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 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 -3 | |||||||||||
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 | |||
-- This plan not offered in 2012 -- |
H8145 -121 -0 | |||||||||||
2013 Humana Gold Choice H8145-121 (PFFS) | $19.00 | n/a | 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 Upper Peninsula Health Plan Plus (HMO SNP) | $34.30 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H2161 -001 -0 | 15% | 15% | 3,204 2012 Formulary | ||||
-- | -- | -- | ||||||||||
2013 Upper Peninsula Health Plan Plus (HMO SNP) | $34.10 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,356 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 | |||
2012 Medicare Plus Blue PPO Vitality (PPO) | $78.00 | $5,500 | $320 | No additional gap coverage, only the Donut Hole Discount | H9572 -002 -3 | 25% | 25% | 25% | 25% | 3,757 2012 Formulary | ||
2013 Medicare Plus Blue PPO Vitality (PPO) | $76.00 | $5,400 | $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 |
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-- This plan not offered in 2012 -- |
H8145 -154 -0 | |||||||||||
2013 Humana Gold Choice H8145-154 (PFFS) | $94.00 | n/a | $0 | Few Generics, Few Brands | $7.00 | $40.00 | $80.00 | $80.00 | 3,906 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 | |||
2012 Medicare Plus Blue PPO Signature (PPO) | $128.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H9572 -001 -3 | $3.00 | $45.00 | $95.00 | $95.00 | 3,757 2012 Formulary | ||
2013 Medicare Plus Blue PPO Signature (PPO) | $132.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 3,883 2013 Formulary | |||
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) | $231.00 | $4,000 | $0 | Many Generics | H9572 -003 -3 | $3.00 | $40.00 | $95.00 | $95.00 | 3,858 2012 Formulary | ||
2013 Medicare Plus Blue PPO Assure (PPO) | $240.00 | $3,400 | $0 | Many Generics | $3.00 | $10.00 | $40.00 | $40.00 | 3,978 2013 Formulary | |||
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