2012 / 2013 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 2012 -- |
H0084 -030 -0 | |||||||||||
2013 Care Improvement Plus Copper RX (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | |||
2012 Care Improvement Plus Gold Rx (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -007 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Gold Rx (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | |||
2012 Care Improvement Plus Medicare Advantage (PPO) | $53.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -009 -0 | $10.00 | $43.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Medicare Advantage (PPO) | $0.00 | $5,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 3,401 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 |
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-- This plan not offered in 2012 -- |
H1463 -008 -0 | |||||||||||
2013 Health Alliance Medicare HMO Basic (HMO-POS) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 HumanaChoice R5826-023 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -023 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HumanaChoice R5826-023 (Regional PPO) | $0.00 | $4,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H0084 -029 -0 | |||||||||||
2013 Care Improvement Plus Chrome RX (PPO SNP) | $30.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 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 |
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2012 Care Improvement Plus Silver Rx (PPO SNP) | $30.20 | n/a | $205 | No additional gap coverage, only the Donut Hole Discount | H0084 -006 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Silver Rx (PPO SNP) | $30.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H1463 -009 -0 | |||||||||||
2013 Health Alliance Medicare HMO Basic Rx (HMO-POS) | $34.00 | $3,400 | $150 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $33.00 | $45.00 | $45.00 | 5,230 2013 Formulary | |||
2012 Health Alliance Medicare PPO30 (PPO) | $45.00 | $3,000 | No Rx Coverage | H1417 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Health Alliance Medicare PPO30 (PPO) | $35.00 | $3,000 | 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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2012 Health Alliance Medicare PPO30 Rx (PPO) | $89.00 | $3,000 | $105 | No additional gap coverage, only the Donut Hole Discount | H1417 -004 -0 | $0.00 | $35.00 | $45.00 | $45.00 | 4,871 2012 Formulary | ||
2013 Health Alliance Medicare PPO30 Rx (PPO) | $69.00 | $3,000 | $180 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $33.00 | $45.00 | $45.00 | 5,230 2013 Formulary | |||
2012 Health Alliance Medicare HMO20 (HMO) | $100.00 | $1,500 | No Rx Coverage | H1463 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Health Alliance Medicare HMO20 (HMO) | $75.00 | $1,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 HumanaChoice R5826-009 (Regional PPO) | $67.00 | $5,000 | $320 | No additional gap coverage, only the Donut Hole Discount | R5826 -009 -0 | 25% | 25% | 25% | 25% | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-009 (Regional PPO) | $89.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 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 H1418-007 (PPO) | $87.00 | $4,500 | $0 | Few Generics, Few Brands | H1418 -007 -0 | $6.00 | $38.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Prime Choice H1418-007 (PPO) | $92.00 | $6,700 | $0 | Few Generics, Few Brands | $6.00 | $38.00 | $80.00 | $80.00 | 3,906 2013 Formulary | |||
2012 Health Alliance Medicare PPO10 (PPO) | $110.00 | $1,500 | No Rx Coverage | H1417 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Health Alliance Medicare PPO10 (PPO) | $100.00 | $1,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Health Alliance Medicare HMO20 Rx (HMO) | $144.00 | $1,500 | $100 | No additional gap coverage, only the Donut Hole Discount | H1463 -003 -0 | $0.00 | $35.00 | $45.00 | $45.00 | 4,871 2012 Formulary | ||
2013 Health Alliance Medicare HMO20 Rx (HMO) | $119.00 | $1,500 | $130 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $33.00 | $45.00 | $45.00 | 5,230 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 |
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2012 Health Alliance Medicare PPO10 Rx (PPO) | $154.00 | $1,500 | $105 | No additional gap coverage, only the Donut Hole Discount | H1417 -002 -0 | $0.00 | $35.00 | $45.00 | $45.00 | 4,871 2012 Formulary | ||
2013 Health Alliance Medicare PPO10 Rx (PPO) | $144.00 | $1,500 | $140 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $33.00 | $45.00 | $45.00 | 5,230 2013 Formulary | |||
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