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 Advocare Essence (HMO-POS) | $0.00 | $3,400 | No Rx Coverage | H5211 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 Advocare Essence (HMO-POS) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 Humana Gold Choice H8145-121 (PFFS) | $39.00 | $5,000 | No Rx Coverage | H8145 -121 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2012 Humana Gold Choice H8145-121 (PFFS) | $0.00 | $5,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 HumanaChoice R5826-023 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -023 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2012 HumanaChoice R5826-023 (Regional PPO) | $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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2011 HumanaChoice H5216-007 (PPO) | $31.00 | $4,500 | $0 | Few Generics, Few Brands |
H5216 -007 -0 | $5.00 | $34.00 | $75.00 | $75.00 | n/a | ||
2012 HumanaChoice H5216-007 (PPO) | $36.00 | $4,500 | $0 | Few Generics, Few Brands | $5.00 | $34.00 | $75.00 | $75.00 | 3,798 2012 Formulary | |||
2011 Advocare Essence Rx (HMO-POS) | $33.00 | $3,400 | $0 | Few Generics | H5211 -002 -0 | $6.00 | $35.00 | $70.00 | $70.00 | n/a | ||
2012 Advocare Essence Rx (HMO-POS) | $39.00 | $3,400 | $0 | Few Generics | $6.00 | $35.00 | $70.00 | $70.00 | 4,262 2012 Formulary | |||
2011 Medica Prime Solution Value Thrift with Rx (Cost) | $61.50 | $5,000 | $185 | No additional gap coverage, only the Donut Hole Discount | H2450 -007 -0 | $10.00 | $34.00 | $74.00 | $74.00 | n/a | ||
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2012 Medica Prime Solution Thrift with Part D Option 1 (Cost) | $55.50 | $6,700 | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 4,886 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 Humana Gold Choice H8145-006 (PFFS) | $61.00 | $6,000 | $0 | Few Generics, Few Brands |
H8145 -006 -0 | $7.00 | $41.00 | $80.00 | $80.00 | n/a | ||
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2012 Humana Gold Choice H8145-006 (PFFS) | $61.00 | $6,000 | $0 | Few Generics, Few Brands | $7.00 | $41.00 | $80.00 | $80.00 | 3,798 2012 Formulary | |||
2011 UCare for Seniors Value (HMO-POS) | $58.00 | $3,400 | No Rx Coverage | H4270 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 UCare for Seniors Value (HMO-POS) | $61.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 HealthPartners Wisconsin Freedom Plan I (Cost) | $61.00 | $-1 | No Rx Coverage | H2462 -015 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2012 HealthPartners Wisconsin Freedom Basic (Cost) | $62.00 | n/a | 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 HumanaChoice R5826-009 (Regional PPO) | $61.00 | $5,000 | $310 | No additional gap coverage, only the Donut Hole Discount | R5826 -009 -0 | n/a | ||||||
-- | ||||||||||||
2012 HumanaChoice R5826-009 (Regional PPO) | $67.00 | $5,000 | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,798 2012 Formulary | |||
2011 UCare for Seniors Standard D (HMO-POS) | $70.00 | $3,400 | $310 | No additional gap coverage, only the Donut Hole Discount | H4270 -004 -0 | n/a | ||||||
2012 UCare for Seniors Standard D (HMO-POS) | $67.00 | $3,400 | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 2,804 2012 Formulary | |||||
-- This plan not offered in 2011 -- |
H2450 -022 -0 | |||||||||||
-- | ||||||||||||
2012 Medica Prime Solution Value with Part D Option 1 (Cost) | $85.50 | $3,350 | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 4,886 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 UCare for Seniors Value Plus (HMO-POS) | $82.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4270 -003 -0 | $9.00 | $35.00 | $70.00 | $70.00 | n/a | ||
2012 UCare for Seniors Value Plus (HMO-POS) | $89.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $35.00 | $70.00 | $70.00 | 4,776 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H2450 -023 -0 | |||||||||||
-- | ||||||||||||
2012 Medica Prime Solution Value with Part D Option 2 (Cost) | $102.60 | $3,350 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $34.00 | $74.00 | $74.00 | 4,886 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H2450 -016 -0 | |||||||||||
-- | ||||||||||||
2012 Medica Prime Solution Basic with Part D Option 1 (Cost) | $105.50 | $3,000 | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 4,886 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 Advocare Spirit (HMO-POS) | $118.00 | $900 | No Rx Coverage | H5211 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 Advocare Spirit (HMO-POS) | $118.00 | $900 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2011 -- |
H2450 -001 -0 | |||||||||||
-- | ||||||||||||
2012 Medica Prime Solution Basic with Part D Option 2 (Cost) | $122.60 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $34.00 | $74.00 | $74.00 | 4,886 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H2450 -017 -0 | |||||||||||
-- | ||||||||||||
2012 Medica Prime Solution Enhanced w/Part D Option 1 (Cost) | $155.50 | $3,000 | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 4,886 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 UCare for Seniors Classic (HMO-POS) | $147.00 | $3,400 | $0 | Many Generics | H4270 -002 -0 | $9.00 | $35.00 | $70.00 | $70.00 | n/a | ||
2012 UCare for Seniors Classic (HMO-POS) | $159.00 | $3,400 | $0 | Many Generics | $10.00 | $35.00 | $70.00 | $70.00 | 4,776 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H2450 -028 -0 | |||||||||||
-- | ||||||||||||
2012 Medica Prime Solution Value with Part D Option 3 (Cost) | $161.20 | $3,350 | $0 | Many Generics | $10.00 | $34.00 | $74.00 | $74.00 | 4,886 2012 Formulary | |||
2011 Advocare Spirit Rx (HMO-POS) | $163.00 | $900 | $0 | Few Generics | H5211 -004 -0 | $6.00 | $35.00 | $70.00 | $70.00 | n/a | ||
2012 Advocare Spirit Rx (HMO-POS) | $167.00 | $900 | $0 | Few Generics | $6.00 | $35.00 | $70.00 | $70.00 | 4,262 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 -- |
H2450 -002 -0 | |||||||||||
-- | ||||||||||||
2012 Medica Prime Solution Enhanced w/Part D Option 2 (Cost) | $172.60 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $34.00 | $74.00 | $74.00 | 4,886 2012 Formulary | |||
-- This plan not offered in 2011 -- |
H2450 -005 -0 | |||||||||||
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2012 Medica Prime Solution Basic with Part D Option 3 (Cost) | $181.20 | $3,000 | $0 | Many Generics | $10.00 | $34.00 | $74.00 | $74.00 | 4,886 2012 Formulary | |||
2011 Advocare Vitality (HMO-POS) | $176.00 | n/a | No Rx Coverage | H5211 -006 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2012 Advocare Vitality (HMO-POS) | $192.00 | n/a | 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 -- |
H2450 -006 -0 | |||||||||||
-- | ||||||||||||
2012 Medica Prime Solution Enhanced w/Part D Option 3 (Cost) | $231.20 | $3,000 | $0 | Many Generics | $10.00 | $34.00 | $74.00 | $74.00 | 4,886 2012 Formulary | |||
2011 HealthPartners Wisconsin Freedom Plan II (Cost) | $229.00 | $3,000 | No Rx Coverage | H2462 -016 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2012 HealthPartners Wisconsin Freedom Ultimate (Cost) | $236.00 | $3,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2011 Advocare Vitality Rx (HMO-POS) | $232.00 | n/a | $0 | Few Generics | H5211 -005 -0 | $6.00 | $35.00 | $70.00 | $70.00 | n/a | ||
2012 Advocare Vitality Rx (HMO-POS) | $254.00 | n/a | $0 | Few Generics | $6.00 | $35.00 | $70.00 | $70.00 | 4,262 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 HealthPartners Wisconsin Freedom Plan II Std Rx (Cost) | $259.80 | $3,000 | $310 | No additional gap coverage, only the Donut Hole Discount | H2462 -017 -0 | n/a | ||||||
-- | ||||||||||||
2012 HealthPartners Wisconsin Freedom Ultimate with Rx (Cost) | $258.50 | $3,000 | $320 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,632 2012 Formulary | |||
2011 HumanaChoice R5826-009 (Regional PPO) | $61.00 | $5,000 | $310 | No additional gap coverage, only the Donut Hole Discount | R5826 -009 -0 | n/a | ||||||
-- This plan not offered in 2012 -- |
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2011 HumanaChoice R5826-023 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -023 -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 Medica Prime Solution Basic with Enhanced Rx - WI (Cost) | $175.30 | $3,000 | $0 | Many Generics | H2450 -010 -0 | $10.00 | $34.00 | $74.00 | $74.00 | n/a | ||
-- This plan not offered in 2012 -- |
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2011 Medica Prime Solution Basic with Standard Rx - WI (Cost) | $122.30 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H2450 -008 -0 | $10.00 | $34.00 | $74.00 | $74.00 | n/a | ||
-- This plan not offered in 2012 -- |
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2011 Medica Prime Solution Basic with Thrift Rx - WI (Cost) | $113.50 | $3,000 | $180 | No additional gap coverage, only the Donut Hole Discount | H2450 -018 -0 | $10.00 | $34.00 | 25% | 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 |
||||||
2011 Medica Prime Solution Enhanced w/Enhanced Rx - WI (Cost) | $223.30 | $3,000 | $0 | Many Generics | H2450 -009 -0 | $10.00 | $34.00 | $74.00 | $74.00 | n/a | ||
-- This plan not offered in 2012 -- |
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2011 Medica Prime Solution Enhanced w/Standard Rx - WI (Cost) | $170.30 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H2450 -011 -0 | $10.00 | $34.00 | $74.00 | $74.00 | n/a | ||
-- This plan not offered in 2012 -- |
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2011 Medica Prime Solution Enhanced with Thrift Rx - WI (Cost) | $161.50 | $3,000 | $180 | No additional gap coverage, only the Donut Hole Discount | H2450 -019 -0 | $10.00 | $34.00 | 25% | 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 |
||||||
2011 Medica Prime Solution Value Plus w/Thrift Rx - WI (Cost) | $89.50 | $3,350 | $180 | No additional gap coverage, only the Donut Hole Discount | H2450 -024 -0 | $10.00 | $34.00 | 25% | n/a | |||
-- This plan not offered in 2012 -- |
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2011 Medica Prime Solution Value Plus with Std Rx - WI (Cost) | $98.30 | $3,350 | $0 | No additional gap coverage, only the Donut Hole Discount | H2450 -025 -0 | $10.00 | $34.00 | $74.00 | $74.00 | n/a | ||
-- This plan not offered in 2012 -- |
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