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 Essential (HMO) | $0.00 | $6,700 | No Rx Coverage | H0543 -121 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 AARP MedicareComplete SecureHorizons Essential (HMO) | $0.00 | $4,900 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 AARP MedicareComplete SecureHorizons Plan 2 (HMO) | $0.00 | $6,700 | $0 | Some Generics | H0543 -138 -0 | $3.00 | $5.00 | $45.00 | $45.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete SecureHorizons Plan 2 (HMO) | $0.00 | $3,400 | $0 | Some Generics | $0.00 | $5.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 AARP MedicareComplete SecureHorizons Premier (HMO) | $0.00 | $5,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H0543 -004 -0 | $3.00 | $6.00 | $44.00 | $44.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete SecureHorizons Premier (HMO) | $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 | |||
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 Select Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | H0523 -002 -0 | $5.00 | $33.00 | $40.00 | $40.00 | 3,158 2012 Formulary | ||
2013 Aetna Medicare Select Plan (HMO) | $0.00 | $3,400 | $0 | Some Generics | $7.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | |||
2012 Blue Cross Senior Secure Plan I (HMO) | $0.00 | $3,400 | $0 | Many Generics | H0564 -006 -0 | $7.00 | $43.00 | $85.00 | $85.00 | 4,453 2012 Formulary | ||
2013 Blue Cross Senior Secure Plan I (HMO) | $0.00 | $4,000 | $0 | Many Generics | $4.00 | $13.00 | $45.00 | $45.00 | 4,173 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0564 -049 -0 | |||||||||||
2013 Blue Cross Senior Secure Plan II (HMO) | $0.00 | $4,000 | $0 | Many Generics | $7.00 | $13.00 | $36.00 | $36.00 | 4,173 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 Blue Shield 65 Plus (HMO) | $0.00 | $3,000 | $0 | Many Generics | H0504 -015 -0 | $5.00 | $40.00 | $80.00 | $80.00 | 3,510 2012 Formulary | ||
2013 Blue Shield 65 Plus (HMO) | $0.00 | $3,000 | $0 | Many Generics | $5.00 | $40.00 | $80.00 | $80.00 | 3,331 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0504 -021 -0 | |||||||||||
2013 Blue Shield 65 Plus Choice Plan (HMO) | $0.00 | $2,000 | $0 | Many Generics | $0.00 | $35.00 | $70.00 | $70.00 | 3,330 2013 Formulary | |||
2012 Brand New Day (HMO) | $0.00 | $3,400 | $0 | Many Generics | H0838 -022 -0 | $2.50 | $40.00 | 3,125 2012 Formulary | ||||
2013 Brand New Day (HMO) | $0.00 | $3,400 | $0 | Many Generics | $5.00 | $40.00 | 3,285 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 Care1st AdvantageOptimum Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5928 -006 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 2,635 2012 Formulary | ||
2013 Care1st AdvantageOptimum Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $5.00 | $30.00 | $30.00 | 2,752 2013 Formulary | |||
2012 CareMore Breathe (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands |
H0544 -014 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,713 2012 Formulary | ||
2013 CareMore Breathe (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands | $0.00 | $5.00 | $25.00 | $25.00 | 2,830 2013 Formulary | |||
2012 CareMore ESRD (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands |
H0544 -015 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,713 2012 Formulary | ||
2013 CareMore ESRD (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands | $0.00 | $5.00 | $25.00 | $25.00 | 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 |
||||||
2012 CareMore Heart (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands |
H0544 -013 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,713 2012 Formulary | ||
2013 CareMore Heart (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands | $0.00 | $5.00 | $25.00 | $25.00 | 2,830 2013 Formulary | |||
2012 CareMore Reliance (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands |
H0544 -004 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,713 2012 Formulary | ||
2013 CareMore Reliance (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands | $0.00 | $5.00 | $25.00 | $25.00 | 2,830 2013 Formulary | |||
2012 CareMore Touch (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands |
H0544 -005 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,713 2012 Formulary | ||
2013 CareMore Touch (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands | $0.00 | $5.00 | $25.00 | $25.00 | 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 |
||||||
2012 CareMore Value Plus (HMO) | $0.00 | $3,400 | $0 | All Generics, All Brands |
H0544 -002 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,713 2012 Formulary | ||
2013 CareMore Value Plus (HMO) | $0.00 | $3,400 | $0 | All Generics, All Brands | $0.00 | $5.00 | $25.00 | $25.00 | 2,830 2013 Formulary | |||
2012 Central Health Medicare Plan (HMO) | $0.00 | $3,400 | $0 | All Generics | H5649 -001 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,768 2012 Formulary | ||
2013 Central Health Medicare Plan (HMO) | $0.00 | $6,700 | $0 | All Generics | $0.00 | $5.00 | $25.00 | $25.00 | 2,763 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H5649 -004 -0 | |||||||||||
2013 Central Health Premier Plan (HMO) | $0.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,763 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 Citizens Choice Healthplan (HMO) | $0.00 | $3,400 | $0 | Many Generics | H3815 -001 -0 | $0.00 | $15.00 | $60.00 | $60.00 | 2,968 2012 Formulary | ||
2013 Citizens Choice Healthplan (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $15.00 | $60.00 | $60.00 | 3,072 2013 Formulary | |||
2012 Easy Choice Best Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5087 -005 -0 | $0.00 | $10.00 | $30.00 | $30.00 | 3,417 2012 Formulary | ||
-- | ||||||||||||
2013 Easy Choice Best Plan (HMO) | $0.00 | $6,700 | $0 | Many Generics | $0.00 | $10.00 | $40.00 | $40.00 | 3,458 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H5087 -007 -0 | |||||||||||
-- | ||||||||||||
2013 Freedom VIP Care (HMO SNP) | $0.00 | n/a | $0 | Many Generics | $0.00 | $10.00 | $40.00 | $40.00 | 3,458 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 -- |
H5087 -008 -0 | |||||||||||
-- | ||||||||||||
2013 Freedom VIP Care COPD (HMO SNP) | $0.00 | n/a | $0 | Many Generics | $0.00 | $10.00 | $40.00 | $40.00 | 3,458 2013 Formulary | |||
2012 Golden State Medicare Health Plan, Golden (HMO) | $0.00 | $5,000 | $0 | Many Generics | H2241 -001 -0 | $0.00 | $30.00 | $65.00 | $65.00 | 4,856 2012 Formulary | ||
-- | -- | |||||||||||
2013 Golden (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $40.00 | $80.00 | $80.00 | 5,161 2013 Formulary | |||
2012 Salud con Health Net Medicare Advantage (HMO) | $0.00 | $3,400 | $0 | Many Generics | H0562 -085 -0 | n/a | ||||||
2013 Health Net Gold Select (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $10.00 | $45.00 | $45.00 | 4,263 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 Healthy Heart Plan 1 (HMO) | $0.00 | $3,400 | $0 | Many Generics | H0562 -082 -0 | n/a | ||||||
2013 Health Net Healthy Heart Plan 1 (HMO) | $0.00 | $3,400 | $0 | Many Generics | $3.00 | $10.00 | $45.00 | $45.00 | 4,263 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0562 -092 -0 | |||||||||||
2013 Health Net Jade (HMO SNP) | $0.00 | n/a | $0 | Many Generics | $0.00 | $10.00 | $45.00 | $45.00 | 4,263 2013 Formulary | |||
2012 Health Net Seniority Plus Green (HMO) | $0.00 | $3,400 | No Rx Coverage | H0562 -044 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Health Net Seniority Plus Green (HMO) | $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 Health Net Seniority Plus Ruby Plan 1 (HMO) | $0.00 | $3,400 | $0 | Many Generics | H0562 -083 -0 | n/a | ||||||
2013 Health Net Seniority Plus Ruby Plan 1 (HMO) | $0.00 | $3,400 | $0 | Many Generics | $3.00 | $10.00 | $45.00 | $45.00 | 4,263 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H5425 -028 -0 | |||||||||||
2013 Heart First (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $0.00 | $5.00 | $30.00 | $30.00 | 2,703 2013 Formulary | |||
2012 Humana Gold Plus H0108-013 (HMO) | $0.00 | $3,400 | $0 | Few Generics, Few Brands |
H0108 -013 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Plus H0108-013 (HMO) | $0.00 | $3,400 | $0 | Some 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 |
||||||
-- This plan not offered in 2012 -- |
H0108 -030 -0 | |||||||||||
2013 Humana Gold Plus H0108-030 (HMO) | $0.00 | $1,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H0524 -002 -0 | |||||||||||
2013 Kaiser Permanente Senior Advantage B Only South (HMO) | $0.00 | n/a | $0 | n/a | $5.00 | $8.00 | $45.00 | $45.00 | 5,250 2013 Formulary | |||
2012 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) | $0.00 | $3,400 | $0 | All Generics, Few Brands |
H0524 -003 -0 | n/a | ||||||
2013 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) | $0.00 | $3,400 | $0 | All Generics, Few Brands | $3.00 | $7.00 | $40.00 | $40.00 | 5,250 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 -- |
H5425 -034 -0 | |||||||||||
2013 SCAN Balance (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $0.00 | $5.00 | $30.00 | $30.00 | 2,703 2013 Formulary | |||
2012 SCAN Classic (HMO) | $0.00 | $5,000 | $0 | Many Generics | H5425 -007 -0 | $3.00 | $8.00 | $40.00 | $40.00 | 2,548 2012 Formulary | ||
2013 SCAN Classic (HMO) | $0.00 | $3,400 | $0 | Many Generics | $4.00 | $10.00 | $40.00 | $40.00 | 2,703 2013 Formulary | |||
2012 SCAN Healthy at Home (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H9104 -007 -0 | $3.00 | $8.00 | $39.00 | $39.00 | 2,548 2012 Formulary | ||
2013 SCAN Healthy at Home (HMO SNP) | $0.00 | n/a | $0 | Many Generics | $3.00 | $8.00 | $39.00 | $39.00 | 2,703 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 StartSmart with CareMore (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H0544 -007 -0 | $5.00 | $8.00 | $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 Senior Advantage Medicare Medi-Cal Plan South (HMO SNP) | $8.80 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0524 -029 -0 | n/a | ||||||
2013 Senior Advantage Medicare Medi-Cal Plan South (HMO SNP) | $11.40 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0108 -016 -0 | |||||||||||
2013 Humana Gold Plus SNP-DE H0108-016 (HMO SNP) | $27.40 | 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 |
||||||
-- This plan not offered in 2012 -- |
H5425 -037 -0 | |||||||||||
2013 SCAN Plus (HMO) | $27.50 | $3,000 | $325 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | 25% | 25% | 2,703 2013 Formulary | |||
2012 Brand New Day (HMO SNP) | $30.90 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H0838 -020 -0 | 25% | 25% | 3,125 2012 Formulary | ||||
2013 Brand New Day (HMO SNP) | $29.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 3,285 2013 Formulary | |||||
-- This plan not offered in 2012 -- |
H0838 -024 -0 | |||||||||||
2013 Brand New Day D SNP (HMO SNP) | $29.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 3,285 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 Brand New Day HMO Extra Care (HMO) | $30.90 | $6,700 | $320 | No additional gap coverage, only the Donut Hole Discount | H0838 -023 -0 | 25% | 25% | 3,125 2012 Formulary | ||||
2013 Brand New Day HMO Extra Care (HMO) | $29.80 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 3,285 2013 Formulary | |||||
2012 Care1st TotalDual Plan (HMO SNP) | $30.80 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H5928 -005 -0 | 25% | 25% | 25% | 25% | 2,635 2012 Formulary | ||
2013 Care1st TotalDual Plan (HMO SNP) | $29.80 | n/a | $325 | Few Generics | $0.00 | 25% | 25% | 25% | 2,752 2013 Formulary | |||
2012 Health Net Seniority Plus Amber I (HMO SNP) | $25.80 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H0562 -055 -0 | n/a | ||||||
2013 Health Net Seniority Plus Amber I (HMO SNP) | $29.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 4,263 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 Seniority Plus Amber II (HMO SNP) | $30.90 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H0562 -070 -0 | n/a | ||||||
2013 Health Net Seniority Plus Amber II (HMO SNP) | $29.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 4,263 2013 Formulary | |||
2012 Easy Choice Plus Plan (HMO) | $23.60 | $3,400 | $320 | No additional gap coverage, only the Donut Hole Discount | H5087 -002 -0 | $0.00 | 25% | 25% | 25% | 3,417 2012 Formulary | ||
-- | ||||||||||||
2013 Easy Choice Plus Plan (HMO) | $29.90 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,458 2013 Formulary | |||
2012 OneCare (HMO SNP) | $30.80 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H5433 -001 -0 | $0.00 | $0.00 | 3,125 2012 Formulary | ||||
2013 OneCare (HMO SNP) | $29.90 | n/a | $0 | Few Generics | $0.00 | $0.00 | $0.00 | 3,273 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) | $30.90 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H0543 -079 -0 | 15% | 15% | 3,614 2012 Formulary | ||||
2013 UnitedHealthcare Dual Complete (HMO SNP) | $29.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
2012 Health Net Healthy Heart Plan 2 (HMO) | $20.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H0562 -086 -0 | n/a | ||||||
2013 Health Net Healthy Heart Plan 2 (HMO) | $39.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $45.00 | $45.00 | 4,263 2013 Formulary | |||
2012 Humana Gold Plus H0108-014 (HMO-POS) | $39.00 | $5,000 | $0 | Few Generics, Few Brands |
H0108 -014 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Plus H0108-014 (HMO-POS) | $39.00 | $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 Anthem Medicare Preferred Standard (PPO) | $40.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H8552 -002 -0 | $7.00 | $43.00 | $85.00 | $85.00 | 4,453 2012 Formulary | ||
-- | -- | |||||||||||
2013 Anthem Medicare Preferred Standard (PPO) | $66.00 | $4,500 | $90 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $17.00 | $45.00 | $45.00 | 4,173 2013 Formulary | |||
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