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 -- |
H8145 -158 -0 | |||||||||||
2013 Humana Gold Choice H8145-158 (PFFS) | $0.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H6609 -004 -0 | |||||||||||
2013 HumanaChoice H6609-004 (PPO) | $0.00 | $4,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Medica Prime Solution Thrift with Part D Option 1 (Cost) | $55.50 | $6,700 | $320 | No additional gap coverage, only the Donut Hole Discount | H2450 -007 -0 | 25% | 25% | 25% | 25% | 4,886 2012 Formulary | ||
2013 Medica Prime Solution Thrift with Part D Option 1 (Cost) | $51.70 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 5,138 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 -- |
H6609 -017 -0 | |||||||||||
2013 HumanaChoice H6609-017 (PPO) | $58.00 | $4,000 | $325 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $10.00 | $40.00 | $40.00 | 3,906 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H8145 -138 -0 | |||||||||||
2013 Humana Gold Choice H8145-138 (PFFS) | $69.00 | n/a | $250 | Few Generics, Few Brands | $5.00 | $10.00 | $35.00 | $35.00 | 3,906 2013 Formulary | |||
2012 Medica Prime Solution Value with Part D Option 1 (Cost) | $85.50 | $3,350 | $320 | No additional gap coverage, only the Donut Hole Discount | H2450 -022 -0 | 25% | 25% | 25% | 25% | 4,886 2012 Formulary | ||
2013 Medica Prime Solution Value with Part D Option 1 (Cost) | $77.70 | $3,350 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 5,138 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 Medica Prime Solution Basic with Part D Option 1 (Cost) | $105.50 | $3,000 | $320 | No additional gap coverage, only the Donut Hole Discount | H2450 -016 -0 | 25% | 25% | 25% | 25% | 4,886 2012 Formulary | ||
2013 Medica Prime Solution Basic with Part D Option 1 (Cost) | $95.70 | $3,000 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 5,138 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H3283 -003 -0 | |||||||||||
-- | -- | -- | ||||||||||
2013 Medica Clear Solution Essential (PPO) | $102.00 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 5,138 2013 Formulary | |||
2012 Medica Prime Solution Value with Part D Option 2 (Cost) | $102.60 | $3,350 | $0 | No additional gap coverage, only the Donut Hole Discount | H2450 -023 -0 | $10.00 | $34.00 | $74.00 | $74.00 | 4,886 2012 Formulary | ||
2013 Medica Prime Solution Value with Part D Option 2 (Cost) | $111.90 | $3,350 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $34.00 | $74.00 | $74.00 | 5,138 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 Medica Prime Solution Basic with Part D Option 2 (Cost) | $122.60 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H2450 -001 -0 | $10.00 | $34.00 | $74.00 | $74.00 | 4,886 2012 Formulary | ||
2013 Medica Prime Solution Basic with Part D Option 2 (Cost) | $129.90 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $34.00 | $74.00 | $74.00 | 5,138 2013 Formulary | |||
2012 Medica Prime Solution Enhanced w/Part D Option 1 (Cost) | $155.50 | $3,000 | $320 | No additional gap coverage, only the Donut Hole Discount | H2450 -017 -0 | 25% | 25% | 25% | 25% | 4,886 2012 Formulary | ||
2013 Medica Prime Solution Enhanced w/Part D Option 1 (Cost) | $149.70 | $3,000 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 5,138 2013 Formulary | |||
2012 Medica Prime Solution Value with Part D Option 3 (Cost) | $161.20 | $3,350 | $0 | Many Generics | H2450 -028 -0 | $10.00 | $34.00 | $74.00 | $74.00 | 4,886 2012 Formulary | ||
2013 Medica Prime Solution Value with Part D Option 3 (Cost) | $171.80 | $3,350 | $0 | Many Generics | $10.00 | $34.00 | $74.00 | $74.00 | 5,138 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 Medica Prime Solution Enhanced w/Part D Option 2 (Cost) | $172.60 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H2450 -002 -0 | $10.00 | $34.00 | $74.00 | $74.00 | 4,886 2012 Formulary | ||
2013 Medica Prime Solution Enhanced w/Part D Option 2 (Cost) | $183.90 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $34.00 | $74.00 | $74.00 | 5,138 2013 Formulary | |||
2012 Medica Prime Solution Basic with Part D Option 3 (Cost) | $181.20 | $3,000 | $0 | Many Generics | H2450 -005 -0 | $10.00 | $34.00 | $74.00 | $74.00 | 4,886 2012 Formulary | ||
2013 Medica Prime Solution Basic with Part D Option 3 (Cost) | $189.80 | $3,000 | $0 | Many Generics | $10.00 | $34.00 | $74.00 | $74.00 | 5,138 2013 Formulary | |||
2012 Medica Clear Solution with Part D Option 1 (PPO) | $262.70 | $2,500 | $320 | No additional gap coverage, only the Donut Hole Discount | H3283 -001 -0 | 25% | 25% | 25% | 25% | 4,886 2012 Formulary | ||
-- | -- | -- | ||||||||||
2013 Medica Clear Solution Premier (PPO) | $206.70 | $2,500 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 5,138 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 Medica Prime Solution Enhanced w/Part D Option 3 (Cost) | $231.20 | $3,000 | $0 | Many Generics | H2450 -006 -0 | $10.00 | $34.00 | $74.00 | $74.00 | 4,886 2012 Formulary | ||
2013 Medica Prime Solution Enhanced w/Part D Option 3 (Cost) | $243.80 | $3,000 | $0 | Many Generics | $10.00 | $34.00 | $74.00 | $74.00 | 5,138 2013 Formulary | |||
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