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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-- This plan not offered in 2012 -- |
H3449 -012 -0 | |||||||||||
2013 Blue Medicare HMO Medical Only (HMO) | $0.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H3449 -013 -0 | |||||||||||
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 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. | ||||||||
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 -- |
H3449 -005 -0 | |||||||||||
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 | |||
-- This plan not offered in 2012 -- |
H3404 -001 -0 | |||||||||||
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 Today's Options Premier 400 (PFFS) | $60.00 | $6,700 | No Rx Coverage | H5421 -049 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Today's Options Premier 600 (PFFS) | $60.00 | 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 R5826-079 (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 | |||
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 450D (PFFS) | $82.00 | $6,700 | $50 | No additional gap coverage, only the Donut Hole Discount | H5421 -073 -0 | n/a | ||||||
2013 Today's Options Premier Plus 650H (PFFS) | $87.00 | n/a | $87 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 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 Today's Options Premier 200 (PFFS) | $95.00 | $3,250 | No Rx Coverage | H5421 -209 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Today's Options Premier 300 (PFFS) | $95.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H3404 -002 -0 | |||||||||||
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 | |||
2012 Today's Options Premier Plus 250A (PFFS) | $139.00 | $3,250 | $0 | No additional gap coverage, only the Donut Hole Discount | H5421 -067 -0 | n/a | ||||||
2013 Today's Options Premier Plus 350A (PFFS) | $144.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | |||
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 Any, Any, Any Gold (PFFS) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5820 -002 -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 | H5820 -026 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2013 -- |
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