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 Plus (HMO-POS) | $0.00 | $3,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H5253 -030 -0 | $3.00 | $5.00 | $42.00 | $42.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete Plus (HMO-POS) | $0.00 | $3,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H8145 -153 -0 | |||||||||||
2013 Humana Gold Choice H8145-153 (PFFS) | $0.00 | $4,500 | 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. | ||||||||
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 MercyCare Advantage Classic (HMO) | $0.00 | $3,400 | No Rx Coverage | H4123 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2013 MercyCare Advantage Classic (HMO-POS) | $0.00 | $3,800 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 MercyCare Advantage Elite 30 (HMO) | $39.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4123 -001 -0 | $8.00 | $40.00 | $85.00 | $85.00 | 2,681 2012 Formulary | ||
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2013 MercyCare Advantage Elite 30 (HMO-POS) | $29.00 | $3,800 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $45.00 | $85.00 | $85.00 | 2,887 2013 Formulary | |||
2012 MercyCare Advantage Premier (HMO SNP) | $36.70 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H4123 -002 -0 | 0% | 0% | 2,681 2012 Formulary | ||||
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2013 MercyCare Advantage Premier (HMO SNP) | $38.30 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,887 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 HumanaChoice H5216-006 (PPO) | $31.00 | $4,500 | $0 | Few Generics, Few Brands |
H5216 -006 -0 | $6.00 | $34.00 | $75.00 | $75.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice H5216-006 (PPO) | $42.00 | $6,700 | $0 | Few Generics, Few Brands | $6.00 | $34.00 | $75.00 | $75.00 | 3,906 2013 Formulary | |||
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. | ||||||||
-- This plan not offered in 2012 -- |
H4123 -004 -0 | |||||||||||
-- | -- | -- | ||||||||||
2013 MercyCare Advantage Elite 20 (HMO-POS) | $59.00 | $3,800 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $40.00 | $75.00 | $75.00 | 2,887 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 -- |
H4036 -005 -0 | |||||||||||
2013 Anthem Medicare Preferred Standard (PPO) | $61.00 | $4,200 | $92 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $8.00 | $42.00 | $42.00 | 2,838 2013 Formulary | |||
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 DeanCare Gold Shared Value (Cost) | $65.00 | n/a | No Rx Coverage | H5264 -005 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 DeanCare Gold Shared Value (Cost) | $68.00 | 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 |
||||||
2012 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 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-006 (PFFS) | $72.00 | n/a | $0 | Few Generics, Few Brands | $7.00 | $41.00 | $80.00 | $80.00 | 3,906 2013 Formulary | |||
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 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 |
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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 | |||
2012 DeanCare Gold Basic (Cost) | $103.00 | n/a | No Rx Coverage | H5264 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 DeanCare Gold Basic (Cost) | $108.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 DeanCare Gold Enhanced (Cost) | $108.00 | n/a | No Rx Coverage | H5264 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 DeanCare Gold Enhanced (Cost) | $113.00 | 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 |
||||||
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 | |||
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