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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2012 AARP MedicareComplete SecureHorizons (HMO) | $0.00 | $4,900 | $0 | Some Generics | H4590 -012 -0 | $3.00 | $6.00 | $44.00 | $44.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete SecureHorizons (HMO) | $0.00 | $3,900 | $0 | Some Generics | $0.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 AARP MedicareComplete SecureHorizons Essential (HMO) | $0.00 | $4,500 | No Rx Coverage | H4590 -027 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 AARP MedicareComplete SecureHorizons Essential (HMO) | $0.00 | $3,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Aetna Medicare Premier Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | H4523 -005 -0 | $4.00 | $33.00 | $45.00 | $45.00 | 3,158 2012 Formulary | ||
2013 Aetna Medicare Premier Plan (HMO) | $0.00 | $3,200 | $0 | Some Generics | $7.00 | $33.00 | $45.00 | $45.00 | 3,323 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 Amerivantage Classic Choice + Rx (HMO-POS) | $0.00 | $6,700 | $0 | Some Generics | H5817 -010 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 3,055 2012 Formulary | ||
2013 Amerivantage Classic+ Rx (HMO) | $0.00 | $6,700 | $0 | Some Generics | $0.00 | $4.00 | $40.00 | $40.00 | 2,941 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0084 -027 -0 | |||||||||||
2013 Care Improvement Plus Copper RX (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | |||
-- This plan not offered in 2012 -- |
R6801 -022 -0 | |||||||||||
2013 Care Improvement Plus Copper RX (Regional 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 | |||
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 Care Improvement Plus Gold Rx (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -004 -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 | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | |||
2012 Care Improvement Plus Gold Rx (Regional PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | R6801 -009 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Gold Rx (Regional 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) | $15.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -001 -0 | $10.00 | $43.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Medicare Advantage (PPO) | $0.00 | $6,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $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 |
||||||
2012 Care Improvement Plus Medicare Advantage (Regional PPO) | $59.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | R6801 -012 -0 | $9.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Medicare Advantage (Regional PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H6328 -006 -0 | |||||||||||
2013 Care N' Care Health Plan II MA-Only (PPO) | $0.00 | $3,100 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H6328 -003 -0 | |||||||||||
2013 Care N' Care Health Plan III (PPO) | $0.00 | $3,400 | $0 | Many Generics | $2.00 | $15.00 | $40.00 | $40.00 | 4,879 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 Bravo Achieve (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H4528 -014 -0 | $3.00 | $8.00 | $35.00 | $35.00 | 2,990 2012 Formulary | ||
2013 HealthSpring Achieve (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $8.00 | $35.00 | $35.00 | 3,057 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H4528 -016 -0 | |||||||||||
2013 HealthSpring Advantage (HMO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 HealthyAdvantage (PPO) | $0.00 | $3,400 | No Rx Coverage | H7787 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HealthSpring Advantage (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 |
||||||
2012 Bravo Classic Plus (HMO-POS) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4528 -001 -0 | $3.00 | $8.00 | $35.00 | $35.00 | 2,990 2012 Formulary | ||
2013 HealthSpring Preferred (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $4.00 | $35.00 | $35.00 | 3,056 2013 Formulary | |||
2012 Humana Reader's Digest Healthy Living Plan (HMO) | $0.00 | $3,400 | $0 | Few Generics, Few Brands |
H4510 -018 -0 | $7.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Plus H4510-018 (HMO) | $0.00 | $3,400 | $125 | Few Generics, Few Brands | $7.00 | $12.00 | $40.00 | $40.00 | 3,906 2013 Formulary | |||
2012 HumanaChoice R5826-026 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -026 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HumanaChoice R5826-026 (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 |
||||||
-- This plan not offered in 2012 -- |
H1264 -008 -0 | |||||||||||
2013 WellCare Dividend (HMO) | $0.00 | $6,700 | $0 | All Generics | $3.00 | $30.00 | $60.00 | $60.00 | 2,835 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H1264 -004 -0 | |||||||||||
2013 WellCare Value (HMO-POS) | $0.00 | $6,700 | $0 | All Generics | $3.00 | $30.00 | $60.00 | $60.00 | 2,835 2013 Formulary | |||
2012 Humana Gold Choice H8145-126 (PFFS) | $0.00 | $5,000 | No Rx Coverage | H8145 -126 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Humana Gold Choice H8145-126 (PFFS) | $10.00 | 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 2012 -- |
H1264 -007 -0 | |||||||||||
2013 WellCare Access (HMO SNP) | $18.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $45.00 | $95.00 | $95.00 | 2,835 2013 Formulary | |||
2012 UnitedHealthcare Dual Complete (HMO SNP) | $22.10 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H4590 -020 -0 | 15% | 15% | 3,614 2012 Formulary | ||||
2013 UnitedHealthcare Dual Complete (HMO SNP) | $22.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H6328 -002 -0 | |||||||||||
2013 Care N' Care Health Plan II (PPO) | $29.00 | $3,100 | $0 | Many Generics | $0.00 | $12.00 | $36.00 | $36.00 | 4,879 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 UnitedHealthcare Nursing Home Plan (HMO SNP) | $28.50 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H4590 -038 -0 | 25% | 25% | 25% | 25% | 3,614 2012 Formulary | ||
2013 UnitedHealthcare Nursing Home Plan (HMO SNP) | $29.10 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H6328 -005 -0 | |||||||||||
2013 Care N' Care Health Plan I MA-Only (PPO) | $30.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Humana Gold Plus SNP-DE H4510-023 (HMO SNP) | $29.90 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H4510 -023 -0 | 0% | 0% | 3,798 2012 Formulary | ||||
2013 Humana Gold Plus SNP-DE H4510-023 (HMO SNP) | $31.70 | n/a | $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 Amerivantage Specialty + Rx (HMO SNP) | $29.90 | n/a | $320 | Many Generics | H5817 -009 -0 | $0.00 | $0.00 | 25% | 25% | 3,055 2012 Formulary | ||
2013 Amerivantage Specialty + Rx (HMO SNP) | $31.80 | n/a | $325 | Many Generics, Few Brands | $0.00 | $0.00 | 25% | 25% | 2,941 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0084 -026 -0 | |||||||||||
2013 Care Improvement Plus Chrome RX (PPO SNP) | $31.80 | 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 -- |
R6801 -021 -0 | |||||||||||
2013 Care Improvement Plus Chrome RX (Regional PPO SNP) | $31.80 | 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 |
||||||
2012 Care Improvement Plus Dual Advantage (PPO SNP) | $30.00 | n/a | $195 | No additional gap coverage, only the Donut Hole Discount | H0084 -005 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Dual Advantage (PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | |||
2012 Care Improvement Plus Dual Advantage (Regional PPO SNP) | $30.00 | n/a | $215 | No additional gap coverage, only the Donut Hole Discount | R6801 -011 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Dual Advantage (Regional PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | |||
2012 Care Improvement Plus Silver Rx (PPO SNP) | $30.00 | n/a | $210 | No additional gap coverage, only the Donut Hole Discount | H0084 -003 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Silver Rx (PPO SNP) | $31.80 | 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 |
||||||
2012 Care Improvement Plus Silver Rx (Regional PPO SNP) | $30.00 | n/a | $165 | No additional gap coverage, only the Donut Hole Discount | R6801 -008 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Silver Rx (Regional PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | |||
2012 Bravo Select (HMO SNP) | $30.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H4528 -002 -0 | 15% | 15% | 2,990 2012 Formulary | ||||
2013 HealthSpring TotalCare (HMO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 3,025 2013 Formulary | ||||||
2012 HealthyAdvantage Preferred DFW (PPO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H7787 -001 -0 | $0.00 | $4.00 | $30.00 | $30.00 | 2,990 2012 Formulary | ||
2013 HealthSpring Preferred (PPO) | $35.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $30.00 | $30.00 | 3,056 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 Aetna Medicare Value Plan (PPO) | $39.00 | $5,000 | $0 | Many Generics | H4524 -007 -0 | $6.00 | $33.00 | $40.00 | $40.00 | 3,158 2012 Formulary | ||
2013 Aetna Medicare Value Plan (PPO) | $56.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | |||
2012 HumanaChoice H4520-006 (PPO) | $49.00 | $3,400 | $0 | Few Generics, Few Brands |
H4520 -006 -0 | $7.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Prime Choice H4520-006 (PPO) | $57.00 | $4,500 | $0 | Few Generics, Few Brands | $7.00 | $12.00 | $42.00 | $42.00 | 3,906 2013 Formulary | |||
2012 HumanaChoice R5826-012 (Regional PPO) | $54.00 | $5,000 | $0 | Few Generics, Few Brands |
R5826 -012 -0 | $7.00 | $42.00 | $82.00 | $82.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-012 (Regional PPO) | $59.00 | $6,700 | $125 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $12.00 | $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 -- |
H1666 -002 -0 | |||||||||||
new | new | new | ||||||||||
2013 Blue Medicare Advantage (PPO) | $69.90 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $43.00 | $43.00 | 2,905 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H6328 -001 -0 | |||||||||||
2013 Care N' Care Health Plan I (PPO) | $75.00 | $2,500 | $0 | Many Generics | $0.00 | $10.00 | $33.00 | $33.00 | 4,879 2013 Formulary | |||
2012 Humana Gold Choice H8145-084 (PFFS) | $79.00 | $5,000 | $0 | Few Generics, Few Brands |
H8145 -084 -0 | $6.00 | $38.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-084 (PFFS) | $87.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $12.00 | $39.00 | $39.00 | 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 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 -- |
||||||||||||
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 Texas Hassle-Free C-SNP (HMO-POS SNP) | $0.00 | n/a | $0 | Many Generics | H6642 -007 -0 | $0.00 | $10.00 | $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 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 -- |
||||||||||||
2012 Texas Hassle-Free (HMO-POS) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H6642 -001 -0 | $0.00 | $10.00 | $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 Texas Hassle-Free D-SNP (HMO-POS SNP) | $29.90 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H6642 -008 -0 | 15% | 15% | 3,152 2012 Formulary | ||||
-- This plan not offered in 2013 -- |
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