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 (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0303 -015 -0 | $4.00 | $7.00 | $45.00 | $45.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $7.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 AARP MedicareComplete Plus (HMO-POS) | $0.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H0316 -002 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete Plus (HMO-POS) | $0.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 Abrazo Advantage (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5985 -001 -0 | $0.00 | $20.00 | $40.00 | $40.00 | 2,910 2012 Formulary | ||
2013 Abrazo Advantage (HMO) | $0.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $35.00 | $35.00 | 3,102 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 MediSunONE Classic (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0302 -006 -0 | 13% | 13% | 13% | 13% | 4,794 2012 Formulary | ||
2013 Blue Medicare Advantage Classic (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | 22% | 22% | 22% | 22% | 3,402 2013 Formulary | |||
2012 CareMore Breathe (HMO SNP) | $0.00 | n/a | $0 | All Generics, Few Brands |
H2593 -015 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 2,713 2012 Formulary | ||
2013 CareMore Breathe (HMO SNP) | $0.00 | n/a | $0 | All Generics, Few Brands | $0.00 | $5.00 | $35.00 | $35.00 | 2,830 2013 Formulary | |||
2012 CareMore Diabetes (HMO SNP) | $0.00 | n/a | $0 | All Generics, Few Brands |
H2593 -011 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 2,713 2012 Formulary | ||
2013 CareMore Diabetes (HMO SNP) | $0.00 | n/a | $0 | All Generics, Few Brands | $0.00 | $5.00 | $35.00 | $35.00 | 2,830 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 CareMore Heart (HMO SNP) | $0.00 | n/a | $0 | All Generics, Few Brands |
H2593 -014 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 2,713 2012 Formulary | ||
2013 CareMore Heart (HMO SNP) | $0.00 | n/a | $0 | All Generics, Few Brands | $0.00 | $5.00 | $35.00 | $35.00 | 2,830 2013 Formulary | |||
2012 CareMore Touch (HMO SNP) | $0.00 | n/a | $0 | All Generics, Few Brands |
H2593 -009 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 2,713 2012 Formulary | ||
2013 CareMore Touch (HMO SNP) | $0.00 | n/a | $0 | All Generics, Few Brands | $0.00 | $5.00 | $35.00 | $35.00 | 2,830 2013 Formulary | |||
2012 CareMore Value Plus (HMO) | $0.00 | $3,400 | $0 | All Generics | H2593 -007 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 2,713 2012 Formulary | ||
2013 CareMore Value Plus (HMO) | $0.00 | $3,400 | $0 | All Generics, Few Brands | $0.00 | $5.00 | $35.00 | $35.00 | 2,830 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 -- |
H0354 -021 -0 | |||||||||||
2013 Cigna Medicare Select Plus Rx-Diabetes Heart (HMO SNP) | $0.00 | n/a | $0 | Many Generics | $2.00 | $5.00 | $45.00 | $45.00 | 3,854 2013 Formulary | |||
2012 CIGNA Medicare Select Plus Rx-Standard (HMO) | $0.00 | $6,700 | $0 | Many Generics | H0354 -001 -0 | $5.00 | $45.00 | $75.00 | $75.00 | 3,805 2012 Formulary | ||
2013 Cigna Medicare Select Plus Rx-Standard (HMO) | $0.00 | $5,000 | $0 | Many Generics | $3.00 | $5.00 | $45.00 | $45.00 | 3,854 2013 Formulary | |||
2012 Health Net Green (HMO) | $0.00 | $6,700 | No Rx Coverage | H0351 -030 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Health Net Green (HMO) | $0.00 | $6,700 | 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 Health Net Jade (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0351 -038 -0 | n/a | ||||||
2013 Health Net Jade (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $44.00 | $44.00 | 4,263 2013 Formulary | |||
2012 Health Net Ruby 4 (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0351 -036 -0 | n/a | ||||||
2013 Health Net Ruby 4 (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 4,263 2013 Formulary | |||
2012 Humana Reader's Digest Healthy Living Plan (HMO) | $0.00 | $5,000 | $0 | Few Generics, Few Brands |
H0307 -011 -0 | $0.00 | $10.00 | $44.00 | $44.00 | 3,798 2012 Formulary | ||
2013 Humana Reader's Digest Healthy Living Plan (HMO) | $0.00 | $5,000 | $0 | Few Generics, Few Brands | $0.00 | $10.00 | $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 Humana Reader's Digest Healthy Living Plan (HMO-POS) | $0.00 | $5,000 | $0 | Few Generics, Few Brands |
H0307 -009 -0 | $5.00 | $10.00 | $43.00 | $43.00 | 3,798 2012 Formulary | ||
2013 Humana Reader's Digest Healthy Living Plan (HMO) | $0.00 | $5,500 | $0 | Few Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $0.00 | $6,700 | No Rx Coverage | R5826 -070 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $0.00 | $6,700 | No Rx Coverage | R5826 -070 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $0.00 | $6,700 | 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 StartSmart with CareMore (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2593 -016 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 2,713 2012 Formulary | ||
2013 StartSmart with CareMore (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $45.00 | $45.00 | 2,830 2013 Formulary | |||
2012 MediSunONE Plus (HMO) | $14.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0302 -001 -0 | $4.00 | $40.00 | $80.00 | $80.00 | 4,794 2012 Formulary | ||
2013 Blue Medicare Advantage Plus (HMO) | $14.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $40.00 | $80.00 | $80.00 | 3,402 2013 Formulary | |||
2012 CIGNA Medicare Select Plus Rx-Premium (HMO) | $25.00 | $5,000 | $0 | Many Generics | H0354 -018 -0 | $5.00 | $45.00 | $75.00 | $75.00 | 3,805 2012 Formulary | ||
2013 Cigna Medicare Select Plus Rx-Premium (HMO) | $25.00 | $5,000 | $0 | Many Generics | $0.00 | $5.00 | $35.00 | $35.00 | 3,854 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 (PPO SNP) | $26.80 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H0319 -001 -0 | 25% | 25% | 25% | 25% | 3,614 2012 Formulary | ||
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2013 UnitedHealthcare Nursing Home Plan (PPO SNP) | $27.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
2012 CIGNA Medicare Select Plus Rx-Dual (HMO SNP) | $22.30 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H0354 -012 -0 | 15% | 15% | 3,805 2012 Formulary | ||||
2013 Cigna Medicare Select Plus Rx-Dual (HMO SNP) | $28.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,854 2013 Formulary | |||
2012 UnitedHealthcare Dual Complete LP (HMO SNP) | $24.70 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H0303 -034 -0 | 15% | 15% | 3,614 2012 Formulary | ||||
2013 UnitedHealthcare Dual Complete LP (HMO SNP) | $28.20 | 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 |
||||||
2012 UnitedHealthcare Dual Complete (HMO SNP) | $19.90 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H0321 -002 -0 | 15% | 15% | 3,614 2012 Formulary | ||||
2013 UnitedHealthcare Dual Complete (HMO SNP) | $29.30 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
2012 Abrazo Advantage Plus (HMO SNP) | $26.80 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H5985 -002 -0 | 15% | 15% | 2,910 2012 Formulary | ||||
2013 Abrazo Advantage Plus (HMO SNP) | $29.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 3,102 2013 Formulary | ||||||
2012 Health Choice Generations (HMO SNP) | $26.80 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H5587 -001 -0 | 15% | 15% | 2,910 2012 Formulary | ||||
2013 Health Choice Generations (HMO SNP) | $29.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 3,794 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 Net Amber (HMO SNP) | $26.80 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H0351 -029 -0 | n/a | ||||||
2013 Health Net Amber (HMO SNP) | $29.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $11.00 | $41.00 | $41.00 | 4,263 2013 Formulary | |||
2012 University Physicians Care Advantage (HMO SNP) | $24.10 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H7352 -004 -0 | 0% | 0% | 2,910 2012 Formulary | ||||
2013 University Care Advantage (HMO SNP) | $29.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 3,128 2013 Formulary | ||||
2012 MediSunONE Premier (HMO) | $45.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0302 -007 -0 | $4.00 | $30.00 | $80.00 | $80.00 | 4,794 2012 Formulary | ||
2013 Blue Medicare Advantage Premier (HMO) | $45.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $30.00 | $80.00 | $80.00 | 3,402 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 Net Ruby 1 (HMO) | $39.00 | $5,300 | $0 | No additional gap coverage, only the Donut Hole Discount | H0351 -014 -0 | n/a | ||||||
2013 Health Net Ruby 1 (HMO) | $49.00 | $5,300 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 4,263 2013 Formulary | |||
2012 Humana Reader's Digest Healthy Living Plan (HMO-POS) | $39.00 | $5,000 | $0 | Few Generics, Few Brands |
H0307 -008 -0 | $0.00 | $10.00 | $44.00 | $44.00 | 3,798 2012 Formulary | ||
2013 Humana Reader's Digest Healthy Living Plan (HMO-POS) | $62.00 | $5,500 | $0 | Few Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 Humana Reader's Digest Healthy Living Plan (PPO) | $86.00 | $5,000 | $0 | Few Generics, Few Brands |
H0317 -004 -0 | $6.00 | $40.00 | $82.00 | $82.00 | 3,798 2012 Formulary | ||
2013 Humana Reader's Digest Healthy Living Plan (PPO) | $92.00 | $6,700 | $0 | Few Generics, Few Brands | $0.00 | $10.00 | $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 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $129.00 | $5,000 | $0 | Few Generics, Few Brands |
R5826 -014 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,798 2012 Formulary | ||
2013 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $142.10 | $6,700 | $0 | Few Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $129.00 | $5,000 | $0 | Few Generics, Few Brands |
R5826 -014 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,798 2012 Formulary | ||
2013 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $142.10 | $6,700 | $0 | Few Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $149.00 | $3,400 | $320 | No additional gap coverage, only the Donut Hole Discount | R5826 -076 -0 | 25% | 25% | 25% | 25% | 3,798 2012 Formulary | ||
2013 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $154.00 | $3,400 | $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 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $149.00 | $3,400 | $320 | No additional gap coverage, only the Donut Hole Discount | R5826 -076 -0 | 25% | 25% | 25% | 25% | 3,798 2012 Formulary | ||
2013 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $154.00 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | |||
2012 Humana Gold Choice H8145-103 (PFFS) | $174.00 | $6,700 | $0 | Few Generics, Few Brands |
H8145 -103 -0 | $7.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-103 (PFFS) | $177.00 | n/a | $0 | Few Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
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