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 BCN Advantage HMO-POS Basic (HMO-POS) | $0.00 | $5,200 | $320 | No additional gap coverage, only the Donut Hole Discount | H5883 -004 -1 | 25% | 25% | 25% | 25% | 3,447 2012 Formulary | ||
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. | ||||||||
2012 PriorityMedicare Value (HMO-POS) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2320 -015 -0 | $9.00 | $40.00 | $81.00 | $81.00 | 3,239 2012 Formulary | ||
2013 PriorityMedicare Value (HMO-POS) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $9.00 | $40.00 | $90.00 | $90.00 | 3,466 2013 Formulary | |||
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 -- |
H9572 -004 -1 | |||||||||||
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 | |||
2012 Humana Gold Choice H8145-121 (PFFS) | $0.00 | $5,000 | No Rx Coverage | H8145 -121 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Humana Gold Choice H8145-121 (PFFS) | $19.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 BCN Advantage HMO-POS Elements (HMO-POS) | $15.00 | $4,600 | No Rx Coverage | H5883 -001 -1 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 BCN Advantage HMO-POS Elements (HMO-POS) | $20.00 | $3,600 | 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 Medicare Plus Blue PPO Vitality (PPO) | $38.00 | $5,500 | $320 | No additional gap coverage, only the Donut Hole Discount | H9572 -002 -1 | 25% | 25% | 25% | 25% | 3,757 2012 Formulary | ||
2013 Medicare Plus Blue PPO Vitality (PPO) | $41.00 | $5,400 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,883 2013 Formulary | |||
2012 HumanaChoice H5470-005 (PPO) | $41.00 | $4,500 | $0 | Few Generics, Few Brands |
H5470 -005 -0 | $6.00 | $39.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice H5470-005 (PPO) | $62.00 | $6,000 | $0 | Few Generics, Few Brands | $6.00 | $45.00 | $90.00 | $90.00 | 3,906 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 |
||||||
2012 Humana Gold Choice H8145-005 (PFFS) | $57.00 | $5,000 | $0 | Few Generics, Few Brands |
H8145 -005 -0 | $7.00 | $42.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-005 (PFFS) | $72.00 | n/a | $0 | Few Generics, Few Brands | $7.00 | $42.00 | $80.00 | $80.00 | 3,906 2013 Formulary | |||
2012 BCN Advantage HMO-POS Classic (HMO-POS) | $60.00 | $4,400 | $0 | Many Generics | H5883 -002 -1 | $3.00 | $40.00 | $80.00 | $80.00 | 3,447 2012 Formulary | ||
2013 BCN Advantage HMO-POS Classic (HMO-POS) | $75.00 | $3,400 | $0 | Many Generics | $3.00 | $10.00 | $40.00 | $40.00 | 3,686 2013 Formulary | |||
2012 PriorityMedicare (HMO-POS) | $64.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2320 -013 -0 | $8.00 | $35.00 | $70.00 | $70.00 | 3,239 2012 Formulary | ||
2013 PriorityMedicare (HMO-POS) | $81.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $35.00 | $80.00 | $80.00 | 3,466 2013 Formulary | |||
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 PriorityMedicare Select (PPO) | $68.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4875 -011 -0 | $8.00 | $40.00 | $80.00 | $80.00 | 3,239 2012 Formulary | ||
2013 PriorityMedicare Select (PPO) | $90.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $40.00 | $85.00 | $85.00 | 3,466 2013 Formulary | |||
2012 Medicare Plus Blue PPO Signature (PPO) | $83.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H9572 -001 -1 | $3.00 | $45.00 | $95.00 | $95.00 | 3,757 2012 Formulary | ||
2013 Medicare Plus Blue PPO Signature (PPO) | $96.00 | $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 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 |
||||||
2012 Medicare Plus Blue PPO Assure (PPO) | $139.00 | $4,000 | $0 | Many Generics | H9572 -003 -1 | $3.00 | $40.00 | $95.00 | $95.00 | 3,858 2012 Formulary | ||
2013 Medicare Plus Blue PPO Assure (PPO) | $151.00 | $3,400 | $0 | Many Generics | $3.00 | $10.00 | $40.00 | $40.00 | 3,978 2013 Formulary | |||
2012 BCN Advantage HMO-POS Prestige (HMO-POS) | $213.00 | $4,200 | $0 | Many Generics | H5883 -003 -1 | $3.00 | $35.00 | $75.00 | $75.00 | 3,447 2012 Formulary | ||
2013 BCN Advantage HMO-POS Prestige (HMO-POS) | $203.00 | $3,200 | $0 | Many Generics | $3.00 | $10.00 | $35.00 | $35.00 | 3,686 2013 Formulary | |||
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