2012 / 2013 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 |
||||||
2012 AARP MedicareComplete (HMO) | $0.00 | $5,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H1080 -043 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete (HMO) | $0.00 | $3,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 AARP MedicareComplete Choice Essential (Regional PPO) | $0.00 | $4,500 | No Rx Coverage | R5287 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 AARP MedicareComplete Choice Essential (Regional PPO) | $0.00 | $3,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 AARP MedicareComplete Choice Plan 2 (Regional PPO) | $0.00 | $5,900 | $0 | No additional gap coverage, only the Donut Hole Discount | R5287 -001 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete Choice Plan 2 (Regional PPO) | $0.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 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 2012 -- |
H1026 -045 -0 | |||||||||||
2013 BlueMedicare HMO (HMO) | $0.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $45.00 | $45.00 | 3,729 2013 Formulary | |||
2012 BlueMedicare Regional PPO (Regional PPO) | $0.00 | $4,750 | $0 | No additional gap coverage, only the Donut Hole Discount | R3332 -001 -0 | $6.00 | $45.00 | $85.00 | $85.00 | 3,656 2012 Formulary | ||
2013 BlueMedicare Regional PPO (Regional PPO) | $0.00 | $5,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $10.00 | $45.00 | $45.00 | 3,729 2013 Formulary | |||
2012 CareOne (HMO) | $0.00 | $5,500 | $0 | Few Generics, Few Brands |
H1019 -043 -0 | $0.00 | $7.00 | $45.00 | $45.00 | 3,798 2012 Formulary | ||
2013 CareOne (HMO) | $0.00 | $5,500 | $0 | Few Generics, Few Brands | $0.00 | $7.00 | $45.00 | $45.00 | 3,906 2013 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 2012 -- |
H4199 -009 -0 | |||||||||||
-- | -- | |||||||||||
2013 Day Light (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Freedom Medicare Plan Rx (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5427 -059 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 2,608 2012 Formulary | ||
2013 Freedom Medicare Plan Rx (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $20.00 | $60.00 | $60.00 | 2,768 2013 Formulary | |||
2012 Freedom Savings Plan (HMO) | $0.00 | $3,400 | No Rx Coverage | H5427 -052 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Freedom Savings Plan (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 |
||||||
2012 Freedom Savings Plan Rx (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5427 -053 -0 | $0.00 | $25.00 | $65.00 | $65.00 | 2,608 2012 Formulary | ||
2013 Freedom Savings Plan Rx (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $25.00 | $65.00 | $65.00 | 2,768 2013 Formulary | |||
2012 Freedom VIP Savings (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H5427 -082 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 2,608 2012 Formulary | ||
2013 Freedom VIP Savings (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $60.00 | $60.00 | 2,768 2013 Formulary | |||
2012 Freedom VIP Savings COPD (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H5427 -083 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 2,608 2012 Formulary | ||
2013 Freedom VIP Savings COPD (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $60.00 | $60.00 | 2,768 2013 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 |
||||||
2012 Health First Rewards Plan (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H1099 -014 -0 | $2.00 | $10.00 | $45.00 | $45.00 | 2,471 2012 Formulary | ||
2013 Health First Rewards Plan (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $45.00 | $45.00 | 2,688 2013 Formulary | |||
2012 Health First Value Plan (HMO) | $0.00 | $6,000 | $0 | Some Generics | H1099 -006 -0 | $2.00 | $10.00 | $45.00 | $45.00 | 2,471 2012 Formulary | ||
2013 Health First Value Plan (HMO) | $0.00 | $6,000 | $0 | Some Generics | $2.00 | $10.00 | $45.00 | $45.00 | 2,688 2013 Formulary | |||
2012 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $0.00 | $4,950 | $0 | Few Generics, Few Brands |
R5826 -074 -0 | $7.00 | $41.00 | $81.00 | $81.00 | 3,798 2012 Formulary | ||
2013 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $0.00 | $4,950 | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 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 |
||||||
2012 HumanaChoice R5826-018 (Regional PPO) | $0.00 | $4,000 | No Rx Coverage | R5826 -018 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HumanaChoice R5826-018 (Regional PPO) | $0.00 | $4,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 PUP PLUS (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5696 -034 -0 | $4.00 | $4.00 | $35.00 | $35.00 | 3,427 2012 Formulary | ||
2013 PUP PLUS (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $35.00 | $95.00 | $95.00 | 3,542 2013 Formulary | |||
2012 PUP REWARDS (HMO) | $0.00 | $4,300 | $0 | No additional gap coverage, only the Donut Hole Discount | H5696 -004 -0 | $0.00 | $4.00 | $35.00 | $35.00 | 3,427 2012 Formulary | ||
2013 PUP REWARDS (HMO) | $0.00 | $4,300 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $35.00 | $95.00 | $95.00 | 3,542 2013 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 |
||||||
2012 PUP SIMPLE (HMO) | $0.00 | $4,200 | $0 | Some Generics | H5696 -033 -0 | $0.00 | $0.00 | $20.00 | $20.00 | 3,427 2012 Formulary | ||
2013 PUP SIMPLE (HMO) | $0.00 | $4,200 | $0 | Many Generics | $0.00 | $20.00 | $80.00 | $80.00 | 3,542 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H4199 -007 -0 | |||||||||||
-- | -- | |||||||||||
2013 Sunrise (HMO) | $0.00 | $3,400 | $0 | All Generics | $0.00 | $10.00 | $40.00 | $40.00 | 2,887 2013 Formulary | |||
2012 WellCare Advance (HMO) | $0.00 | $6,700 | No Rx Coverage | H1032 -037 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 WellCare Advance (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 |
||||||
-- This plan not offered in 2012 -- |
H1032 -179 -0 | |||||||||||
2013 WellCare Dividend (HMO) | $0.00 | $5,500 | $0 | All Generics | $3.00 | $39.00 | $75.00 | $75.00 | 2,835 2013 Formulary | |||
2012 WellCare Essential (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H1032 -133 -0 | $0.00 | $39.00 | $79.00 | $79.00 | 2,506 2012 Formulary | ||
2013 WellCare Essential (HMO) | $0.00 | $3,400 | $0 | All Generics | $0.00 | $39.00 | $79.00 | $79.00 | 2,835 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H5696 -021 -0 | |||||||||||
2013 PUP EXTRA (HMO SNP) | $4.90 | n/a | $0 | n/a | $0.00 | $0.00 | $0.00 | $0.00 | 3,542 2013 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 2012 -- |
H4199 -011 -0 | |||||||||||
-- | -- | |||||||||||
2013 Sunny Days (HMO SNP) | $5.00 | n/a | $325 | n/a | 25% | 25% | 25% | 25% | 2,887 2013 Formulary | |||
2012 WellCare Select (HMO-POS SNP) | $18.10 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H1032 -061 -0 | $4.00 | $45.00 | $95.00 | $95.00 | 2,506 2012 Formulary | ||
2013 WellCare Select (HMO-POS SNP) | $8.50 | n/a | $325 | n/a | $0.00 | $45.00 | $95.00 | $95.00 | 2,835 2013 Formulary | |||
2012 WellCare Access (HMO SNP) | $19.20 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H1032 -124 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 2,506 2012 Formulary | ||
2013 WellCare Liberty (HMO SNP) | $8.70 | n/a | $325 | n/a | $0.00 | $45.00 | $95.00 | $95.00 | 2,835 2013 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 2012 -- |
H1032 -175 -0 | |||||||||||
2013 WellCare Access (HMO SNP) | $12.10 | n/a | $325 | n/a | $0.00 | $45.00 | $95.00 | $95.00 | 2,835 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H4199 -010 -0 | |||||||||||
-- | -- | |||||||||||
2013 Clear Skies (HMO SNP) | $18.80 | n/a | $0 | All Generics | $0.00 | $10.00 | $40.00 | $40.00 | 2,887 2013 Formulary | |||
2012 Freedom Medi-Medi Full (HMO SNP) | $23.80 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H5427 -087 -0 | 0% | 0% | 2,608 2012 Formulary | ||||
2013 Freedom Medi-Medi Full (HMO SNP) | $23.10 | n/a | $325 | n/a | 25% | 2,764 2013 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 2012 -- |
H5417 -001 -0 | |||||||||||
-- | ||||||||||||
2013 UnitedHealthcare Nursing Home Plan (PPO SNP) | $23.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
2012 Freedom Medi-Medi Partial (HMO SNP) | $18.10 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H5427 -078 -0 | 15% | 15% | 2,608 2012 Formulary | ||||
2013 Freedom Medi-Medi Partial (HMO SNP) | $24.70 | n/a | $325 | n/a | 25% | 2,764 2013 Formulary | ||||||
2012 CareNeeds PLUS (HMO SNP) | $23.80 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H1019 -045 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,798 2012 Formulary | ||
2013 CareNeeds PLUS (HMO SNP) | $24.80 | n/a | $325 | n/a | $0.00 | $0.00 | $42.00 | $42.00 | 3,906 2013 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 2012 -- |
R5287 -003 -0 | |||||||||||
2013 UnitedHealthcare Dual Complete RP (Regional PPO SNP) | $24.80 | n/a | $325 | n/a | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H4199 -008 -0 | |||||||||||
-- | -- | |||||||||||
2013 Day Break (HMO) | $24.90 | $3,400 | $0 | All Generics | $0.00 | $20.00 | $60.00 | $60.00 | 2,887 2013 Formulary | |||
2012 Health First Secure Plan (HMO) | $30.00 | $3,400 | No Rx Coverage | H1099 -009 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Health First Secure Plan (HMO) | $30.00 | $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 |
||||||
2012 WellCare Choice (HMO-POS) | $35.60 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H1032 -002 -0 | $0.00 | $25.00 | $60.00 | $60.00 | 2,506 2012 Formulary | ||
2013 WellCare Choice (HMO-POS) | $40.60 | $3,400 | $0 | All Generics | $0.00 | $25.00 | $60.00 | $60.00 | 2,835 2013 Formulary | |||
2012 HumanaChoice R5826-005 (Regional PPO) | $80.00 | $4,750 | $0 | Few Generics, Few Brands |
R5826 -005 -0 | $2.00 | $8.00 | $40.00 | $40.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-005 (Regional PPO) | $85.00 | $4,750 | $0 | Few Generics, Few Brands | $3.00 | $8.00 | $40.00 | $40.00 | 3,906 2013 Formulary | |||
2012 Health First Classic Plan (HMO-POS) | $86.00 | $5,000 | $0 | Many Generics | H1099 -001 -0 | $2.00 | $10.00 | $45.00 | $45.00 | 2,471 2012 Formulary | ||
2013 Health First Classic Plan (HMO-POS) | $91.00 | $5,000 | $0 | Many Generics | $2.00 | $10.00 | $45.00 | $45.00 | 2,688 2013 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 |
||||||
2012 Humana Gold Choice H8145-061 (PFFS) | $99.00 | $6,700 | $0 | Few Generics, Few Brands |
H8145 -061 -0 | $8.00 | $42.00 | $81.00 | $81.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-061 (PFFS) | $102.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H1099 -015 -0 | |||||||||||
2013 Health First Platinum Plan (HMO) | $155.00 | $3,400 | $0 | Many Generics | $2.00 | $10.00 | $45.00 | $45.00 | 2,688 2013 Formulary | |||
2012 Any, Any, Any Gold (PFFS) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H8098 -001 -0 | $6.00 | $15.00 | $45.00 | $45.00 | 3,148 2012 Formulary | ||
-- This plan not offered in 2013 -- |
||||||||||||
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 |
||||||
2012 Any, Any, Any Gold MA Only (PFFS) | $0.00 | $6,700 | No Rx Coverage | H8098 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2013 -- |
||||||||||||
2012 Medicare Masterpiece (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5404 -001 -0 | $0.00 | $8.00 | $45.00 | $45.00 | 3,152 2012 Formulary | ||
-- This plan not offered in 2013 -- |
||||||||||||
2012 Medicare Masterpiece Plus (HMO-POS) | $29.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5404 -086 -0 | $4.00 | $15.00 | $45.00 | $45.00 | 3,152 2012 Formulary | ||
-- This plan not offered in 2013 -- |
||||||||||||
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 |
||||||
2012 Medicare Masterpiece Premier - COPD (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H5404 -137 -0 | $0.00 | $0.00 | $20.00 | $20.00 | 3,152 2012 Formulary | ||
-- This plan not offered in 2013 -- |
||||||||||||
2012 Medicare Masterpiece Premier - Dementia (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H5404 -136 -0 | $0.00 | $0.00 | $20.00 | $20.00 | 3,152 2012 Formulary | ||
-- This plan not offered in 2013 -- |
||||||||||||
2012 Medicare Masterpiece Premier - Diabetes, CHF, CVD (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H5404 -135 -0 | $0.00 | $0.00 | $20.00 | $20.00 | 3,152 2012 Formulary | ||
-- This plan not offered in 2013 -- |
||||||||||||
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 |
||||||
2012 Universal Hassle-Free (PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5096 -001 -0 | $6.00 | $15.00 | $45.00 | $45.00 | 3,148 2012 Formulary | ||
-- | -- | |||||||||||
-- This plan not offered in 2013 -- |
||||||||||||
2012 Universal Hassle-Free MA Only (PPO) | $0.00 | $6,700 | No Rx Coverage | H5096 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | -- | |||||||||||
-- This plan not offered in 2013 -- |
||||||||||||
|