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 Care1st AdvantageOptimum Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5928 -020 -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 | |||
-- This plan not offered in 2012 -- |
H5087 -010 -0 | |||||||||||
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2013 Easy Choice Value Plan (HMO) | $0.00 | $6,700 | $0 | Many Generics | $0.00 | $10.00 | $40.00 | $40.00 | 3,458 2013 Formulary | |||
2012 Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) | $0.00 | $3,400 | $0 | All Generics, Few Brands |
H0524 -043 -0 | n/a | ||||||
2013 Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) | $0.00 | $3,400 | $0 | All Generics, Few Brands | $5.00 | $10.00 | $45.00 | $45.00 | 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 |
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2012 Senior Advantage Medicare Medi-Cal Plan North (HMO SNP) | $15.30 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0524 -030 -0 | n/a | ||||||
2013 Senior Advantage Medicare Medi-Cal Plan North (HMO SNP) | $16.60 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $12.00 | $45.00 | $45.00 | 5,250 2013 Formulary | |||
2012 SCAN Options (HMO) | $29.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H5811 -005 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 2,548 2012 Formulary | ||
2013 SCAN Options (HMO) | $25.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $45.00 | $45.00 | 2,703 2013 Formulary | |||
2012 Health Net Seniority Plus Ruby (HMO) | $29.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H0562 -088 -0 | n/a | ||||||
2013 Health Net Ruby Select (HMO) | $29.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $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 |
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-- This plan not offered in 2012 -- |
H5087 -002 -0 | |||||||||||
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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 SCAN Connections (HMO SNP) | $30.80 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H5811 -002 -0 | 15% | 15% | 2,548 2012 Formulary | ||||
2013 SCAN Connections (HMO SNP) | $29.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,703 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0108 -022 -0 | |||||||||||
2013 Humana Gold Plus H0108-022 (HMO) | $32.00 | $5,000 | $0 | Few Generics, Few Brands | $5.00 | $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 SCAN Classic (HMO) | $39.00 | $5,000 | $0 | Many Generics | H5811 -001 -0 | $5.00 | $10.00 | $35.00 | $35.00 | 2,548 2012 Formulary | ||
2013 SCAN Classic (HMO) | $39.00 | $3,400 | $0 | Many Generics | $5.00 | $10.00 | $35.00 | $35.00 | 2,703 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0108 -021 -0 | |||||||||||
2013 Humana Gold Plus H0108-021 (HMO) | $62.00 | $3,400 | $0 | Some Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) | $75.00 | $3,400 | $0 | All Generics, Few Brands |
H0524 -042 -0 | n/a | ||||||
2013 Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) | $75.00 | $3,400 | $0 | All Generics, Few Brands | $5.00 | $10.00 | $45.00 | $45.00 | 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 |
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2012 Health Net Seniority Plus Green (HMO) | $89.00 | $3,400 | No Rx Coverage | H0562 -045 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Health Net Seniority Plus Green (HMO) | $99.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H0562 -017 -0 | |||||||||||
2013 Health Net Seniority Plus Ruby (HMO) | $182.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $45.00 | $45.00 | 4,263 2013 Formulary | |||
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