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 Advantra Advantage (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2672 -001 -0 | $6.00 | $35.00 | $70.00 | $70.00 | 3,238 2012 Formulary | ||
2013 Advantra Advantage (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $45.00 | $80.00 | $80.00 | 3,281 2013 Formulary | |||
2012 Advantra Freedom (PPO) | $0.00 | $3,950 | $0 | No additional gap coverage, only the Donut Hole Discount | H5509 -001 -0 | $6.00 | $35.00 | $65.00 | $65.00 | 3,171 2012 Formulary | ||
2013 Advantra Freedom (PPO) | $0.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $45.00 | $80.00 | $80.00 | 3,224 2013 Formulary | |||
2012 Humana Gold Plus H2649-012 (HMO) | $0.00 | $3,400 | No Rx Coverage | H2649 -012 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Humana Gold Plus H2649-012 (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 |
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2012 Humana Reader's Digest Healthy Living Plan (HMO) | $0.00 | $4,100 | $320 | Few Generics, Few Brands |
H2649 -024 -0 | $1.00 | $5.00 | 20% | 20% | 3,100 2012 Formulary | ||
2013 Humana Gold Plus H2649-024 (HMO) | $0.00 | $5,000 | $325 | Few Generics | $1.00 | $3.00 | 18% | 18% | 3,251 2013 Formulary | |||
2012 HumanaChoice R5826-069 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -069 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HumanaChoice R5826-069 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Humana Gold Plus H2649-004 (HMO) | $20.00 | $3,400 | $0 | Some Generics, Few Brands |
H2649 -004 -0 | $5.00 | $40.00 | $75.00 | $75.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Plus H2649-004 (HMO) | $21.00 | $3,400 | $0 | Few Generics, Few Brands | $5.00 | $10.00 | $40.00 | $40.00 | 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 |
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-- This plan not offered in 2012 -- |
H5509 -018 -0 | |||||||||||
2013 Advantra Freedom Plus (PPO) | $25.00 | $3,950 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $6.00 | $40.00 | $40.00 | 3,281 2013 Formulary | |||
2012 HumanaChoice H1716-020 (PPO) | $39.00 | $5,000 | $320 | Few Generics, Few Brands |
H1716 -020 -0 | $1.00 | $5.00 | 20% | 20% | 3,100 2012 Formulary | ||
2013 HumanaChoice H1716-020 (PPO) | $47.00 | $5,000 | $325 | Few Generics | $1.00 | $3.00 | 18% | 18% | 3,251 2013 Formulary | |||
2012 HumanaChoice H1716-001 (PPO) | $63.00 | $5,000 | $0 | Few Generics, Few Brands |
H1716 -001 -0 | $8.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice H1716-001 (PPO) | $71.00 | $5,000 | $0 | Few Generics, Few Brands | $7.00 | $12.00 | $41.00 | $41.00 | 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 HumanaChoice R5826-013 (Regional PPO) | $161.00 | $3,400 | $320 | No additional gap coverage, only the Donut Hole Discount | R5826 -013 -0 | 25% | 25% | 25% | 25% | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-013 (Regional PPO) | $164.00 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | |||
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