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 | $5,900 | No Rx Coverage | H0609 -018 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 AARP MedicareComplete SecureHorizons Essential (HMO) | $0.00 | $3,900 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 AARP MedicareComplete SecureHorizons Plan 2 (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0609 -012 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete SecureHorizons Plan 2 (HMO) | $0.00 | $4,200 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 Aetna Medicare Select Plan (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H6923 -001 -0 | $7.00 | $33.00 | $45.00 | $45.00 | 3,158 2012 Formulary | ||
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2013 Aetna Medicare Select Plan (HMO) | $0.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $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 Humana Gold Choice H8145-120 (PFFS) | $0.00 | $6,700 | No Rx Coverage | H8145 -120 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Humana Gold Choice H8145-120 (PFFS) | $0.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Humana Gold Plus H5291-002 (HMO) | $0.00 | $3,400 | $320 | Few Generics, Few Brands |
H5291 -002 -0 | $1.00 | $5.00 | 20% | 20% | 3,100 2012 Formulary | ||
2013 Humana Gold Plus H5291-002 (HMO) | $0.00 | $5,500 | $325 | Few Generics | $1.00 | $3.00 | 15% | 15% | 3,251 2013 Formulary | |||
2012 HumanaChoice H0623-009 (PPO) | $0.00 | $3,400 | No Rx Coverage | H0623 -009 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HumanaChoice H0623-009 (PPO) | $0.00 | $4,900 | 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 Kaiser Permanente Senior Advantage Core (HMO) | $0.00 | $3,400 | $0 | All Generics, Few Brands |
H0630 -013 -0 | n/a | ||||||
2013 Kaiser Permanente Senior Advantage Core (HMO) | $0.00 | $3,400 | $0 | All Generics, Few Brands | $7.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | |||
2012 AB Basic Plan (Cost) | $5.00 | n/a | No Rx Coverage | H0602 -026 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 AB Basic Plan (Cost) | $3.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Rocky Mountain Green Plan (Cost) | $8.00 | $6,700 | No Rx Coverage | H0602 -042 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Rocky Mountain Green Plan (Cost) | $5.00 | $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 Rocky Mountain Thrifty Plan (Cost) | $34.00 | n/a | No Rx Coverage | H0602 -027 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Rocky Mountain Thrifty Plan (Cost) | $25.00 | $6,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Humana Gold Plus H5291-001 (HMO) | $20.00 | $3,400 | $0 | Few Generics, Few Brands |
H5291 -001 -0 | $8.00 | $42.00 | $75.00 | $75.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Plus H5291-001 (HMO) | $27.00 | $3,400 | $0 | Few Generics, Few Brands | $7.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 UnitedHealthcare Dual Complete (HMO SNP) | $24.40 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H0624 -001 -0 | 15% | 15% | 3,614 2012 Formulary | ||||
2013 UnitedHealthcare Dual Complete (HMO SNP) | $28.50 | 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 Nursing Home Plan (PPO SNP) | $32.40 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H0620 -002 -0 | 25% | 25% | 25% | 25% | 3,614 2012 Formulary | ||
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2013 UnitedHealthcare Nursing Home Plan (PPO SNP) | $29.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
2012 Colorado Access Advantage - Plan E (HMO) | $32.40 | $6,700 | $320 | No additional gap coverage, only the Donut Hole Discount | H0621 -006 -0 | $8.50 | $45.00 | $95.00 | $95.00 | 2,984 2012 Formulary | ||
2013 Colorado Access Advantage Peak Plan (HMO) | $31.90 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $45.00 | $95.00 | $95.00 | 3,143 2013 Formulary | |||
2012 Colorado Access Advantage Plan D (HMO SNP) | $32.40 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H0621 -010 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 2,984 2012 Formulary | ||
2013 Colorado Access Advantage Summit Plan (HMO SNP) | $31.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | $7.50 | $45.00 | $95.00 | $95.00 | 3,143 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 Senior Advantage Medicare Medicaid Plan (HMO SNP) | $25.30 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H0630 -014 -0 | n/a | ||||||
2013 Senior Advantage Medicare Medicaid Plan (HMO SNP) | $31.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 5,250 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H5679 -003 -0 | |||||||||||
2013 SureValue Select (HMO) | $35.00 | $5,500 | $60 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 2,838 2013 Formulary | |||
2012 HumanaChoice H0623-011 (PPO) | $35.00 | $5,000 | $320 | Few Generics, Few Brands |
H0623 -011 -0 | $1.00 | $5.00 | 20% | 20% | 3,100 2012 Formulary | ||
2013 HumanaChoice H0623-011 (PPO) | $39.00 | $5,500 | $325 | Few Generics | $1.00 | $3.00 | 18% | 18% | 3,251 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 AARP MedicareComplete SecureHorizons Plan 1 (HMO) | $54.00 | $5,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H0609 -007 -0 | $3.00 | $6.00 | $42.00 | $42.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete SecureHorizons Plan 1 (HMO) | $45.00 | $3,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $42.00 | $42.00 | 3,825 2013 Formulary | |||
2012 Kaiser Permanente Senior Advantage Silver (HMO) | $48.00 | $3,400 | $0 | All Generics, Few Brands |
H0630 -015 -0 | n/a | ||||||
2013 Kaiser Permanente Senior Advantage Silver (HMO) | $48.00 | $3,400 | $0 | All Generics, Few Brands | $6.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H2997 -009 -0 | |||||||||||
2013 Anthem Medicare Preferred Standard (PPO) | $55.00 | $5,700 | $90 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $43.00 | $43.00 | 2,838 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 Rocky Mountain Green Plan + Rx (Cost) | $48.10 | $6,700 | $125 | No additional gap coverage, only the Donut Hole Discount | H0602 -043 -0 | $2.00 | $13.00 | $45.00 | $45.00 | 4,695 2012 Formulary | ||
2013 Rocky Mountain Green Plan + Rx (Cost) | $56.00 | $6,700 | $125 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $13.00 | $40.00 | $40.00 | 4,905 2013 Formulary | |||
2012 Rocky Mountain Standard Plan (Cost) | $69.00 | n/a | No Rx Coverage | H0602 -009 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Rocky Mountain Standard Plan (Cost) | $61.50 | $5,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Aetna Medicare Select Plan (PPO) | $60.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5521 -028 -0 | $7.00 | $33.00 | $45.00 | $45.00 | 3,158 2012 Formulary | ||
2013 Aetna Medicare Select Plan (PPO) | $68.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $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 |
||||||
2012 HumanaChoice H0623-001 (PPO) | $61.00 | $4,500 | $0 | Few Generics, Few Brands |
H0623 -001 -0 | $8.00 | $42.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice H0623-001 (PPO) | $70.00 | $5,500 | $0 | Few Generics, Few Brands | $7.00 | $15.00 | $42.00 | $42.00 | 3,906 2013 Formulary | |||
2012 Rocky Mountain Thrifty Plan + Rx (Cost) | $74.20 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0602 -039 -0 | $3.00 | $12.00 | $45.00 | $45.00 | 4,695 2012 Formulary | ||
2013 Rocky Mountain Thrifty Plan + Rx (Cost) | $74.30 | $6,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $45.00 | $45.00 | 4,905 2013 Formulary | |||
2012 Humana Gold Choice H8145-123 (PFFS) | $68.00 | $5,000 | $0 | Few Generics, Few Brands |
H8145 -123 -0 | $8.00 | $41.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-123 (PFFS) | $81.00 | n/a | $0 | Few Generics, Few Brands | $7.00 | $15.00 | $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 Kaiser Permanente Senior Advantage Plus Choice (HMO-POS) | $86.00 | $3,400 | $0 | All Generics, Few Brands |
H0630 -019 -0 | n/a | ||||||
2013 Kaiser Permanente Senior Advantage Plus Choice (HMO-POS) | $91.00 | $3,400 | $0 | All Generics, Few Brands | $6.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | |||
2012 Rocky Mountain Standard Plan + Rx (Cost) | $135.50 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0602 -022 -0 | $10.00 | $10.00 | $40.00 | $40.00 | 4,695 2012 Formulary | ||
2013 Rocky Mountain Standard Plan + Rx (Cost) | $139.20 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $45.00 | $45.00 | 4,905 2013 Formulary | |||
2012 Rocky Mountain Plus Plan (Cost) | $156.80 | n/a | No Rx Coverage | H0602 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Rocky Mountain Plus Plan (Cost) | $147.00 | 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 Kaiser Permanente Senior Advantage Gold (HMO) | $177.00 | $2,350 | $0 | All Generics, Few Brands |
H0630 -016 -0 | n/a | ||||||
2013 Kaiser Permanente Senior Advantage Gold (HMO) | $185.00 | $2,350 | $0 | All Generics, Few Brands | $4.00 | $10.00 | $40.00 | $40.00 | 5,250 2013 Formulary | |||
2012 Rocky Mountain Plus Plan + Rx (Cost) | $246.20 | n/a | $0 | All Generics | H0602 -019 -0 | $8.50 | $8.50 | $38.00 | $38.00 | 4,695 2012 Formulary | ||
2013 Rocky Mountain Plus Plan + Rx (Cost) | $249.80 | n/a | $0 | All Generics | $3.00 | $9.00 | $40.00 | $40.00 | 4,905 2013 Formulary | |||
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