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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-- This plan not offered in 2011 -- |
H5793 -001 -0 | |||||||||||
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2012 Aetna Medicare Value Plan (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $33.00 | $45.00 | $45.00 | 3,158 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H2836 -001 -0 | |||||||||||
new | new | new | ||||||||||
2012 Anthem MediBlue Preferred Standard (PPO) | $0.00 | $3,400 | $60 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $42.00 | $42.00 | 3,013 2012 Formulary | |||
2011 MediBlue Value (HMO) | $0.00 | $6,000 | $0 | Many Generics | H5854 -005 -0 | $7.00 | $42.00 | $80.00 | $80.00 | n/a | ||
2012 Anthem MediBlue Value (HMO) | $0.00 | $5,400 | $60 | No additional gap coverage, only the Donut Hole Discount | $9.00 | $45.00 | $95.00 | $95.00 | 4,453 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 ConnectiCare VIP Option 3 (HMO-POS) | $0.00 | $6,700 | $150 | No additional gap coverage, only the Donut Hole Discount | H3528 -008 -0 | n/a | ||||||
2012 ConnectiCare VIP Option 3 (HMO-POS) | $0.00 | $6,700 | $150 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $40.00 | $80.00 | $80.00 | 3,114 2012 Formulary | |||
2011 ConnectiCare VIP Prime 1 (HMO) | $0.00 | $4,900 | $150 | No additional gap coverage, only the Donut Hole Discount | H3528 -001 -0 | n/a | ||||||
2012 ConnectiCare VIP Prime 1 (HMO) | $0.00 | $5,400 | $150 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $40.00 | $80.00 | $80.00 | 3,114 2012 Formulary | |||
2011 ConnectiCare VIP Prime 4 (HMO) | $0.00 | $5,500 | No Rx Coverage | H3528 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 ConnectiCare VIP Prime 4 (HMO) | $0.00 | $5,500 | 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 |
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2011 UnitedHealthcare MedicareComplete Essential (HMO) | $0.00 | $4,500 | No Rx Coverage | H0755 -032 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 UnitedHealthcare MedicareComplete Essential (HMO) | $0.00 | $5,200 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 UnitedHealthcare MedicareComplete Plan 2 (HMO) | $0.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H0755 -031 -0 | $6.00 | $42.00 | $89.00 | $89.00 | n/a | ||
2012 UnitedHealthcare MedicareComplete Plan 2 (HMO) | $0.00 | $5,600 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $7.00 | $44.00 | $44.00 | 3,614 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H0712 -019 -0 | |||||||||||
2012 Wellcare Value (HMO) | $0.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $45.00 | $89.00 | $89.00 | 2,506 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 AARP MedicareComplete Choice (Regional PPO) | $0.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | R7444 -001 -0 | $6.00 | $45.00 | $85.00 | $85.00 | n/a | ||
2012 AARP MedicareComplete Choice (Regional PPO) | $20.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $8.00 | $45.00 | $45.00 | 3,614 2012 Formulary | |||
2011 Evercare Plan DP (PPO SNP) | $30.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H0710 -002 -0 | n/a | ||||||
2012 UnitedHealthcare Dual Complete (PPO SNP) | $25.30 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 3,614 2012 Formulary | |||||
2011 WellCare Access (HMO SNP) | $33.70 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H0712 -005 -0 | $3.00 | $41.00 | $85.00 | $85.00 | n/a | ||
2012 WellCare Access (HMO SNP) | $32.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $45.00 | $95.00 | $95.00 | 2,506 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 WellCare Choice (HMO-POS) | $31.50 | $3,250 | $0 | No additional gap coverage, only the Donut Hole Discount | H0712 -001 -0 | $3.00 | $39.00 | $79.00 | $79.00 | n/a | ||
2012 WellCare Choice (HMO-POS) | $49.00 | $3,250 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $39.00 | $79.00 | $79.00 | 2,506 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H5521 -013 -0 | |||||||||||
-- | -- | |||||||||||
2012 Aetna Medicare Standard Plan (PPO) | $87.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $31.00 | $45.00 | $45.00 | 3,158 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H5793 -008 -0 | |||||||||||
-- | ||||||||||||
2012 Aetna Medicare Standard Plan (HMO) | $94.00 | $3,400 | $0 | Many Generics | $5.00 | $33.00 | $45.00 | $45.00 | 3,158 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 ConnectiCare VIP Prime 3 (HMO) | $109.00 | $2,900 | $0 | Many Generics | H3528 -002 -0 | n/a | ||||||
2012 ConnectiCare VIP Prime 3 (HMO) | $119.00 | $3,400 | $0 | Many Generics | $10.00 | $40.00 | $80.00 | $80.00 | 3,114 2012 Formulary | |||
2011 UnitedHealthcare MedicareComplete Plan 1 (HMO) | $119.00 | $2,900 | $0 | Some Generics | H0755 -030 -0 | $6.00 | $40.00 | $82.00 | $82.00 | n/a | ||
2012 UnitedHealthcare MedicareComplete Plan 1 (HMO) | $121.00 | $3,400 | $0 | Some Generics | $3.00 | $6.00 | $42.00 | $42.00 | 3,614 2012 Formulary | |||
2011 ConnectiCare VIP Option 1 (HMO-POS) | $168.00 | $5,500 | $0 | Many Generics | H3528 -006 -0 | n/a | ||||||
2012 ConnectiCare VIP Option 1 (HMO-POS) | $179.00 | $5,500 | $0 | Many Generics | $10.00 | $40.00 | $80.00 | $80.00 | 3,114 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 MediBlue Essential (HMO) | $0.00 | $6,000 | No Rx Coverage | H5854 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2012 -- |
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2011 MediBlue Plus (HMO) | $75.00 | $3,300 | $0 | Many Generics | H5854 -002 -0 | 0% | $42.00 | $80.00 | $80.00 | n/a | ||
-- This plan not offered in 2012 -- |
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2011 WellCare Premium (HMO-POS) | $102.00 | $1,750 | $0 | No additional gap coverage, only the Donut Hole Discount | H0712 -018 -0 | $5.00 | $29.00 | $59.00 | $59.00 | n/a | ||
-- This plan not offered in 2012 -- |
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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 AARP MedicareComplete Choice (Regional PPO) | $0.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | R7444 -001 -0 | $6.00 | $45.00 | $85.00 | $85.00 | n/a | ||
-- This plan not offered in 2012 -- |
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2011 Evercare Plan IP (PPO SNP) | $30.70 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H0710 -001 -0 | n/a | ||||||
-- This plan not offered in 2012 -- |
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2011 Aetna Medicare Standard Plan (PPO) | $20.90 | n/a | $0 | n/a | H5521 -013 -0 | $8.00 | $38.00 | $45.00 | $45.00 | n/a | ||
-- This plan not offered in 2012 -- |
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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 Aetna Medicare Value Plan (HMO) | $0.00 | n/a | $0 | n/a | H5793 -001 -0 | $6.00 | $34.00 | $45.00 | $45.00 | n/a | ||
-- This plan not offered in 2012 -- |
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2011 Aetna Medicare Standard Plan (HMO) | $29.70 | n/a | $0 | n/a | H5793 -008 -0 | $5.00 | $35.00 | $45.00 | $45.00 | n/a | ||
-- This plan not offered in 2012 -- |
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