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 Kaiser Permanente Medicare Plus Basic no D AB (Cost) | $0.00 | $3,400 | No Rx Coverage | H2150 -017 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Kaiser Permanente Medicare Plus Basic w/o D (AB) (Cost) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Kaiser Permanente Medicare Plus Std w/o D AB (Cost) | $0.00 | $3,400 | No Rx Coverage | H2150 -022 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Kaiser Permanente Medicare Plus Std w/o D (AB) (Cost) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Kaiser Permanente Medicare Plus Std w/D AB (Cost) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2150 -009 -0 | n/a | ||||||
2013 Kaiser Permanente Medicare Plus Std w/Part D (AB) (Cost) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $25.00 | $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 |
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2012 Aetna Medicare Basic Plan (HMO) | $19.00 | $6,700 | No Rx Coverage | H2112 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Aetna Medicare Basic Plan (HMO) | $19.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H2150 -029 -0 | |||||||||||
2013 Kaiser Permanente Medicare Plus Std w/Part D (B) (Cost) | $23.10 | n/a | $0 | n/a | $7.00 | $19.00 | $40.00 | $40.00 | 5,250 2013 Formulary | |||
2012 Bravo Achieve (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H2108 -030 -0 | $8.00 | $15.00 | $45.00 | $45.00 | 2,990 2012 Formulary | ||
2013 Bravo-HealthSpring Achieve Essential (HMO SNP) | $24.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $15.00 | $45.00 | $45.00 | 3,057 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 Bravo Classic (HMO) | $0.00 | $6,700 | $50 | No additional gap coverage, only the Donut Hole Discount | H2108 -022 -0 | $8.00 | $15.00 | $45.00 | $45.00 | 2,990 2012 Formulary | ||
2013 Bravo-HealthSpring Essential (HMO) | $25.00 | $6,700 | $45 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $15.00 | $45.00 | $45.00 | 3,056 2013 Formulary | |||
2012 Bravo Select (HMO SNP) | $34.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H2108 -001 -0 | 15% | 15% | 2,990 2012 Formulary | ||||
2013 Bravo-HealthSpring Select (HMO SNP) | $32.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 3,025 2013 Formulary | ||||||
2012 Aetna Medicare Standard Plan (HMO) | $38.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H2112 -007 -0 | $7.00 | $33.00 | $45.00 | $45.00 | 3,158 2012 Formulary | ||
2013 Aetna Medicare Standard Plan (HMO) | $33.00 | $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 |
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2012 UnitedHealthcare Nursing Home Plan (PPO SNP) | $31.20 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H2111 -001 -0 | 25% | 25% | 25% | 25% | 3,614 2012 Formulary | ||
-- | ||||||||||||
2013 UnitedHealthcare Nursing Home Plan (PPO SNP) | $34.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
2012 Amerivantage Specialty + Rx (HMO SNP) | $34.50 | n/a | $320 | Some Generics | H5896 -007 -0 | $0.00 | 25% | 25% | 25% | 3,055 2012 Formulary | ||
2013 Amerivantage Specialty + Rx (HMO SNP) | $34.90 | n/a | $325 | Some Generics | $0.00 | 25% | 25% | 25% | 2,941 2013 Formulary | |||
2012 Bravo Traditions (HMO SNP) | $34.60 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H2108 -020 -0 | 25% | 25% | 2,990 2012 Formulary | ||||
2013 Bravo-HealthSpring Traditions (HMO SNP) | $35.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 3,025 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 Kaiser Permanente Medicare Plus High w/o D AB (Cost) | $64.00 | $3,400 | No Rx Coverage | H2150 -021 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Kaiser Permanente Medicare Plus High w/o D (AB) (Cost) | $64.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Aetna Medicare Premier Plan (HMO) | $98.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H2112 -014 -0 | $7.00 | $33.00 | $45.00 | $45.00 | 3,158 2012 Formulary | ||
2013 Aetna Medicare Premier Plan (HMO) | $83.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | |||
2012 Aetna Medicare Standard Plan (PPO) | $97.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5521 -036 -0 | $6.00 | $33.00 | $45.00 | $45.00 | 3,158 2012 Formulary | ||
2013 Aetna Medicare Standard Plan (PPO) | $93.00 | $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 |
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2012 Kaiser Permanente Medicare Plus High w/D AB (Cost) | $99.00 | $3,400 | $0 | All Generics, Few Brands |
H2150 -002 -0 | n/a | ||||||
2013 Kaiser Permanente Medicare Plus High w/Part D (AB) (Cost) | $103.00 | $3,400 | $0 | All Generics, Few Brands | $5.00 | $10.00 | $40.00 | $40.00 | 5,250 2013 Formulary | |||
2012 Any, Any, Any Gold (PFFS) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H8098 -001 -0 | $6.00 | $15.00 | $45.00 | $45.00 | 3,148 2012 Formulary | ||
-- This plan not offered in 2013 -- |
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2012 Any, Any, Any Gold MA Only (PFFS) | $0.00 | $6,700 | No Rx Coverage | H8098 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2013 -- |
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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 Universal Hassle-Free MA Only (PPO) | $0.00 | $6,700 | No Rx Coverage | H5096 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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-- This plan not offered in 2013 -- |
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