $20.00 | n/a | ||
-- This plan not offered in 2012 -- |
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