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 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 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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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 | |||
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 |
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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 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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