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 -- |
H1509 -010 -0 | |||||||||||
2013 AARP MedicareComplete Choice Plan 2 (PPO) | $0.00 | $5,200 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $7.00 | $45.00 | $45.00 | 3,282 2013 Formulary | |||
2012 ADVANTAGE Preferred (PPO) | $0.00 | $3,400 | No Rx Coverage | H5508 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 ADVANTAGE Preferred (PPO) | $0.00 | $4,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 ADVANTAGE Select (PPO) | $0.00 | $3,900 | $0 | Many Generics | H5508 -005 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 2,813 2012 Formulary | ||
2013 ADVANTAGE Select (PPO) | $0.00 | $4,100 | $0 | Many Generics | $8.00 | $8.00 | $45.00 | $45.00 | 3,068 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 Humana Gold Plus H2012-009 (HMO) | $0.00 | $3,900 | $0 | Few Generics, Few Brands |
H2012 -009 -0 | $6.00 | $43.00 | $87.00 | $87.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Plus H2012-009 (HMO) | $0.00 | $5,900 | $0 | Few Generics, Few Brands | $5.00 | $12.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 HumanaChoice R5826-066 (Regional PPO) | $0.00 | $5,000 | No Rx Coverage | R5826 -066 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HumanaChoice R5826-066 (Regional PPO) | $0.00 | $5,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 IU Health Plans Medicare Select (HMO) | $0.00 | $4,500 | No Rx Coverage | H7220 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 IU Health Plans Medicare Select (HMO) | $0.00 | $4,500 | 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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2012 Today's Options Classic (HMO) | $22.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5656 -014 -0 | n/a | ||||||
2013 Today's Options Classic (HMO) | $27.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | |||
2012 ADVANTAGE Network (HMO) | $19.00 | $3,400 | $0 | Many Generics | H8822 -004 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 2,813 2012 Formulary | ||
2013 ADVANTAGE Network (HMO) | $33.00 | $3,900 | $0 | Many Generics | $8.00 | $8.00 | $45.00 | $45.00 | 3,068 2013 Formulary | |||
2012 UnitedHealthcare Dual Complete (PPO SNP) | $31.80 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H1509 -004 -0 | 15% | 15% | 3,614 2012 Formulary | ||||
2013 UnitedHealthcare Dual Complete (PPO SNP) | $33.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 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 |
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2012 Blue Medicare Access Value (Regional PPO) | $0.00 | $4,200 | $60 | No additional gap coverage, only the Donut Hole Discount | R5941 -009 -0 | $7.00 | $43.00 | $85.00 | $85.00 | 4,453 2012 Formulary | ||
2013 Blue Medicare Access Value (Regional PPO) | $34.00 | $6,500 | $80 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $45.00 | $45.00 | 4,173 2013 Formulary | |||
2012 ADVANTAGE Special Needs Plan (HMO SNP) | $35.90 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H8822 -005 -0 | 15% | 15% | 2,813 2012 Formulary | ||||
2013 ADVANTAGE Special Needs Plan (HMO SNP) | $37.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 3,065 2013 Formulary | ||||||
2012 UnitedHealthcare Nursing Home Plan (PPO SNP) | $35.90 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H1509 -006 -0 | 25% | 25% | 25% | 25% | 3,614 2012 Formulary | ||
2013 UnitedHealthcare Nursing Home Plan (PPO SNP) | $37.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 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 |
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2012 AARP MedicareComplete Choice (PPO) | $38.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H1509 -007 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete Choice (PPO) | $38.00 | $4,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 ADVANTAGE Choice (PPO) | $29.00 | $3,600 | $0 | Many Generics | H5508 -006 -0 | $4.00 | $4.00 | $35.00 | $35.00 | 2,813 2012 Formulary | ||
2013 ADVANTAGE Choice (PPO) | $39.00 | $4,000 | $0 | Many Generics | $8.00 | $8.00 | $45.00 | $45.00 | 3,068 2013 Formulary | |||
2012 HumanaChoice H1510-001 (PPO) | $49.00 | $5,000 | $0 | Few Generics, Few Brands |
H1510 -001 -0 | $8.00 | $42.00 | $83.00 | $83.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice H1510-001 (PPO) | $50.00 | $5,900 | $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 |
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2012 Today's Options Premier 400 (PFFS) | $50.00 | $6,700 | No Rx Coverage | H6169 -013 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2013 Today's Options Premier 600 (PFFS) | $50.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Anthem Medicare Preferred Standard (PPO) | $29.00 | $4,000 | $60 | Many Generics | H1607 -001 -0 | $7.00 | $43.00 | $85.00 | $85.00 | 4,453 2012 Formulary | ||
2013 Anthem Medicare Preferred Standard (PPO) | $53.00 | $5,200 | $60 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $8.00 | $45.00 | $45.00 | 4,173 2013 Formulary | |||
2012 IU Health Plans Medicare Select Plus (HMO) | $63.90 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H7220 -003 -0 | $5.50 | $35.00 | $85.00 | $85.00 | 3,814 2012 Formulary | ||
2013 IU Health Plans Medicare Select Plus (HMO) | $54.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $40.00 | $85.00 | $85.00 | 3,884 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 Today's Options Advantage Plus 450F (PPO) | $51.00 | $6,700 | $75 | No additional gap coverage, only the Donut Hole Discount | H5378 -184 -0 | n/a | ||||||
2013 Today's Options Advantage Plus 650B (PPO) | $64.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 2013 Formulary | |||
2012 Today's Options Premier (HMO) | $60.00 | $3,250 | $0 | Many Generics, Some Brands |
H5656 -015 -0 | n/a | ||||||
2013 Today's Options Premier (HMO) | $65.00 | $3,250 | $0 | Many Generics, Few Brands | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | |||
2012 HumanaChoice R5826-008 (Regional PPO) | $71.00 | $6,700 | $200 | No additional gap coverage, only the Donut Hole Discount | R5826 -008 -0 | $7.00 | $35.00 | $60.00 | $60.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-008 (Regional PPO) | $66.00 | $6,700 | $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 |
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2012 Today's Options Premier 200 (PFFS) | $80.00 | $3,250 | No Rx Coverage | H6169 -051 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2013 Today's Options Premier 300 (PFFS) | $80.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 ADVANTAGE Enhanced (PPO) | $69.00 | $3,400 | $0 | Many Generics | H5508 -001 -0 | $4.00 | $4.00 | $35.00 | $35.00 | 2,813 2012 Formulary | ||
2013 ADVANTAGE Enhanced (PPO) | $84.00 | $4,000 | $0 | Many Generics | $8.00 | $8.00 | $45.00 | $45.00 | 3,068 2013 Formulary | |||
2012 Today's Options Premier Plus 450C (PFFS) | $87.00 | $6,700 | $35 | No additional gap coverage, only the Donut Hole Discount | H6169 -033 -0 | n/a | ||||||
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2013 Today's Options Premier Plus 650D (PFFS) | $92.00 | n/a | $85 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 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 IU Health Plans Medicare Choice (HMO-POS) | $122.70 | $4,500 | $0 | Many Generics | H7220 -004 -0 | $5.00 | $35.00 | $85.00 | $85.00 | 3,814 2012 Formulary | ||
2013 IU Health Plans Medicare Choice (HMO-POS) | $98.00 | $3,950 | $0 | Many Generics | $7.00 | $40.00 | $85.00 | $85.00 | 3,884 2013 Formulary | |||
2012 Today's Options Advantage Plus 250A (PPO) | $122.00 | $3,250 | $0 | No additional gap coverage, only the Donut Hole Discount | H5378 -200 -0 | n/a | ||||||
2013 Today's Options Advantage Plus 350A (PPO) | $127.00 | $3,250 | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | |||
2012 Today's Options Premier Plus 250A (PFFS) | $147.00 | $3,250 | $0 | No additional gap coverage, only the Donut Hole Discount | H6169 -024 -0 | n/a | ||||||
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2013 Today's Options Premier Plus 350A (PFFS) | $152.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 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 H8145-012 (PFFS) | $169.00 | $6,700 | $0 | Few Generics, Few Brands |
H8145 -012 -0 | $7.00 | $40.00 | $82.00 | $82.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-012 (PFFS) | $172.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $13.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
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