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 HumanaChoice H6609-012 (PPO) | $0.00 | $3,400 | No Rx Coverage | H6609 -012 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Humana Prime Choice H6609-012 (PPO) | $0.00 | $3,600 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H4754 -006 -0 | |||||||||||
-- | ||||||||||||
2013 PacificSource Medicare Explorer 6 (PPO) | $0.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H1304 -008 -0 | |||||||||||
2013 Regence MedAdvantage Basic (PPO) | $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 |
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-- This plan not offered in 2012 -- |
H5698 -182 -0 | |||||||||||
2013 Windsor Medicare Extra Emerald Plan (HMO) | $0.00 | $6,700 | $0 | Some Generics | $3.00 | $10.00 | $44.00 | $44.00 | 2,715 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H5698 -188 -0 | |||||||||||
2013 Windsor Medicare Extra Silver Plan (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H3864 -016 -0 | |||||||||||
2013 PacificSource Medicare Essentials Rx 16 (HMO) | $10.00 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $40.00 | $80.00 | $80.00 | 4,762 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 -- |
H1304 -009 -0 | |||||||||||
2013 Regence MedAdvantage + Rx Classic (PPO) | $20.00 | $3,400 | $165 | No additional gap coverage, only the Donut Hole Discount | $7.50 | $33.00 | $45.00 | $45.00 | 3,733 2013 Formulary | |||
2012 Humana Gold Plus H2012-022 (HMO) | $17.00 | $3,400 | $0 | Few Generics, Few Brands |
H2012 -022 -0 | $6.00 | $39.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Plus H2012-022 (HMO) | $28.00 | $4,500 | $0 | Few Generics, Few Brands | $6.00 | $39.00 | $80.00 | $80.00 | 3,906 2013 Formulary | |||
2012 True Blue (HMO) | $25.00 | $3,000 | No Rx Coverage | H1350 -006 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 True Blue (HMO) | $30.00 | $3,000 | 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 |
||||||
-- This plan not offered in 2012 -- |
H4754 -002 -0 | |||||||||||
-- | ||||||||||||
2013 PacificSource Medicare Explorer Rx 2 (PPO) | $36.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $40.00 | $80.00 | $80.00 | 4,762 2013 Formulary | |||
2012 Secure Blue (PPO) | $40.00 | $3,400 | No Rx Coverage | H1302 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Secure Blue (PPO) | $40.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H5698 -183 -0 | |||||||||||
2013 Windsor Medicare Extra Gold Plan (HMO) | $40.00 | $3,400 | $0 | Some Generics | $3.00 | $10.00 | $43.00 | $43.00 | 2,715 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 H6609-009 (PPO) | $38.00 | $3,400 | $0 | Few Generics, Few Brands |
H6609 -009 -0 | $6.00 | $39.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Prime Choice H6609-009 (PPO) | $42.00 | $4,000 | $0 | Few Generics, Few Brands | $6.00 | $39.00 | $80.00 | $80.00 | 3,906 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H1302 -006 -0 | |||||||||||
2013 Secure Blue (PPO) | $63.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $43.00 | $93.00 | $93.00 | 5,002 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H5698 -184 -0 | |||||||||||
2013 Windsor Medicare Extra Diamond Plan (HMO) | $103.00 | $4,500 | $0 | Some Generics | $3.00 | $10.00 | $40.00 | $40.00 | 2,715 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 True Blue Rx Option II (HMO) | $116.00 | $3,000 | $260 | No additional gap coverage, only the Donut Hole Discount | H1350 -010 -0 | $6.00 | $31.00 | $41.00 | $41.00 | 4,794 2012 Formulary | ||
2013 True Blue Rx Option II (HMO) | $121.00 | $3,000 | $300 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $31.00 | $70.00 | $70.00 | 5,002 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H1304 -010 -0 | |||||||||||
2013 Regence MedAdvantage + Rx Enhanced (PPO) | $135.00 | $2,500 | $0 | Many Generics | $5.00 | $33.00 | $45.00 | $45.00 | 3,733 2013 Formulary | |||
2012 True Blue Rx Option I (HMO) | $135.00 | $3,000 | $0 | Many Generics | H1350 -001 -0 | $6.00 | $31.00 | $41.00 | $41.00 | 4,794 2012 Formulary | ||
2013 True Blue Rx Option I (HMO) | $142.00 | $3,000 | $0 | Many Generics | $6.00 | $31.00 | $70.00 | $70.00 | 5,002 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 True Blue Special Needs Plan (HMO SNP) | $173.60 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H1350 -009 -0 | 25% | 25% | 25% | 25% | 4,794 2012 Formulary | ||
2013 True Blue Special Needs Plan (HMO SNP) | $176.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 5,002 2013 Formulary | |||
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