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 AARP MedicareComplete Plus (HMO-POS) | $0.00 | $4,750 | $0 | No additional gap coverage, only the Donut Hole Discount | H3456 -001 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete (HMO) | $0.00 | $3,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 AARP MedicareComplete Plus Essential (HMO-POS) | $0.00 | $4,200 | No Rx Coverage | H3456 -020 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 AARP MedicareComplete Essential (HMO) | $0.00 | $3,900 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Advantra Gold (PPO) | $0.00 | $3,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H9847 -001 -0 | $5.00 | $40.00 | $75.00 | $75.00 | 3,238 2012 Formulary | ||
2013 Advantra Gold (PPO) | $0.00 | $3,950 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $22.00 | $45.00 | $45.00 | 3,224 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 Blue Medicare HMO Medical Only (HMO) | $0.00 | $2,500 | No Rx Coverage | H3449 -012 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Blue Medicare HMO Medical Only (HMO) | $0.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Blue Medicare HMO Standard (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3449 -013 -0 | $7.00 | $25.00 | $40.00 | $40.00 | 3,689 2012 Formulary | ||
2013 Blue Medicare HMO Standard (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $25.00 | $40.00 | $40.00 | 3,949 2013 Formulary | |||
2012 Humana Gold Choice H8145-114 (PFFS) | $15.00 | $6,700 | No Rx Coverage | H8145 -114 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Humana Gold Choice H8145-114 (PFFS) | $0.00 | 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 HumanaChoice R5826-063 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -063 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HumanaChoice R5826-063 (Regional PPO) | $0.00 | $3,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Today's Options Premier 400 (PFFS) | $0.00 | $6,700 | No Rx Coverage | H6169 -011 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2013 Today's Options Premier 600 (PFFS) | $0.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Blue Medicare HMO Enhanced (HMO) | $16.40 | $3,400 | $0 | Many Generics | H3449 -005 -0 | $4.00 | $20.00 | $30.00 | $30.00 | 3,689 2012 Formulary | ||
2013 Blue Medicare HMO Enhanced (HMO) | $16.40 | $3,400 | $0 | Some Generics, Few Brands | $4.00 | $20.00 | $30.00 | $30.00 | 3,949 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 Today's Options Premier 200 (PFFS) | $20.00 | $3,250 | No Rx Coverage | H6169 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2013 Today's Options Premier 300 (PFFS) | $20.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 UnitedHealthcare Dual Complete (HMO SNP) | $28.20 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H3456 -016 -0 | 15% | 15% | 3,614 2012 Formulary | ||||
2013 UnitedHealthcare Dual Complete (HMO SNP) | $29.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H3405 -005 -0 | |||||||||||
2013 HumanaChoice H3405-005 (PPO) | $31.00 | $3,900 | $0 | Few Generics, Few Brands | $4.00 | $10.00 | $45.00 | $45.00 | 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 Today's Options Advantage Plus 650B (PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5378 -190 -0 | n/a | ||||||
2013 Today's Options Advantage Plus 650B (PPO) | $32.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 2013 Formulary | |||
2012 Today's Options Premier Plus 450B (PFFS) | $27.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H6169 -031 -0 | n/a | ||||||
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2013 Today's Options Premier Plus 650B (PFFS) | $32.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 2013 Formulary | |||
2012 UnitedHealthcare Nursing Home Plan (HMO SNP) | $33.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H3456 -010 -0 | 25% | 25% | 25% | 25% | 3,614 2012 Formulary | ||
2013 UnitedHealthcare Nursing Home Plan (HMO SNP) | $32.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 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 Humana Gold Choice H8145-063 (PFFS) | $42.00 | $5,500 | $0 | Few Generics, Few Brands |
H8145 -063 -0 | $7.00 | $41.00 | $85.00 | $85.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-063 (PFFS) | $47.00 | n/a | $0 | Few Generics, Few Brands | $2.00 | $12.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 Blue Medicare PPO Enhanced (PPO) | $47.20 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3404 -001 -0 | $7.00 | $25.00 | $40.00 | $40.00 | 3,689 2012 Formulary | ||
2013 Blue Medicare PPO Enhanced (PPO) | $47.20 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $25.00 | $40.00 | $40.00 | 3,949 2013 Formulary | |||
2012 HumanaChoice R5826-079 (Regional PPO) | $58.00 | $5,900 | $320 | No additional gap coverage, only the Donut Hole Discount | R5826 -079 -0 | 25% | 25% | 25% | 25% | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-079 (Regional PPO) | $63.00 | $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 HumanaChoice R5826-003 (Regional PPO) | $69.00 | $5,900 | $0 | Few Generics, Few Brands |
R5826 -003 -0 | $8.00 | $45.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-003 (Regional PPO) | $75.00 | $6,200 | $0 | Few Generics, Few Brands | $5.00 | $11.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 Today's Options Premier Plus 250A (PFFS) | $72.00 | $3,250 | $0 | No additional gap coverage, only the Donut Hole Discount | H6169 -021 -0 | n/a | ||||||
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2013 Today's Options Premier Plus 350A (PFFS) | $77.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | |||
2012 Blue Medicare PPO Enhanced Freedom (PPO) | $99.90 | $3,400 | $0 | Many Generics | H3404 -002 -0 | $4.00 | $20.00 | $30.00 | $30.00 | 3,689 2012 Formulary | ||
2013 Blue Medicare PPO Enhanced Freedom (PPO) | $109.60 | $3,400 | $0 | Some Generics, Few Brands | $4.00 | $20.00 | $30.00 | $30.00 | 3,949 2013 Formulary | |||
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