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 AARP MedicareComplete Plus Plan 1 (HMO-POS) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4456 -013 -0 | $6.00 | $45.00 | $85.00 | $85.00 | n/a | ||
2012 AARP MedicareComplete Plus Plan 1 (HMO-POS) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $7.00 | $45.00 | $45.00 | 3,614 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H7917 -030 -0 | |||||||||||
2012 BlueAdvantage Sapphire (PPO) | $0.00 | $4,950 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $80.00 | $80.00 | 2,185 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H4454 -012 -0 | |||||||||||
2012 HealthyAdvantage (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 |
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-- This plan not offered in 2011 -- |
H4454 -031 -0 | |||||||||||
2012 HealthyAdvantage Preferred ETN (HMO) | $0.00 | $3,400 | $0 | Many Generics | $5.00 | $12.00 | $45.00 | $45.00 | 2,990 2012 Formulary | |||
2011 HumanaChoice R5826-065 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -065 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2012 HumanaChoice R5826-065 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 Windsor Medicare Extra Emerald Plan (HMO) | $0.00 | $6,700 | $0 | Some Generics | H5698 -062 -0 | $5.00 | $12.00 | $42.00 | $42.00 | n/a | ||
2012 Windsor Medicare Extra Emerald Plan (HMO) | $0.00 | $6,700 | $0 | Some Generics | $7.00 | $12.00 | $42.00 | $42.00 | 2,536 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 Windsor Medicare Extra Silver Plan (HMO) | $0.00 | $3,400 | No Rx Coverage | H5698 -035 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 Windsor Medicare Extra Silver Plan (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 Humana Gold Plus H4461-015 (HMO) | $28.00 | $3,400 | $0 | Few Generics, Few Brands |
H4461 -015 -0 | $8.00 | $40.00 | $80.00 | $80.00 | n/a | ||
2012 Humana Gold Plus H4461-015 (HMO) | $18.00 | $3,400 | $0 | Few Generics, Few Brands | $8.00 | $41.00 | $82.00 | $82.00 | 3,798 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H4454 -032 -0 | |||||||||||
2012 HealthyAdvantage Premier ETN (HMO-POS) | $26.00 | $3,400 | $0 | Many Generics | $5.00 | $12.00 | $45.00 | $45.00 | 2,990 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 UnitedHealthcare Dual Complete Preferred (HMO SNP) | $33.70 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H0251 -002 -0 | n/a | ||||||
2012 UnitedHealthcare Dual Complete (HMO SNP) | $29.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 3,614 2012 Formulary | |||||
-- This plan not offered in 2011 -- |
H9988 -019 -0 | |||||||||||
-- | ||||||||||||
2012 Fresenius Health Partners (PPO SNP) | $30.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,536 2012 Formulary | |||
2011 Evercare Plan IH-POS (HMO-POS SNP) | $27.40 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H0408 -002 -0 | n/a | ||||||
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2012 UnitedHealthcare Nursing Home Plan (HMO-POS SNP) | $30.30 | 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 |
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-- This plan not offered in 2011 -- |
H4461 -022 -0 | |||||||||||
2012 Humana Gold Plus SNP-DE H4461-022 (HMO SNP) | $30.80 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $34.00 | $71.00 | $71.00 | 3,798 2012 Formulary | |||
2011 Humana Gold Plus SNP-DE H4461-011 (HMO SNP) | $33.80 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | H4461 -011 -0 | n/a | ||||||
2012 Humana Gold Plus SNP-DE H4461-011 (HMO SNP) | $31.70 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $35.00 | $70.00 | $70.00 | 3,798 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H5698 -140 -0 | |||||||||||
2012 Windsor Medicare Extra Comp Plus Plan (HMO SNP) | $31.70 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 2,536 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 Windsor Medicare Extra Gold Plan (HMO) | $35.00 | $3,400 | $0 | Some Generics | H5698 -036 -0 | $3.00 | $10.00 | $40.00 | $40.00 | n/a | ||
2012 Windsor Medicare Extra Gold Plan (HMO) | $35.00 | $3,400 | $0 | Some Generics | $3.00 | $10.00 | $40.00 | $40.00 | 2,536 2012 Formulary | |||
2011 Humana Gold Plus H4461-004 (HMO) | $45.00 | $3,400 | No Rx Coverage | H4461 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 Humana Gold Plus H4461-004 (HMO) | $45.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 HumanaChoice H4408-007 (PPO) | $42.00 | $4,900 | $0 | Few Generics, Few Brands |
H4408 -007 -0 | $8.00 | $42.00 | $80.00 | $80.00 | n/a | ||
2012 HumanaChoice H4408-007 (PPO) | $47.00 | $5,300 | $0 | Few Generics, Few Brands | $8.00 | $42.00 | $80.00 | $80.00 | 3,798 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 BlueAdvantage Ruby (PPO) | $51.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H7917 -014 -0 | $7.00 | $30.00 | $75.00 | $75.00 | n/a | ||
2012 BlueAdvantage Ruby (PPO) | $50.00 | $4,800 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $30.00 | $75.00 | $75.00 | 2,837 2012 Formulary | |||
2011 AARP MedicareComplete Essential (HMO) | $60.00 | $3,200 | No Rx Coverage | H4456 -020 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 AARP MedicareComplete Essential (HMO) | $58.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 HumanaChoice R5826-001 (Regional PPO) | $59.00 | $3,900 | $310 | No additional gap coverage, only the Donut Hole Discount | R5826 -001 -0 | n/a | ||||||
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2012 HumanaChoice R5826-001 (Regional PPO) | $59.00 | $4,900 | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,798 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 AARP MedicareComplete Plan 2 (HMO) | $85.00 | $3,200 | $0 | No additional gap coverage, only the Donut Hole Discount | H4456 -021 -0 | $5.00 | $42.00 | $80.00 | $80.00 | n/a | ||
2012 AARP MedicareComplete Plan 2 (HMO) | $83.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $44.00 | $44.00 | 3,614 2012 Formulary | |||
2011 Humana Gold Plus H4461-001 (HMO) | $98.00 | $3,400 | $0 | Few Generics, Few Brands |
H4461 -001 -0 | $6.00 | $38.00 | $80.00 | $80.00 | n/a | ||
2012 Humana Gold Plus H4461-001 (HMO) | $98.00 | $3,400 | $0 | Few Generics, Few Brands | $6.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | |||
2011 Windsor Medicare Extra Diabetes Plan (HMO SNP) | $85.00 | n/a | $0 | Some Generics | H5698 -156 -0 | $5.00 | $10.00 | $35.00 | $35.00 | n/a | ||
2012 Windsor Medicare Extra Diabetes Plan (HMO SNP) | $100.00 | n/a | $0 | Some Generics | $5.00 | $10.00 | $35.00 | $35.00 | 2,536 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 Windsor Medicare Extra Fusion Plan (HMO SNP) | $50.00 | n/a | $0 | Some Generics | H5698 -141 -0 | $5.00 | $10.00 | $35.00 | $35.00 | n/a | ||
2012 Windsor Medicare Extra Fusion Plan (HMO SNP) | $110.00 | n/a | $0 | Some Generics | $5.00 | $10.00 | $35.00 | $35.00 | 2,536 2012 Formulary | |||
2011 Windsor Medicare Extra Diamond Plan (HMO) | $145.00 | $3,400 | $0 | Some Generics | H5698 -068 -0 | $5.00 | $10.00 | $39.00 | $39.00 | n/a | ||
2012 Windsor Medicare Extra Diamond Plan (HMO) | $145.00 | $3,400 | $0 | Some Generics | $5.00 | $10.00 | $39.00 | $39.00 | 2,536 2012 Formulary | |||
2011 BlueAdvantage Diamond (PPO) | $151.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H7917 -010 -0 | $7.00 | $30.00 | $75.00 | $75.00 | n/a | ||
2012 BlueAdvantage Diamond (PPO) | $150.00 | $4,650 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $30.00 | $75.00 | $75.00 | 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 BlueAdvantage Emerald (PPO) | $57.00 | $4,900 | No Rx Coverage | H7917 -027 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2012 -- |
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2011 Humana Gold Choice H8145-080 (PFFS) | $65.00 | $5,000 | $0 | Few Generics, Few Brands |
H8145 -080 -0 | $6.00 | $40.00 | $80.00 | $80.00 | n/a | ||
-- This plan not offered in 2012 -- |
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2011 Humana Gold Choice H8145-113 (PFFS) | $0.00 | $6,700 | No Rx Coverage | H8145 -113 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- 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 |
||||||
2011 HumanaChoice R5826-001 (Regional PPO) | $59.00 | $3,900 | $310 | No additional gap coverage, only the Donut Hole Discount | R5826 -001 -0 | n/a | ||||||
-- This plan not offered in 2012 -- |
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2011 HumanaChoice R5826-065 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -065 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2012 -- |
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