2012 / 2013 Medicare Advantage Plan Information Click here to jump to the Chart Legend | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
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 |
||||||
-- This plan not offered in 2012 -- |
H5883 -004 -4 | |||||||||||
2013 BCN Advantage HMO-POS Basic (HMO-POS) | $0.00 | $4,200 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,686 2013 Formulary | |||
2012 HumanaChoice R5826-053 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -053 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HumanaChoice R5826-053 (Regional PPO) | $0.00 | $3,900 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H9572 -004 -4 | |||||||||||
2013 Medicare Plus Blue PPO Essential (PPO) | $12.50 | $6,400 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,883 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 -- |
H5883 -001 -4 | |||||||||||
2013 BCN Advantage HMO-POS Elements (HMO-POS) | $20.00 | $3,600 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 PriorityMedicare Value (HMO-POS) | $28.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2320 -012 -0 | $9.00 | $40.00 | $81.00 | $81.00 | 3,239 2012 Formulary | ||
2013 PriorityMedicare Value (HMO-POS) | $43.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $9.00 | $40.00 | $90.00 | $90.00 | 3,466 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H2312 -012 -0 | |||||||||||
2013 HAP Senior Plus - Expanded Network (HMO-POS) | $44.00 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $15.00 | $45.00 | $45.00 | 3,343 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 -- |
H4875 -016 -1 | |||||||||||
2013 PriorityMedicare Merit (PPO) | $47.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $90.00 | $90.00 | 3,466 2013 Formulary | |||
2012 Medicare Plus Blue PPO Vitality (PPO) | $63.00 | $5,500 | $320 | No additional gap coverage, only the Donut Hole Discount | H9572 -002 -4 | 25% | 25% | 25% | 25% | 3,757 2012 Formulary | ||
2013 Medicare Plus Blue PPO Vitality (PPO) | $56.00 | $5,400 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,883 2013 Formulary | |||
2012 HumanaChoice R5826-072 (Regional PPO) | $65.00 | $6,700 | $320 | No additional gap coverage, only the Donut Hole Discount | R5826 -072 -0 | 25% | 25% | 25% | 25% | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-072 (Regional PPO) | $66.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 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 |
||||||
-- This plan not offered in 2012 -- |
H5883 -002 -4 | |||||||||||
2013 BCN Advantage HMO-POS Classic (HMO-POS) | $78.00 | $3,400 | $0 | Many Generics | $3.00 | $10.00 | $40.00 | $40.00 | 3,686 2013 Formulary | |||
2012 HAP Senior Plus - Expanded Network (HMO-POS) | $105.00 | $3,400 | $25 | No additional gap coverage, only the Donut Hole Discount | H2312 -007 -0 | $6.00 | $10.00 | $45.00 | $45.00 | 3,139 2012 Formulary | ||
2013 HAP Senior Plus - Expanded Network (HMO-POS) | $94.00 | $3,000 | $25 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $45.00 | $45.00 | 3,343 2013 Formulary | |||
2012 HumanaChoice R5826-006 (Regional PPO) | $96.00 | $3,400 | $0 | Few Generics, Few Brands |
R5826 -006 -0 | $8.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-006 (Regional PPO) | $99.00 | $6,700 | $0 | Few Generics, Few Brands | $8.00 | $40.00 | $80.00 | $80.00 | 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 |
||||||
-- This plan not offered in 2012 -- |
H2322 -008 -0 | |||||||||||
2013 Alliance Medicare PPO (PPO) | $103.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $45.00 | $45.00 | 3,343 2013 Formulary | |||
2012 PriorityMedicare (HMO-POS) | $96.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2320 -008 -0 | $8.00 | $35.00 | $70.00 | $70.00 | 3,239 2012 Formulary | ||
2013 PriorityMedicare (HMO-POS) | $107.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $35.00 | $80.00 | $80.00 | 3,466 2013 Formulary | |||
2012 PriorityMedicare Select (PPO) | $99.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4875 -013 -0 | $8.00 | $40.00 | $80.00 | $80.00 | 3,239 2012 Formulary | ||
2013 PriorityMedicare Select (PPO) | $111.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $40.00 | $85.00 | $85.00 | 3,466 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 Medicare Plus Blue PPO Signature (PPO) | $143.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H9572 -001 -4 | $3.00 | $45.00 | $95.00 | $95.00 | 3,757 2012 Formulary | ||
2013 Medicare Plus Blue PPO Signature (PPO) | $123.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 3,883 2013 Formulary | |||
2012 HAP Senior Plus - Expanded Network (HMO-POS) | $158.00 | $3,400 | $50 | All Generics | H2312 -010 -0 | $4.00 | $10.00 | $40.00 | $40.00 | 3,139 2012 Formulary | ||
2013 HAP Senior Plus - Expanded Network (HMO-POS) | $169.00 | $2,800 | $25 | All Generics | $2.00 | $10.00 | $45.00 | $45.00 | 3,343 2013 Formulary | |||
2012 Alliance Medicare PPO (PPO) | $177.00 | $6,700 | $0 | All Generics | H2322 -004 -0 | $4.00 | $8.00 | $40.00 | $40.00 | 3,139 2012 Formulary | ||
2013 Alliance Medicare PPO (PPO) | $174.00 | $3,400 | $50 | All Generics | $4.00 | $10.00 | $40.00 | $40.00 | 3,343 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 Medicare Plus Blue PPO Assure (PPO) | $204.00 | $4,000 | $0 | Many Generics | H9572 -003 -4 | $3.00 | $40.00 | $95.00 | $95.00 | 3,858 2012 Formulary | ||
2013 Medicare Plus Blue PPO Assure (PPO) | $194.00 | $3,400 | $0 | Many Generics | $3.00 | $10.00 | $40.00 | $40.00 | 3,978 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H5883 -003 -4 | |||||||||||
2013 BCN Advantage HMO-POS Prestige (HMO-POS) | $200.00 | $3,200 | $0 | Many Generics | $3.00 | $10.00 | $35.00 | $35.00 | 3,686 2013 Formulary | |||
|